Sabotaging Harm Reduction in the Name of Public Health


On Friday 19 June 2020, the Australian Government announced that “to reduce the risk to public health through addiction to nicotine and nicotine poisoning”, it intended to ban the importation of e-cigarettes containing vaporiser nicotine (nicotine liquids and salts) from 1 July 2020, unless on prescription from a doctor. A week later, on the 26th of June, the Minister of Health issued a statement, delaying implementation of the ban by six months.

Both announcements contain statements that underline real obstacles that stand in the way of tobacco harm reduction, ostensibly in the interests of protecting public health.

In the first announcement, the Department of Health stated that “Evidence suggests that the use of e-cigarettes by non-smoking youths predicts future take-up of smoking. In the USA, there was a 78% increase in the number of high school children who are vaping over the most recent 12-month period surveyed. Without action, Australian youth will also be at risk.”

The statement above does not stand up to scrutiny, though. Although no evidence is presented, it invites the reader to conclude that a 78% increase in the number of students who vaped in the US resulted in increased take-up of smoking. By implication, these students were also addicted to nicotine. Furthermore, a similar fate will befall the Australian youth if the Government did not ban the importation of nicotine-containing vaping products into Australia.

Let’s address the often quoted 78% increase in the number of US students who vape. The statistic comes from the annual National Youth Tobacco Survey (NYTS) and refers to any e-cigarette use over the past 30 day period. This amounted to 20.8% of high school students in 2018; up from 11.7% in 2017. Using these figures to suggest a problem with nicotine addiction and subsequent take-up of smoking is problematic on several fronts.

  • The survey did not record whether these students vaped nicotine-containing liquids, zero-nicotine liquids or, indeed, cannabinoids.
  • These figures do not reflect regular use and therefore, cannot form the basis for conclusions on nicotine dependency. In reality, nearly 60% of student vapers were only occasional (< 9 days p.m.) users and only 0.6% of students were regular users who had never used other tobacco products (for a detailed analysis see

Is vaping leading to increased take-up of smoking? Statistics suggest that it does the opposite. US youth smoking rates have declined consistently over the past 20 years, with a noticeable reduction from 2014 onwards when vaping starting becoming more popular.

US youth smokingpng

Source: CDC, NYTS data

Delayed implementation. The Hon Greg Hunt MP, Minister of Health, announced that the implementation of the import ban would be delayed by six months to allow smokers, who are using vaping as a quitting tool, time to obtain prescriptions through their GP’s.

In the statement, the Minister said that “In particular, around the world we have seen strong evidence of non-smokers being introduced to nicotine through vaping for the first time. Therefore the Government is responding to the advice by ensuring that nicotine based e-cigarettes can only be imported on the basis of a prescription from a doctor. This will help prevent the introduction of non-smokers to nicotine via vaping.”

These sentences encapsulate much of the approach followed by those opposed to tobacco harm reduction:

  • The existence of “strong evidence” is often cited as justification for policies, albeit without presenting the actual evidence. In this instance, real-world data from the world’s largest vaping markets suggest the opposite of what is being presented by the Minister. We showed earlier that in 2018 among high school students in the US, less than 0.6% were regular vapers who had never used other tobacco products. In the UK, where public health authorities have adopted a vaping-friendly approach to harm reduction, 1.6% of 11-18-year-olds, and only 0.1% of 11-18-year-old never smokers, vaped more than once per week, according to research conducted by ASH.
  • Making nicotine the villain. Notice how the emphasis has shifted from vaping serving as a gateway to smoking to nicotine and addiction being harmful. At the same time, nicotine replacement therapy is available without prescription around the world and in Australia, specifically. Creating moral panic around young, non-smokers, potentially becoming addicted to nicotine through vaping, conveniently ignores the fact that, in the absence of safer alternatives, they likely would have smoked.

It's a shame that governments and public health bodies tasked with our health and wellbeing are denying millions of smokers and would-be smokers around the world access to safer alternatives because consumers appear to be enjoying them.