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14 NZMJ 26 June 2020, Vol 133 No 1517
ISSN 1175-8716 © NZMA
www.nzma.org.nz/journal
E-cigarettes, vaping and
a Smokefree Aotearoa:
where to next?
Richard Edwards, Janet Hoek, Andrew Waa
This edition of the Journal includes a
commentary by Burrowes et al1 dis-
cussing the validity of the claim that
e-cigarettes are 95% safer than smoking. The
commentary is highly topical as legislation
to introduce a regulatory framework for
these and related products is (fi nally) before
Parliament. It is thus timely to take stock
and discuss outstanding issues, including
next steps and priorities, both with the cur-
rent Bill and the Smokefree Aotearoa 2025
goal of minimising use and availability of
smoked tobacco products for all peoples.
Debate about the impacts of vaping and
how it should be regulated have been
fuelled by uncertainty about three key
points. First, the harmfulness of vaping (as
highlighted by Burrowes et al).1 Second, the
balance between the potential positive (eg,
supporting smokers to switch from smoking
to (less harmful) vaping, or helping smokers
quit smoking and nicotine use completely)
and negative impacts (eg, initiation of
vaping among non-smokers and a possible
‘gateway’ effect in youth by increasing
subsequent smoking uptake). Third, impacts
on reducing health inequalities, a major
consideration given the huge disparities
in smoking and in the physical, social and
economic harms it causes Māori and Pacifi c
peoples. Philosophical differences in the
priority accorded to protecting children
compared to helping smokers stop smoking
add further complications.2
Internationally approaches to regulation
of vaping products vary. Some countries,
like Australia have highly restrictive policies
on availability, marketing and use while
others, such as the UK, fully embrace harm
reduction approaches and have much more
permissive regulatory environments.
The urgency of introducing a regulatory
framework in New Zealand increased
recently. First, in March 2018 a court
judgement determining that heated tobacco
products could be legally sold in New
Zealand led to a rapid and largely unreg-
ulated increase in the availability and
marketing of nicotine-containing vaping
products. Second, some school principals
began reporting concerns about increases
in vaping among pupils and ASH Year 10
data showed trial and regular use of vaping
products was growing among adolescents.3,4
In February of this year the Smokefree
Environments and Regulated Products
(Vaping) Amendment Bill (henceforth the
‘Bill’) was introduced to Parliament. Key
provisions include:
• Sale of vaping devices and e-liquids
allowed only to adults (≥18 years) at:
• registered specialist R18 stores
(full range of fl avours available)
• non-specialist stores (mint,
menthol and tobacco fl avours
only)
• Prohibition of advertising and spon-
sorship of vaping products
• Prohibition of vaping in legislated
smokefree areas, except for trying
products in specialist stores
• Systems for product notifi cation and
early warning of adverse effects
• Director General can issue warnings,
recall or cancel product notifi cations,
and prohibit constituents
The Health Select Committee reported
on the Bill on 2 June and was largely
supportive.5 Recommended amendments
included reducing the proportion of sales
from vaping products required to be desig-
nated a specialist store, and some additional
exemptions to the restrictions on advertising
and marketing of vaping products.
EDITORIAL
15 NZMJ 26 June 2020, Vol 133 No 1517
ISSN 1175-8716 © NZMA
www.nzma.org.nz/journal
At least one proposed amendment appears
problematic. The Select Committee proposed
deleting a clause that allowed specialist
vaping store staff to provide advice and
recommendations about vaping products to
their in-store customers. The Committee’s
logic is diffi cult to follow as one of the justi-
fi cations for having different regulations for
specialist and non-specialist retailers is that
the former usually have greater expertise,
and hence are better positioned to advise
smokers new to vaping about the most
suitable products.
However, assuming the current Bill passes
into law largely unchanged, what should be
the next steps?
Firstly, some of the Bill’s provisions require
consultation and development of regula-
tions. For example, regulations will specify
packaging, fl avour descriptors and warning
label requirements. Regulations will also
set out product safety standards for allowed
constituents and fl avours and maximum
concentrations where these are specifi ed.
Key issues to resolve include whether to
introduce a maximum nicotine concentration
for e-liquids, as occurs in the European
Union and the UK; and whether vaping
products should have warnings labels and
be sold in standardised (plain) packaging,
like smoked tobacco products. Another will
be whether regulations should vary between
product types. For example, heated tobacco
products are likely to be more harmful than
vaping products,6 and sleek, discreet, high
nicotine content ‘pod’ devices may appeal
particularly to adolescents.7 More stringent
regulations for packaging, warning labels
and maximum nicotine content for these
products seems sensible.
