With last week’s announcements of new restrictions on vaping, the UK joins a coalition of countries tackling disposable e-cigarettes. A surge in the use of colourful, child-friendly disposables across the world has raised both health and environmental concerns, with an estimated 5 million thrown away every week in the UK alone. A key challenge for governments has been balancing access for smokers wanting to quit cigarettes with keeping vapes out of the hands of non-smokers (especially teenagers) – e-cigarettes are about 60% more effective for smoking cessation than other alternatives, and in the UK more than 90% of vapes are currently used by smokers or ex-smokers. But that is not true for disposables, the majority of which appear to now be used by people who have never smoked, and particularly young people. So what can the UK learn from international regulatory efforts so far?
The UK government’s ban on disposable e-cigarettes has hit headlines, but it’s just one element of the Department of Health and Social Care’s announced response to the smoking and vaping consultation. The UK looks set to implement a broad range of restrictions on vaping generally. The table below, adapted from the consultation response, shows how the UK’s announced approach compares to other governments around the world – where we’re following in their footsteps, or where we’ll be leading the way. There are some countries that aren’t in this table because they’ve gone even further – banning e-cigarettes entirely, whether disposable or rechargeable (including Singapore, India, and Brazil)
The UK is in good company in our approach – we’re well aligned with our usual partners like New Zealand and Canada. But we’ll be a testbed for some newer measures like implementing plain packaging on rechargeable e-cigarette devices. Whether they’ve taken more or less strict regulatory approaches, international governments have seen a range of success in implementing measures to restrict e-cigarette usage. The UK can draw important lessons from these experiences, in order to avoid pitfalls and maximise success wherever possible.
So what can the UK learn?
1. Regulation is only as good as its enforcement – we’ll need to make sure it’s effective.
Every country that has introduced restrictions on e-cigarettes is facing a significant enforcement challenge, with people continuing to get their hands on illegal devices (in the hundreds of thousands). Illegal supply chains are already well established, and are proving difficult to shut down, particularly through mediums such as Facebook Marketplace. Countries that have banned e-cigarettes outright, including India, Singapore, and Brazil are still seeing usage rates increasing – for example, 12% of the 18-24 population in Brazil vape regularly despite total bans since 2009, and 10% in India despite bans since 2019.
Australia’s experience in particular provides a critical lesson. Nicotine vaping devices have been restricted in Australia as ‘prescription only’ since October 2021, with the aim of preventing children from accessing devices whilst allowing smokers to access the products for smoking cessation with a doctor’s prescription. However, children and adults alike have continued to obtain devices in high numbers without a prescription, outside of lawful supply channels – both online and in vape shops. In March 2023, two years after these restrictions were first enacted, about one in seven Australian children aged 14-17 reported using e-cigarettes. This regulatory and enforcement failure prompted a new suite of restrictions enacted late in 2023 that will come into force throughout 2024.
The UK can avoid this by ensuring enforcement of the new restrictions is watertight. The £30 million enforcement boost announced by the Prime Minister signals the government is serious about this, but careful consideration will need to continue for enforcement capacity at the border, as well as monitoring of online forums and retail spot checks.
2. Strike the right balance for harm reduction: lessons from NZ vs Australia
The UK is banning disposable vapes, while retaining market access for rechargeable devices with new protections. While some might criticise this for not going far enough – we think it’s a sensible balance. The Australian experience again provides useful lessons when compared to the New Zealand approach, illustrating the perils of being too tough on vaping.
New Zealand’s smoking rates fell below Australia’s for the first time in 2018. Since then, New Zealand. has achieved smoking cessation at an extraordinary rate, falling 40% between 2018 and 2023. By 2023, the daily adult smoking rate in New Zealand was down to 6.8%. While this is the result of a range of policy interventions, these declines have been possible in an environment where New Zealanders can get vapes where they would otherwise get cigarettes; cheaper, better promoted, and easier to buy, supported by a government that emphasised its commitment to reducing smoking rates, including by promoting vaping as a safer alternative.
