This week, the Victorian Legislative Council debates the draconian legislation to have electronic cigarettes regulated as tobacco products, under the Tobacco Amendment Bill 2016. Although well meaning, this legislation is misguided. It will help perpetuate smoking and have an overall negative effect on public health.

If passed, the legislation will restrict the sale, supply, display and use of e-cigarettes as if they were tobacco products. It will be illegal to vape in designated smoke-free areas in Victoria. Even advertisements to encourage smokers to switch to vaping will not be allowed.

A recent comprehensive review of e-cigarettes by the prestigious UK Royal College of Physicians recommended that e-cigarettes be promoted as widely as possible as a substitute for smoking in the interests of public health. So why are we effectively banning them in Victoria?

Fear and misinformation

The new laws are based on fear and misinformation. E-cigarettes are not tobacco products. They do not contain tobacco, do not burn and do not release smoke. Almost all of the harm from smoking is caused by the smoke, and nicotine has relatively minor health effects, except in pregnancy. E-cigarettes provide the nicotine that smokers are addicted to but with very low levels of harmful chemicals. According to recent comprehensive reviews by Public Health England and the Royal College of Physicians, e-cigarettes are unlikely to exceed 5 percent of the harm from smoking tobacco.

There is also clear evidence that e-cigarettes are helping many people to quit. Studies of early models which deliver low nicotine levels are at least effective as nicotine patches and newer models are substantially more effective. A recent study in the journal Addiction estimated that over 6 million smokers had quit smoking using electronic cigarettes in Europe alone.

According to the Victorian Minister for Health, e-cigarettes will act as a gateway to smoking for young people and ‘renormalise’ smoking. However, 10 years of experience in the UK, US and Europe suggests that the opposite is true — that e-cigarettes may be reducing adolescent smoking rates. Although many adolescents experiment with e-cigarettes, overseas studies have found that regular use is almost exclusively confined to young people who already smoke. Furthermore, in the US, only 20 percent of adolescent vapers use nicotine.

In the UK and US, there is no evidence that e-cigarettes are undermining the decline in smoking rates. In fact, as e-cigarette use is rising, adolescent and adult smoking rates are falling faster than ever before. It is quite possible that e-cigarettes are contributing to this rapid fall. Young people who experiment with e-cigarettes may otherwise have smoked if e-cigarettes were not available. It is obviously better for young people not to use e-cigarettes, but vaping is preferable to smoking and is likely to be 95 percent safer.

More research is needed before we have certainty about the risks and benefits of e-cigarettes. Like any new treatment, there is a possibility of unknown side-effects in the future. However, one thing we are sure of is that two out of three cigarette smokers will be killed prematurely by their habit and vaping can help many of them to quit.

Getting the regulatory balance right

E-cigarettes should be regulated, but in a balanced way that maximises the potential benefits to smokers while minimising the risk of negative public health effects. Regulation also needs to be proportionate to risk. It is irrational to apply severe restrictions to a much safer product while allowing widespread access to deadly cigarettes.

The proposed legislation is focussed solely on avoiding potential dubious risks but ignores the substantial health benefits to smokers. This legislation could have the unintended consequence of undermining a potentially life-saving technology. It will diminish the appeal of vaping relative to smoking and may even destroy the industry altogether, enhancing the unregulated black market.

The proposed total advertising ban on vaping is counterproductive. Carefully regulated advertising to adult smokers can inform them of the significant harm-reduction benefits of vaping and encourage them to switch. Appropriate advertising guidelines would avoid images of young people, targeting youth and non-smokers and glamorous or seductive advertising styles.

E-cigarettes should be given a competitive advantage over cigarettes to encourage switching. Allowing people to vape in some smokefree areas would help to make e-cigarettes more attractive and would reduce the risk of vaping ex-smokers having to use smoking areas with other smokers. Sales tax on e-cigarettes should be minimal to maintain a price advantage over deadly cigarettes.

Further appropriate regulations would ensure childproof containers with accurate labelling, no sale to people under 18 years, quality control and safety standards.