Secondly, comprehensive monitoring
and rigorous and ongoing evaluation and
review of the Bill’s implementation and
impact should occur. Thorough evaluation
of major policy and legislative interventions
is vital to generate evidence about feasi-
bility, effectiveness and possible unintended
consequences. The fi ndings will inform
decision-making in other jurisdictions and
in New Zealand should help determine
whether to continue, discontinue or change
policy. Such monitoring, evaluation and
review is especially important for vaping
regulation given the dynamic market,
rapidly evolving technologies, and uncertain
and contested impacts. Unfortunately, New
Zealand Governments have a lamentable
record of evaluating new policies. For
example, the Government evaluated neither
the 2012 point-of-sale tobacco product
display ban nor the introduction of stan-
dardised packaging and revised pictorial
warning labels for smoked tobacco products
in 2018.
Surveillance is also required to monitor
the actions and tactics of the tobacco
industry. The New Zealand vaping product
market currently comprises independent
manufacturers and retailers, and the
tobacco companies. However, recent adver-
tising blitzes for tobacco industry vaping
products (eg, Vype, BAT), and strenuous
efforts to promote heated tobacco products
(eg, IQoS, Phillip Morris International),
suggest the tobacco companies are striving
to gain greater market share. A key concern
is that the tobacco industry will focus on
promoting heated tobacco products, where
their profi t margin is greatest and they can
monopolise the market.8 Another concern
is the tobacco industry’s long history of
duplicity and deceit, particularly over
promotion of its products to youth.9
A third priority is to build on the oppor-
tunity that the Bill creates to implement
complementary interventions targeting
smoked tobacco products. Crucial initiatives
would see smoked tobacco products made
much less available, as well as less appealing,
palatable and addictive, for example, by
prohibiting fl avours and additives and mini-
mising their nicotine content.10 Widespread
availability of vaping products makes it
more feasible to strengthen the regulation of
smoked tobacco products, and may increase
the impact of such measures in reducing
smoking prevalence, by providing smokers
with an acceptable and accessible alter-
native to smoking. For example, mandated
denicotinisation of tobacco products would
‘push’ smokers away from smoking, as ciga-
rettes with no or minimal nicotine content
are much less satisfying,11 and ‘pull’ them
towards vaping products which deliver
nicotine effectively.
Finally, the Bill will create some
perplexing anomalies that will need
addressing. For example, dairies, gas
stations and supermarkets will only be
EDITORIAL
16 NZMJ 26 June 2020, Vol 133 No 1517
ISSN 1175-8716 © NZMA
www.nzma.org.nz/journal
able to sell a restricted range of fl avoured
vaping products but any fl avour of smoked
tobacco product. Specialist vaping stores
will have to be registered and provide the
Government with product sales data, but
stores selling much more harmful smoked
tobacco products will not. The principle of
proportionate regulation in relation to harm
espoused by the Ministry of Health12 surely
dictates that the most harmful nicotine
delivery products are the most tightly regu-
lated, not the reverse?
In conclusion, although the vaping Bill
probably satisfi es few people completely,
it is undoubtedly much better than the
current unregulated free-for-all that key
stakeholders, except possibly the tobacco
companies, agree is untenable. Once the
Bill and its associated regulations are
fi nalised, an immediate priority should
be to introduce a robust monitoring and
evaluation framework. The Government
and the smokefree sector should then
focus on developing and implementing the
promised Smokefree 2025 action plan,13
including a comprehensive set of measures
to encourage and support all smokers to quit
and discourage young people from starting
to smoke. In the longer term, it is important
to recognise the that Māori leaders who
paved the way for the Smokefree 2025 goal
envisaged a Tupeka Kore Aotearoa, where
the harm caused by tobacco use has been
eliminated and the social and economic
harm that nicotine addiction causes no
longer exists.
Competing interests:
Nil.
Author information:
Richard Edwards, Department of Public Health, University of Otago, Wellington;
Janet Hoek, Department of Public Health, University of Otago, Wellington;
Andrew Waa, Department of Public Health, University of Otago, Wellington.
Corresponding author:
Dr Richard Edwards, Department of Public Health, University of Otago, Wellington.
richard.edwards@otago.ac.nz
URL:
www.nzma.org.nz/journal-articles/e-cigarettes-vaping-and-a-smokefree-aotearoa-where-to-
next
1. Burrowes KS, Beckert L,
Jones S. Human lungs
are created to breathe
clean air: the question-
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2. Fairchild AL, Bayer R,
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EDITORIAL
17 NZMJ 26 June 2020, Vol 133 No 1517
ISSN 1175-8716 © NZMA
www.nzma.org.nz/journal
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EDITORIAL