Over the last decade, a range of new reduced-risk nicotine products such as electronic cigarettes (e cigarette) have appeared on the market. Millions of smokers have used them to successfully replace their regular cigarettes, reducing their risk of cancer, heart disease and lung disease. However, this positive trend is under attack by tobacco control leaders and physicians who fear that the new e cigarette products will be as bad as cigarettes or who simply do not trust the tobacco companies that are creating some of these products.
I can understand their views. For decades I led tobacco control efforts, first in my native South Africa, then globally as a cabinet director at the World Health Organization (WHO). While at WHO, in 1998, I invited tobacco companies to present their progress on what have become known as “reduced-risk nicotine products” in a scientific setting. We were unimpressed. But times have changed. E-cigarettes, and now a wider portfolio of reduced-risk nicotine products, are emerging from laboratories of small start-ups and large tobacco companies. All have a common aim: give smokers a product that removes the harmful and deadly components of tobacco products (the tar) while providing the nicotine in a dose and with the full experience they have as a smoker.
Some companies are now investing billions of dollars in e-cigarettes, hoping they can maintain a market for their products without killing their consumers. The science in favor of e-cigarettes is maturing and the UK government’s evidence update today suggests that e-cigarettes are 95% less harmful to health than normal cigarettes, and earlier this month the Royal Society for Public Health issued a statement on nicotine being no more harmful to health than caffeine. Based on this evidence, it is time for public health groups in the U.S. to recommend that smokers who seek to quit should switch to e-cigarettes.
As for media trends, a review by the Vitality Institute found that over the last 2 years there was a 1,800% increase in e-cigarette mentions in top-tier media coverage in the US! E-cigarettes now eclipse tobacco and traditional cigarettes in stories about smoking and its effects. Yet most e-cigarette articles never highlight the product’s benefits. Instead they focus on scary stories: exploding e-cigarettes; kids overdosing on nicotine fluid; and even doctors and medical associations’ concerns about e-cigarettes being as harmful as or worse than regular cigarettes. The impact of these distorted media stories has led many smokers who had moved to e-cigarettes to move back to regular cigarettes.
It is time to end the war on e-cigarettes and view them as the smoking cessation aid that they are. This cultural change begins with a smarter regulatory path. Policymakers need to adopt regulations that encourage smokers to shift to reduced-harm products such as e-cigarettes and tighten up on regulatory actions aimed at regular cigarettes.
Last week, we saw a glimpse of what those policies might look like. 3 leading health economists writing in the New England Journal of Medicine – Frank Chaloupka, David Sweanor, and Kennet Warner – called for tobacco excise taxes to be set proportionate to the harm the product causes. These 3 played a key role over the last 20 years in placing excise tax and pricing at the core of WHO, World Bank, and government actions taken to curb use. Having worked with them, I know that the world’s finance ministers take their voice seriously.
My view is that we need to build a significant gap between the actual prices of regular tobacco products versus reduced risk products, starting with an increase in tax on the former without favoring local brands (a practice followed in many developing countries) and by keeping the tax on reduced risk products very low for at least 2 decades or until they command 75% of total sales of nicotine products. Careful attention should be paid to raising excise taxes on regular products as their use declines, with the goal of maintaining total government revenues.
The regulatory framework matters. But what has historically mattered even more is the advocacy of physicians. Because of that, it is also important to educate physicians about the difference between the health effects of nicotine and tar. Physicians dominate the policy space and their support will be needed to bring e-cigarettes into the mainstream.
42 million Americans still smoke. Almost 500,000 Americans die from their habit every year. We need to act faster to adopt smarter regulations aimed at accelerating the transition out of harmful tar-based cigarettes—and for the first time, we have a range of scientifically-proven products that will help smokers quit. E-cigarettes have to be part of the solution.
Derek Yach, MBChB MPH, is the Chief Health Officer of the Vitality Institute