As a physician who is interested in the use of vaping as a way to reduce the death and disability due to smoking, it is a bit disturbing to see vaping viewed as a way to make profits for investors. This post is based on a report British American Tobacco (BAT) provided on Investor Day, March 2019. BAT sees new forms of nicotine as a way to attract new consumers, many of whom never smoked. They will use different nicotine products at different times of the day. The profit margins on new products will be higher than on traditional tobacco. The vaping market will become focussed on closed pod systems, mostly sold through traditional retailers rather than specialist adult-only vape shops. There will be consolidation and increased regulation, so only a few big companies, including BAT, will survive. New products will be even better than JUUL at attracting and retaining users. Social media will be heavily used to create branding and customer loyalty. BAT and its investors will make immense profits.

Let’s look at these issues and see how they are likely to affect smokers trying to quit tobacco.

Increase in size of nicotine market, with increased revenue

Fewer people are smoking traditional cigarettes, with consumer numbers down from 433 million in 2007 to 414 million in 2018, but 61 million users of new nicotine products bring the total consumer numbers up to 475 million. Revenue was only rising slowly, but 18 billion pounds worth of new nicotine products accelerates the trend.

New nicotine products should be replacing traditional ones, not adding to them.

The increase in vaping would be a good thing if it was caused by smokers switching to vaping. Unfortunately, switching accounts for only less than half of the rise in vaping, according to BAT data.

Mixed use of different nicotine products

My goal is to get smokers to convert to 100% vaping (what BAT calls “solus vaping”) for harm reduction, and then to quit vaping for the best possible health outcome. Dual-use of cigarettes and vaping should be a short term event as smokers make the switch and become used to vaping. Some people argue that the dual-use of cigarettes and vape may be even more dangerous than smoking. I certainly agree with Health Canada and other groups that switching completely to vaping is important. Mixing vaping with smoking may be a slippery slope back to smoking.

BAT sees poly-use as a way around smoking bans. Customers can use their traditional cigarettes at home, then maintain their nicotine habit with vape (thin black objects) heat-not-burn devices (brown rectangles) or new oral tobacco products (white circles) while at work or with non-smokers. No matter what form of nicotine is being used, BAT makes money.

BAT sees poly-usage as a way to increase profits. In the USA they make 51% more profit from customers who use both cigarettes and vape than from cigarette-only customers. Their financial interests are best served by consumers who add vaping to their current smoking habit.

Switching from open (refillable) to closed systems

While closed pod systems are convenient for some consumers, who may find refilling a pod a little tricky, they are less than ideal for quitting smoking. Closed systems tie consumers to using prefilled pods from the device manufacturer, rather than being able to choose from a wide variety of flavours and nicotine concentrations from many different suppliers. At present, many proprietary closed systems have a very limited range of nicotine concentrations, mostly at the higher end of the range, and often without low or zero nicotine options. This makes them less suited for smokers trying to wean themselves off nicotine. There are many options for flavours in many concentrations of nicotine, so consumers have the greatest choice, and specialist vape stores are needed to stock and curate this variety of products. If the choices become more limited, a convenience store will suffice, and vape shops will go out of business.

Switching from specialist adult-only vape shops to traditional retail

Vape store owners are often ex-smokers who are passionate about getting their customers 100% off cigarette smoking. They are usually very knowledgeable about smoking cessation. Vape stores are an adult-only environment. They stock a wide variety of different vaping devices and a huge range of flavours in varying nicotine concentrations. Convenience stores and supermarkets are frequented by teens. They tend to sell a very limited range of vaping products, concentrating on popular items which may not be the best choice for smokers wanting to quit. Their staff have no expertise in smoking cessation.

Consolidation and regulation of the vape market

Consolidation and regulation may seem to be good things, but consolidation reduces consumer choice. It is likely that only vaping companies backed by Big Tobacco, with their deep pockets and legal expertise, will be able to comply with upcoming FDA regulations.

New product development

Innovation and new developments in vaping are essential. The e-cigarette is far from a refined and finished product, and there are likely many ways it can be improved. E-cigarettes that produce even lower levels of toxic substances would be welcomed by everyone. Improvements that make e-cigarettes more attractive to smokers wanting to quit are helpful, but they need to be carefully managed so as not to attract new never-smokers to vaping.

Branding

Decades of painstaking work by anti-tobacco campaigners had almost eliminated the ability of “Big Tobacco” to display and promote its brands. From bans of advertising and sponsorship, and hiding products behind closed cabinets to plain packaging, the tobacco industry had become almost invisible. That all seems to have gone out the window with e-cigarettes. The idea was that they would be allowed to advertise so that smokers knew there was a new option for smoking cessation, but instead, they showed pictures of cool kids blowing smoke rings on Instagram.

The future according to BAT

BAT has almost infinite resources to apply to the development and sale of new forms of nicotine. Like all big business, its main goal is to make money for its investors. It has clearly put a lot of thought, money and effort into how best to turn vaping and other alternative forms of nicotine use to its advantage.

In my wildest dreams, the management of BAT and all the major tobacco companies would say:’ We are truly sorry for the pain, suffering and early deaths caused by our products. We will reduce the sale of all our traditional tobacco products by 10% every year down to zero by 2030. We will use all our resources to develop safe alternatives to combustible tobacco and to promote smokers switching to them and eventually weaning themselves off all forms of nicotine. Knowing what we know about the dangers of our traditional products, this is the only fair and honourable way forward.”

In my wildest dreams, regulators around the world say: “Unless tobacco companies reduce their annual production of combustible tobacco progressively over years down to zero, their managers will go to jail”.

Meanwhile, I live in a nightmare world where American states depend on tobacco revenue so heavily that they will listen to any nonsense about the risks of vaping, and a megalomaniac multi-billionaire has bought the WHO tobacco control policy.