This week, RCP's special adviser appeared in front of the Tobacco and Vapes public bill committee to give his expert opinion on the bill which passed second reading in November 2024.
The Tobacco and Vapes Bill is ‘well-balanced and world leading’ and will work to prevent future generations from taking up smoking, but we can do more to reduce the uptake of vaping in children such as restricting flavour descriptors. This was the message from RCP’s special adviser on tobacco Professor Sanjay Agrawal this week as he provided his expert opinion to the public bill committee on the Tobacco and Vapes Bill.
Consultant in respiratory and critical care medicine Professor Agrawal said those behind the bill should be congratulated but also warned we must be wary of the future tactics from industry who may look to circumvent restrictions.
Professor Agrawal said: “The majority of people, of adults, who vape have smoked, so they are using vapes to quit smoking. Research, that looks populations who have never smoked and who have only vaped is actually quite small. The longitudinal studies are still not there. We know from shorter-term studies that vaping can lead to coughing and throat irritation.
'But it's really important to consider the alternative and that's continued smoking.
'Just in my professional practise - of roughly 30 years - I estimate about 3 million people have died in the UK from smoking tobacco.
'The intensive care unit that I work in and the lung cancer clinics that I do are full of people who have come to harm from accrued smoking, so there should be no doubt that smoking – combusted tobacco – is the key thing that we want to prevent the future generations being subjected to.
'There are six million smokers in the UK. And we need as many of them - and to help as many of them as we can - to stop smoking. Vaping is one means by which they can stop smoking, which is really important.
'So firstly, I would say that a lot of people who smoke, who want to give up, use vapes because they have tried other products and haven't been able to give up with other products.
'And one of the things that they want to get away from is the taste of tobacco. By having flavours, it allows them to get away from that and actually other NRT products like gums and lozenges also have fruit flavours. It's not just vapes.
'So flavours of are an integral part of helping people get away from smoking.
'Now equally, I would say that flavours as we know attract young people. So I think it's really important that we limit the number of flavours. But perhaps, what's more important are the flavour descriptors. And I think we need to make them bland and the bill as it stands at the moment provides powers to restrict all sorts of developments related to vaping - whether that's the number of flavours but also the descriptors and the packaging, and the appeal, and the advertising.
'There is good survey evidence of what is popular among adult smokers who are using vapes to try and quit so that that's one helpful factor.'
Professor Agrawal also had the opportunity to speak to the environmental factors which could be contributing to the rise in vaping – particularly among young children – and whether the bill is robust enough to deal with future nicotine products.
He said: '[There are] online harms, for example, through social media, through gaming, through music videos. There's lots of depictions. It's a wild west out there with respect to both tobacco and vapes that lure people in. There's a lot of advertising and promotion of both tobacco and vaping products. And one area that we could do much more with is that online and social media area that would strengthen the bill further.
'The bill is really well balanced. It's world leading. So I think the people that put this together should be congratulated, but we also have to be aware that industry never sleeps.
'[Industry] will try and adapt to regulation and legislation and we need to be wary of that and make sure that we use the powers in the bill in the future.
'So for example, disposable vapes which are due to be banned this year. I'm sure that there'll be a lot of companies right now changing their products to make them look as though they're not disposable vapes. When in fact, for all intense and purposes, they are disposable. So there will be lots of adaption by industry that we have to be wary about. And I think this bill provides those future powers for us to adapt to Industry.'
In 2021, figures by the Office for National Statistics found that of people aged 18 years and over in England, 24% were living in the most deprived neighbourhoods, compared with 7% living in the least deprived neighbourhoods. The committee asked how important it is to think about how the bill may impact the health of children as they grow into adulthood, the communities they live in and addressing these clear inequalities.
Professor Agrawal said: '350 children a day start to smoke and a lot of those will be from the most deprived communities. In addition, smoking in the UK brings around a quarter of a million families into poverty, and those families have children.
'This bill is going to go a long way to not only reducing the health harms to individuals. It will reduce poverty, and it will hopefully reduce smoking-related deprivation.
'It's estimated the cost to secondary care is about billion pounds per year - with primary care in addition, that's a total of 2.6 billion pounds to the NHS, around 20 billion pounds a year to social care and about 50 billion pounds a year in lost productivity.
'So there are costs of smoking to our society, whether that's at an individual level - poverty, deprivation – or social care and workforce productivity. That's why this bill is just so important.'
For more than 60 years, the RCP has been a leading voice on the health impacts of smoking tobacco. In 1962, we published Smoking and Health – a ground-breaking report which first highlighted the link between smoking and lung cancer, heart diseases and other serious illness. Since then, the RCP has published a range of reports on tobacco control and more recently vaping/e-cigarettes.
Last year, the RCP published E-cigarettes and harm reduction: an evidence review which made more than 50 recommendations including several on the regulation of vaping products to protect young people and never smokers from vaping.
That report followed several previous RCP publications on e-cigarettes and vaping including:
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Harm reduction in nicotine addiction – a report on alternative nicotine products published in 2007, which covered their regulation and role as alternatives to smoking. The report concluded that there was a role for alternative nicotine products to support people to stop smoking tobacco and that regulation for those products should be formalised.
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Nicotine without smoke - which re-examined emerging data on the role of e-cigarettes and alternative nicotine products. The 2016 report concluded that e-cigarettes were an effective aid to quitting smoking but there needed to be regular surveillance to monitor intended and unintended consequences of regulation.