The Golden Opportunity: How Global Britain can lead on tobacco harm reduction and save millions of lives

The Adam Smith Institute’s latest paper, by Daniel Pryor, Research Economist and Head of Programmes at the ASI, explains how this is the UK’s golden opportunity to take leadership on tobacco harm reduction:

• The United Kingdom has taken a world-leading role in promoting the life-saving ‘harm reduction’ approach to smoking cessation. 

• The UK’s public health consensus in favour of e-cigarettes has played a significant role in accelerating the decline in smoking rates over the past decade.

• However, there remain 7 million smokers in the UK (14.1% of adults) and, at the current rate of decline, the Government’s ‘2030 smoke-free’ goal will be missed. There is also a risk that current low rates will be reversed by an increase in social smoking after lockdowns.

• The reduction in smoking is being undermined by misinformation about e-cigarettes and unfavourable regulatory treatment of nicotine pouches, heated tobacco, and snus.

• Britain’s exit from the European Union provides lawmakers the opportunity to pass vital regulatory reforms that will help more smokers switch to e-cigarettes, as well as other potential reduced-risk alternatives like nicotine pouches, heated tobacco and Swedish snus. 

• If the Government wants to achieve a smoke-free society by 2030, they should:

  • Replace existing restrictions on advertising of low-risk products, such as e-cigarettes, heated tobacco, nicotine pouches and snus, with sensible controls on content and placement;

  • Replace ineffectual warnings with Government-specified risk communication messaging for approved low-risk products;

  • Review Tobacco Products Directive (TPD) rules on e-liquid nicotine concentration with the aim of establishing a new, higher nicotine concentration limit that reflects safe pre-TPD use patterns;

  • Review TPD rules on tank and refill container limits while maintaining appropriate safety features such as child-resistant packaging and warning labels;

  • Introduce product and communications rules for nicotine pouches based on existing regulations around e-cigarettes, including but not limited to: legal minimum age of sale and proxy purchasing legislation, sensible controls on packaging such as information on nicotine content, and prohibition of marketing likely to appeal to children;

  • Apply all product and communication regulations of nicotine-containing e-liquids to non-nicotine e-liquids;

  • Legalise snus and treat it similarly to e-cigarettes with regards to product and communications regulation.

• One promising avenue for achieving such reforms would be harmonising existing e-cigarette product and communications rules with those of other reduced-risk products, using existing legislation as a baseline.

• This new approach should be embraced in England’s forthcoming Tobacco Control Plan.

• The UK should robustly defend its approach to tobacco harm reduction later this year at the Framework Convention on Tobacco Control’s COP9 and related WHO meetings. This will be the first time the UK is participating as an independent party that is not bound by a common EU position, creating an opportunity to showcase the UK’s  world-leading approach to e-cigarettes.

• The UK can promote ‘harm reduction’ at COP9 by:

  • Highlighting the consensus opinions of UK public health bodies and NGOs on the safety and efficacy of e-cigarettes in smoking cessation and harm reduction efforts, including issues relating to alleged ‘gateway effects’ and youth uptake;

  • Actively opposing attempts to introduce recommendations for counterproductive regulations that could harm efforts to encourage smokers to switch to safer alternatives (e.g. taxation regimes not based on relative risk, banning all marketing of e-cigarettes — including to current smokers, misleading mandated health warnings);

  • Including UK experts in tobacco harm reduction as part of our COP9 delegation;

  • Promoting an evidence-based approach to the harnessing the potential of other reduced-risk products such as nicotine pouches, heated tobacco and snus;

  • Collaborating with other countries who have similarly sensible positions on e-cigarette regulation in order to strengthen the case for embracing tobacco harm reduction approaches at COP9.