Action on Smoking and Health (ASH) produced a report in June 2021 showing how Great Britain is getting vaping right (https://ash.org.uk/wp-content/uploads/2021/06/Use-of-e-cigarettes-vapes-among-adults-in-Great-Britain-2021.pdf).

It is interesting to see how vaping is managed in the country where “Big Tobacco” interferes with health care policy the least. And it shows countries like Canada and the USA that a vape flavour ban is not the way to go.

Great Britain has 3.6 million vapers, 65% (2.4 million) of whom are ex-smokers. A further 30.5% (1.1 million) are dual users of vaping and tobacco, a decline from 38.3% the previous year. Only 4.9% of vapers never smoked, and overall fewer than 1% of never-smokers are vapers.

Youth Vaping in Great Britain

ASH issued a similar report about youth vaping in January 2021 (https://ash.org.uk/wp-content/uploads/2021/02/YouthEcig2020.pdf). They reported that only 1.8% of young people used e-cigarettes more than once a week in 2020. In the 11-18 age group, 41.8% of current smokers and 11.0% of ex-smokers vaped, but only 0.7% of never-smokers were current vapers.

The scale of the British experience with vaping gives us answers to some important questions:

How dangerous is vaping?

Great Britain has 2.4 million vapers, 53.8% (1.3 million) of whom have vaped for over three years, providing almost 3.9 million vaper-years of experience. Great Britain has a highly-developed National Health Service which would be able to detect any ill-effects from this amount of vaping. However, the Medicines and Healthcare Products Regulatory Agency has only received 231 adverse reaction reports related to vaping since a reporting system was established in May 2016. Of these, only 108 were labelled as “serious”.(https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/962221/Vaping_in_England_evidence_update_February_2021.pdf)

Are vapes helping smokers quit?

Between 2011 and 2019 the number of smokers declined from 7.7 million (19.9% of people) to 5.5 million (13.9%). Public Health England (PPHE) reported that 27.2% of smokers used a vaping product to quit in the previous year, and that vaping was positively associated with a successful quit attempt. PHE calculated that 50,700 people quit smoking in 2017 by vaping.

How addictive is nicotine in vape?

If nicotine in vape is addictive, one would expect that vapers would progressively use higher nicotine concentrations to meet their cravings. However, in this study, 47% of vapers said that they had DECREASED the nicotine concentration they used over time, compared to only 9% who increased their concentration. Nicotine in vape does not seem to be addictive.

What other novel nicotine products are being used?

“Voke”, a medically licenced nicotine inhalator is being used by less than 1% of the population, and new oral nicotine products such as “Zyn” and “Nordic Spirit” are used by 3%.

Why do people vape? Because of flavours?

In the ASH study, 60% of vapers did it for the health benefits, and 50% said that they used vaping as a medicine for their tobacco addiction.

In 2015 tobacco was the most popular flavour, but its use has declined every year. Now the favourite is fruit flavour, used by 35% of all vapers. Only 20% of vapers still use tobacco flavour.

When asked what they would do if flavours were banned, about one-quarter said they would still try to obtain flavoured e-liquids, and almost one in ten said they would home-brew a flavour. Almost one in five said that they would smoke more. Less than 10% said that they would quit vaping.

Conclusion

Great Britain seems to be doing vaping right. Vaping is being used almost exclusively by adult smokers for the health benefits. Vaping is increasing the number of ex-smokers in the UK. There is minimal evidence of any health problems, dual use of cigarettes and vape is declining, and vapers are not getting addicted to nicotine.

How did Great Britain avoid the North American “Teen Vaping Epidemic”? In my opinion, vaping was seen from the start as a smoking cessation tool, sold in pharmacies and recommended in some “Stop Smoking” clinics. JUUL had a presence in Great Britain, but it seems there was never a social media campaign to persuade teens that vaping was a cool hobby. If vaping in Canada was seen and marketed primarily as a smoking cessation tool, available from pharmacies and specialist vape shops, it would save lives and make vaping seem less cool to teenagers. Vaping flavour bans would not stop many people from vaping. Instead, they may homebrew their own mixes, or use the black market, or smoke more. All these options create a health risk which Health Canada should try to avoid.