Dr, John Oyston

Just like Canada, New Zealand is a highly-developed former British colony, with a strong public health care system. It has an overall smoking prevalence of 13.7%, but this figure increases to 31.2% in the indigenous Māori community. The situation in Canada is very similar, with much higher smoking rates in indigenous communities.

In 2011 the New Zealand government set an ambitious goal for a “Smoke-Free Aotearoa” by 2025. They defined this as an adult daily smoking prevalence of less than 5% and almost no people starting to smoke.

Five years later, in 2016, Canada’s Health Minister committed to a similar “End-Game Strategy”, calling for a smoking prevalence in Canada of “5% by 2035”. However, it now seems unlikely that Canada will reach its target.

When, in 2018,  it seemed that New Zealand would miss their target, Hon Jenny Salesa, Associate Minister of Health, submitted a proposal to catch up that included supporting smokers to switch to significantly less harmful alternatives.

“End Smoking New Zealand” and “ASH New Zealand” jointly published “A Surge Strategy” https://apo.org.au/sites/default/files/resource-files/2019-10/apo-nid262381.pdf in October 2019. This document studied and made recommendations about the role of vaping and smoke-free nicotine products in reducing smoking.

Zealand Ministry of Health revised its position statement on vaping in September 2020. It includes the following Key Messages:

The best thing smokers can do for their health is to quit smoking for good

Vaping products are intended for smokers only

The Ministry considers vaping products could disrupt inequities and contribute to Smokefree 2025

The evidence on vaping products indicates they carry much less risk than smoking cigarettes but are not risk-free

Evidence is growing that vaping can help people to quit smoking

Stop smoking services must support smokers who choose to use vaping products to quit

There is no international evidence that vaping products are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it

New Zealand Ministry of Health position statement on vaping revised September 2020.

In April 2021, the NZ Ministry of Health published a regulatory impact statement entitled “Supporting smokers to switch to significantly less harmful alternatives”

Highlights included:

There is scientific consensus that vaping is significantly (around 95 percent) less harmful than smoking.  It is likely that vaping also helps smokers to quit smoking.

Vaping products either lack many of the toxicants found in cigarette smoke or, where present, these are typically lower than in tobacco smoke and at levels considered a negligible risk to health. 

Evidence from short and long-term use of nicotine replacement therapy suggests that the use of small quantities of nicotine is associated with few risks.  The addiction potential of nicotine in vaping products appears to be low

In 2017, the British Medical Association concluded that current data on vaping and smoking does not support a gateway effect, noting that smoking has continued to decline over the period of time that vaping has increased.

“Supporting smokers to switch to significantly less harmful alternatives”

This document led to the Smokefree Environments and Regulated Products Act, which came into effect in August 2021. This legislation strikes a good balance between ensuring that safe, good-quality products are readily available for adult smokers while minimizing appeal and access to young people.

Associate Health Minister, Dr. Ayesha Verrall, predicted that the Act would result in a ‘healthier future for Aotearoa’ and ‘represented an exciting and significant step towards our Smokefree Aotearoa 2025 goal’.

CURRENT VAPING LAW IN NEW ZEALAND

The NZ government understands that vaping is a safer alternative to smoking and allows retailers to provide the following messages

•               “Completely replacing your cigarette with a vape will reduce harm to your health”, and

•               “If you smoke, switching completely to vaping is a much less harmful option”

New Zealand adults can buy nicotine e-liquid as a consumer product from a wide range of retail outlets.

The guidelines ensure that all products meet high safety and quality standards. Nicotine, PG and VG must be pharmaceutical-grade.

Nicotine limits have been set at 20mg/ml for freebase nicotine and 50mg/mL for nicotine salt products

There are also requirements for labelling, instructions for handling and correct use, safety warnings and bans on certain toxic chemicals. Containers should be no more than 120 ml and must be protected against breakage, leakage, spilling and have child-resistant closures.

