On World No Tobacco Day (May 31^st 2022) let’s look at the state of tobacco control in Canada. The Tobacco and Vaping Products Act is currently up for review. A recent Evaluation of the Health Portfolio Tobacco and Vaping Activities from the Office of Audit and Evaluation was critical of Health Canada. A draconian vape flavour ban is in the works. Health Canada committed to reducing smoking rates to 5% by 2035 but is not on track to meet this goal. It is time to consider the question:

Is Health Canada’s Tobacco Control Directorate “fit for purpose”?

There are about four million Canadians who still smoke. Every month, about 4,000 of them die from smoking-related diseases. Health Canada’s Tobacco Control Directorate is not rising to this challenge or mounting an effective response to this ongoing carnage. In particular, it is ignoring the data that shows that vaping can reduce smoking deaths and assist smokers to quit.

In 2016 Health Canada committed to a “Tobacco End Game” goal of a smoking prevalence of 5% by 2035. Since then, smoking rates have decreased by less than 3%, from 17.7% in 2015 to 14.8% in 2019, despite spending over $200m on tobacco control. The Ontario Tobacco Research Unit states that the target will not be reached, and that “Canada needs to do better”. In a recent review, Health Canada claimed that it had a plan to achieve the goal, but admits they have not communicated it. If they have a plan, they should publish it immediately. If they cannot do so, then presumably they only have jot notes on a napkin, not a real plan.

When the Tobacco and Vaping Products Act was passed in May 2018, it included Section 30.43, a law that prohibits people who sell vaping products from making health claims. They are not allowed to tell potential customers that “Completely replacing cigarette smoking with vaping will reduce your exposure to harmful chemicals” or “Vaping is less harmful than smoking.”, even though these are direct quotes from the Health Canada website. A list of statements that could be used had been on Health Canada’s backburner since at least September 2018. This is an unacceptable limitation of free speech. Health Canada is actively preventing people who smoke from hearing a life-saving message.

Health Canada has done surveys that show that the public, smokers, health care providers and physicians are woefully ill-informed about the relative risks of vaping and smoking. For example, only 4% of people are aware that vaping is, in fact, much less harmful than cigarette smoking. Only 6% of physicians would recommend vaping as a way to quit smoking, despite multiple randomized controlled trials that prove vaping is more effective than conventional nicotine replacement therapy at getting smokers to quit. Health Canada has not made any efforts to correct this situation. If smokers understand that vaping is very much safer than smoking then they may consider switching, but without accurate information, they cannot make a correct choice.

Health Canada has proposed a very strict and widespread ban on flavours in vape, ostensibly to make vaping less attractive to teenagers. They plan to ban all flavours except tobacco and menthol, despite research that shows that adult smokers who use non-tobacco flavoured vape (such as fruit or dessert) are over twice as likely to quit smoking. In order to justify this ban, they did three outrageous things:

Health Canada’s Substance Use and Addictions Program has funded a smoking cessation campaign called “Smoke-free curious” in conjunction with the pharmaceutical company, Johnson & Johnson. The campaign only mentions Johnson & Johnson nicotine replacement products as a way to quit smoking, without referring to quitting cold turkey or using vaping to quit smoking. In effect, they have used tax dollars to fund an advertising campaign for Johnson and Johnson.

Vaping is a much safer substitute for cigarette smoking. It could save millions of lives if it was cheap, effective and enjoyable. Instead, the Canadian Government is making it more expensive (with taxes), less effective (with nicotine concentration limits) and less enjoyable (with flavour bans). This will result in fewer smokers switching to vaping, causing more disease and deaths, and higher medical expenses for taxpayers.

The Tobacco Control Directorate needs to drastically change its approach if it is to meet the 5% by 2025 target. It should look to New Zealand as an example. That country has adopted an aggressive and progressive approach to decreasing cigarette smoking to reach its own “Smoke-Free Aotearoa” goal of a 5% smoking rate by 2025. This includes educating smokers about the relative risks of smoking and vaping and encouraging smokers who cannot quit by other means to switch to vaping.

Conflict of Interest Statement: Dr. John Oyston MB BS, BMedSci, FRCA, FRCP(C) is a retired medical doctor, formerly specializing in anesthesiology. In this capacity, he has earned money assisting with surgical procedures that were only necessary because his patients had smoked. He is establishing a smoking cessation clinic focused on vaping as a way to quit smoking. He has been involved in many tobacco control projects, some of which were funded by the tobacco industry and vaping organizations.