E-cigarettes represent a massive opportunity for Victorian smokers and have the potential for substantial improvements in public health. We cannot afford not to embrace them.

A new report by the Royal College of Physicians in the United Kingdom says electronic cigarettes (e-cigarettes) are much safer than smoking and encourages their widespread use by smokers. It concludes that e-cigarettes have huge potential to prevent death and disease from tobacco use.

The review identifies e-cigarettes as a valuable tool to help smokers quit. For those who are unable to quit with currently available methods, e-cigarettes can substitute for smoking by providing the nicotine to which smokers are addicted without the smoke that causes almost all of the harm. This approach is supported by the scientific and public health community in the UK and is consistent with a previous review by Public Health England, the government health agency.

E-cigarettes are the most commonly used aid to quit smoking in the UK. According to the new review, evidence available so far suggests e-cigarettes are at least as effective as nicotine replacement therapy, such as patches or chewing gum. More than one million people have quit smoking in the UK using e-cigarettes. Quit rates are likely to be even higher with professional counselling and with more advanced devices.

E-cigarettes have been available in the UK since 2007 as a general consumer product – with some additional restrictions on advertising and minimum age of sale. They’re used almost exclusively in the UK by smokers who are trying to cut down or quit smoking, or who have quit smoking.

Concerns About E-Cigarettes

In Australia, e-cigarettes containing nicotine are prohibited. Most Australian health organisations such as the National Heart Foundation, Cancer Council Australia and the Australian Medical Association take a very risk-averse approach based on potential harms. They say e-cigarettes could be a gateway to smoking for non-smokers; they may make the act of smoking socially acceptable again (renormalisation); there may be unknown long-term safety risks; and dual use may delay quitting.

The new review explores the evidence for these concerns and says they are mostly unfounded.

In the UK, there is no evidence e-cigarettes are a gateway to smoking. E-cigarette use is almost entirely restricted to current or past smokers. Use by children who would not otherwise have smoked appears to be minimal.

The report found no evidence to suspect the use of e-cigarettes renormalises smoking. On the contrary, smoking rates in the UK have been falling as e-cigarette use rises.

E-cigarette vapour contains some toxins and the report acknowledges some harm from long-term use cannot be dismissed. However, it supports the widely held view that the hazard to health is unlikely to exceed 5% of the risk of smoking, and may well be substantially lower. This level of harm is similar to nicotine replacement therapy and is likely to reduce with further technological advances. Similarly, the report concludes the harm to bystanders from vapour exposure is negligible.

Many e-cigarette users continue to smoke as well for a period of time (dual use) but there is no evidence this has reduced the number of smokers who quit. Indeed, dual use is often a transitional phase and many users will go on to quit completely as is the case of smokers concurrently using nicotine replacement therapy. A recent study found dual use reduces smoking intake and is less hazardous.

Implications for Australia

Australia has a comprehensive tobacco control policy including high tobacco taxes, mass media campaigns and smoke-free policies that stimulate quit attempts. However, smoking is highly addictive and most of Australia’s three million smokers try and fail repeatedly to quit, even with existing therapies

Based on the UK experience, e-cigarettes could assist many Australian smokers to quit or could replace cigarettes with a much safer source of nicotine. This could potentially save many thousands of lives each year.

As established smokers are more likely to be socioeconomically disadvantaged or to have mental health problems, the burden of disease falls disproportionately on these groups who have higher levels of addiction to nicotine and greater difficulty quitting.

The precautionary position taken by Australian health organisations and governments is not supported by the available evidence and overseas experience. The growing evidence for safety and effectiveness of e-cigarettes significantly outweighs any potential risks to public health.

A rational, evidence-based approach would be to make e-cigarettes available in Australia as consumer products and to encourage their use while minimising uptake by people who would not otherwise have used nicotine products. Ongoing monitoring and appropriate proportionate regulation would help minimise any risks.

E-cigarettes represent a massive opportunity for Australian smokers and have the potential for large-scale improvements in individual and public health, and social inequality. We cannot afford not to embrace them.