Safety standards have also been set for vaping devices including battery and electrical safety and consistent nicotine delivery.

Protection for young people includes a minimum age of sale of 18 years, no vaping in cars with children and a ban on cartoons or toys on packages.

Vape shops can sell a wide range of flavours, but other retail outlets can only sell tobacco, mint or menthol.

Advertising is banned.

Adapted from “New Zealand leads the way with vaping regulations” by Colin Mendelsohn

However, New Zealand did not stop at creating a legal framework that permitted vaping. They created an advertising campaign and used social media to actively promote switching to vaping as a safer alternative to smoking, and a legitimate way of quitting cigarettes.

The New Zealand Ministry of Health now supports two websites related to vaping.

The youth-orientated “QuitStrong.nz” was launched in August 2020. It is supported by the Ministry of Health, as part of a $NZ 1,670,000 campaign that included primetime television and radio, supplemented with poster and bus shelter campaigns in indigenous communities with a high smoking prevalence.

Quit Strong is one of the first public health initiatives to encourage smokers to use vaping to provide nicotine while maintaining the behavioural and psychological rituals associated with smoking. The site encourages people to sign on with a Quit Coach who can support them as they switch to vaping.

The other website, at  https://vapingfacts.health.nz/, is funded by the Ministry of Health — Manatū Hauora and the Health Promotion Agency/Te Hiringa Hauora and launched in June 2019,

The NZ Ministry of Heath promises that “The Vaping Facts website will continue to provide a trusted source of information for smokers wanting to switch to a less harmful product.”

 It includes clear and direct statements such as “Vaping can help you quit smoking” and a user-friendly quiz.

Key messages include:

Vaping has the potential to help people quit smoking and contribute to New Zealand’s Smokefree 2025 goal.

Nicotine is addictive, but it’s the toxins produced by burning tobacco that cause smoking-related illnesses. Vaping can vary from no nicotine to high nicotine, and is much less harmful than smoking.

Vaping has helped many people quit smoking and is a legitimate way to become smoke-free.

Breathing any product into your lungs unnecessarily is not ideal, and that’s why non-smokers should not vape. However, for those who smoke, switching to vaping is likely to substantially reduce health risks.

https://vapingfacts.health.nz/ NZ Ministry of Health — Manatū Hauora and the Health Promotion Agency/Te Hiringa Hauora.

The site has a section on the options for quitting smoking and advises smokers interested in using vape to quit that “Going to a Specialist Vape Retailer is the best way to get a vape that’s right for you. It’s personal, and it depends on so many things, like how often and how much you smoke, your choice of the nicotine base and the flavours. Specialist Vape Retailers are stores that have been classified so that they can sell a wider range of vape flavours, offer taste-testing, and have more ability to advertise their products, etc.”

Is it working? ASH New Zealand reports:

Vaping is helping Aotearoa New Zealand reach Smokefree 2025

E-cigarette use (vaping) continues to be highly disruptive to smoked cigarettes and presents a fraction of the harm. Creating an environment where smokers can use this much less harmful alternative to manage nicotine addiction is likely to have a significant impact on chronic disease prevention in New Zealand, especially for Maori, Pacific and low-income populations.

In stark contrast to the New Zealand approach, Health Canada set a target of reducing smoking to “5% by 2035” but it never developed a plan to achieve this goal. Instead, various levels of government made vaping less affordable (with taxes), less effective (with a low limit on nicotine concentration), and less enjoyable (with a ban on flavours).

Health Canada must urgently re-commit to its “End-game Strategy” goal. Every month they delay, another 4,000 Canadians die un-necessarily from tobacco smoking. They need to follow the example of their sister agency in New Zealand and create plans to leverage the opportunity provided by less-harmful nicotine products such as vape, heat-not-burn and snus that allow smokers to continue to enjoy using nicotine without the lethal chemicals produced by inhaling burnt tobacco leaves.