An obvious response is that these declines were at the cost of increased vaping (including in young people). True, youth vaping rates are high in New Zealand, but they’re similarly high in Australia. Even worse, the Australian devices are illegal, and their contents unregulated. Australia’s prescription-only move in 2021 made cigarettes easier to legally access than vaping, with cigarettes available in petrol stations, supermarkets, and convenience stores, without an immediately available alternative. And Australia’s youth smoking rates show the consequences. Recent data from Australia shows a shocking increase in youth smoking – increasing from 2.1% in 2018 to 12.8% in March 2023. This stands in stark contrast to New Zealand’s year 10 smoking rate in 2023 of 2.8%.
Ensuring e-cigarettes remain easier to access than cigarettes is important for an additional reason – reinforcing correct perceptions of the relative harms. The latest ASH annual survey data for the UK show that in 2023, 37% of smokers now believe vaping is as or more risky compared with smoking (up from a third last year); and 1.8 million smokers (27%) have never tried vaping even though it has a fraction of the harm levels of smoking.
We know that restrictions on vaping have an impact on perceptions (often incorrect) of harm. We’ll be publishing the results of a recent experiment we ran on the impact of vaping-related policy announcements for public understanding of relative harms next week.
3. Avoid the ‘closing down sale’
Late last year, a number of new restrictions on e-cigarettes came into force in New Zealand, including on disposable e-cigarettes. Whilst not an outright ban, these restrictions meant that a range of devices on the market would no longer be allowed from 21 December 2024. In the weeks preceding the commencement of the new restrictions, reports were widespread of retailers selling high-strength ‘pre-ban disposables’ at a heavy discount, and encouraging customers to stockpile. Devices were selling for as low as $2 (£1) and many were being given away free of charge.
Such behaviour is clearly not the intention of the regulations, and there is a risk that the same phenomenon will take place in the UK prior to the full disposable ban commencing. This should prompt enforcement agencies to take a strict mitigation and enforcement approach during this time, and to keep an eye on imports of devices into the country over coming months.
4. The most effective enforcement rests on public support
When tobacco smoking was first banned in public places, formal enforcement was rarely needed because the public were behind the ban. Enforcement agencies should capitalise on community buy-in to banning disposables to maximise the efficacy of enforcement pushes. It’s clear there is strong public support for this move, with nearly 80% of the 25,000 submissions on the proposal supportive of restricting sale and supply of e-cigarettes. Importantly, there also appears to be high support among young people for clamping down on disposables. For example, a recent survey in Ireland found 15-24 year olds wanted disposables banned.
Enforcement agencies can maximise success by ensuring public reporting channels are open so that officers can be alerted to contraventions of restrictions in the community. In schools and local areas where vaping has become more entrenched, lessons might be usefully learnt from programs such as the REAL program, strengthening young people’s capacity to make choices and change culture: Refuse- Explain- Avoid- Leave. We think there is also value in testing messages that could have the highest cut-through with young people – in particular, environmental and financial.
BIT has been a long-standing advocate for ensuring smokers are able to get access to vapes as a route to quitting – and indeed made the case strongly in No10 more than a decade ago for the UK (and EU) not to ban the products. Ironically, among other countries, the UK has been at risk of sliding into a situation where it is harder for a smoker who wants to quit to legally acquire a vape, than it is for a teenager to do so illegally. As such we strongly welcome announcements that focus on the child-centred disposable vape market, whilst ensuring access to rechargeable vaping devices is retained.
Global case studies provide a guide for navigating the complex landscape of vaping regulation, and it’s clear the UK’s job is far from over. International experiences underscore the importance of robust enforcement of new restrictions to prevent a market flooded with non-compliant devices, which could undermine public health objectives. Equally critical is ensuring regulations do not overreach and hinder smokers’ access to a less harmful alternative, potentially stalling tobacco cessation efforts. Indeed, this should include getting more sophisticated vapes into the hands of smokers, GPs and pharmacists that gradually reduce levels of nicotine to aid quit attempts.
Crucially, efforts to regulate should not inadvertently create more problems than they solve by reinforcing misperceptions of the relative harms of smoking and vaping. Keep an eye out for the results of our recent experiment on this next week, which we’ll be featuring on our blog.
If you’re interested in discussing our work in this area further, please get in touch.