1 6 July 2017 the Secretary House of Representatives Standing

6 July 2017 The Secretary House of Representatives Standing Committee on Health, Aged Care and Sport Parliament House CANBERRA ACT 2600 Dear Secretary, INQUIRY INTO THE USE AND MARKETING OF ELECTORINIC CIGARETTES AND PERSONAL VAPORISERS IN AUSTRAIALIA As a public policy consultant and analyst, who has long had a professional interest in promoting good policy and sensible regulation of smoking, alcohol and other forms of personal choice involving health risks, I welcome this Inquiry and the decision of the Minister for Health to give the Committee this reference. While I will already be known to some members of the Committee, a brief outline of my background and expertise is in Appendix A. My comments on the vaping issue, and the Inquiry’s Terms of Reference, are based on my experience and expertise as a long-time public policy professional with extensive political experience. I am not a clinician, scientist or consumer. I do not claim expertise or competence to discuss the validity or otherwise of the science. I also have never smoked or vaped. As a public policy and political professional, however, who has worked in the Australian health policy space for over 20 years, I should say at the outset I have never been involved with an issue that has generated such personal vitriol, anger, ad hominem attacks and complete disrespect for professional integrity and reputations as e-cigarettes and vaping. That includes the virulent attacks on the 2014 GP co-payment proposal, for which I became a leading public and media advocate at personal cost. There is too much smoke and heat, and too little light, in the vaping debate. That is definitely not in the public interest. This Inquiry therefore is a welcome opportunity for a dispassionate, impartial look at the issues around vaping, nicotine, and appropriate legislation and regulation. Definitions Vaping products are also known as Electronic Nicotine Delivery Systems (ENDS). This includes nicotine-containing liquid and vaporisers, but it increasingly includes newer product innovations, including “heat-not-burn” devices containing tobacco. 1 Smokeless tobacco products, notably Swedish snus, also need to be considered. While not ENDS, snus has helped lower the Swedish smoking rate to a phenomenal five per cent. For the purposes of this submission, references to ENDS include snus and other smokeless products unless otherwise stated. Defining ENDS this extends the product definition in the Vaporised Nicotine Products Bill 2017, currently a Private Senator’s Bill subject to a Senate legislation committee inquiry. Purpose of this submission Rather than address each Term of Reference sequentially in detail, this submission will argue a public policy case around them for allowing legal access to nicotine-containing ENDS, particularly: Questioning the erroneous conflating of nicotine and tobacco smoke as a single problem has made the consideration of ENDS more difficult than it could have been. Noting smoking rates have flatlined and innovations that could reduce them further should be embraces, not rejected; Noting the “precautionary principle” of public health, being used to justify suppressing legalised nicotine vaping, is being misapplied in Australia. Expressing concern that Australia increasingly is out of step with comparable jurisdictions, especially the United Kingdom, New Zealand, the European Union and Canada; and Proposing, if nicotine vaping is legalised, the Commonwealth, States and Territories should adopt a consensus position on related legislation and regulation. It will also recommend an appropriate regulatory framework, with suggestions about an appropriate policy approach to implement it. There will be particular comment on the desirability of the Vaporised Nicotine Products Bill as potential Commonwealth legislation. The health impact of e-cigarettes and personal vaporisers: presumptions in this submission Based on the emerging expert analysis, and scientific and clinical studies – especially the comprehensive scientific reports by Public Health England (2015) and Royal College of Physicians (2016) – the policy commentary in this submission makes the following presumptions about the underlying science: Nicotine, separate from the chemicals and gases of tobacco smoke, is relatively safe to users in low-level doses. However, ENDS vaping solutions, and heat-not-burn tobacco products, contain a range of chemical substances ingested in the vaping process. Therefore, ENDS themselves are not risk-free. ENDS nevertheless are very significantly safer than combustible tobacco for direct users – at least 95 per cent safer than combustible cigarettes, according to both Public Health England and the Royal College of Physicians. In respect to “dual use” of cigarettes and ENDS by smokers, there is a prima facie net health benefit to dual users if their cigarette consumption is reduced significantly in favour of ENDS. International emerging evidence indicates the vaping cohort almost entirely consists of ex- smokers and dual users and that, beyond youthful experimentation, regular vaping incidence among minors is minimal; and 2 Emerging evidence also indicates the danger of passive exposure to ENDS vapour is very low, and possibly negligible. Therefore, the major problem with ENDS vapour is it most likely merely an unsociable environmental nuisance rather than a serious danger to non-vapers. Other presumptions Whatever the validity of the claims there is a “gateway” effect from vaping to smoking for young people, ENDS are adult products intended for adults, and their sale and marketing to people under 18 should be prohibited. It is also presumed that the Committee can only recommend legislative and regulatory solutions in the Commonwealth’s jurisdiction, but may recommend policy and strategic approaches the Commonwealth may take as a national government in concert with the States and Territories. Weighting the scientific evidence In considering Term of Reference 2 on the health impacts of the use of e-cigarettes and personal vaporisers, the Committee can place particular weight on the 2016 report of the UK Royal College of Physicians, Nicotine without Smoke: Tobacco Harm Reduction1. The RCP report, prepared by the College’s expert Tobacco Advisory Group, reinforced the ground- breaking 2015 meta-analysis commissioned by Public Health England. The report is valuable for three reasons: It was prepared by distinguished clinicians, scientists and harm reduction researchers with for one of the world’s leading clinical associations. It cannot be accused of being tainted by special interests, especially so-called Big Tobacco; and In 1962, it was the Royal College of Physicians that was the first scientific body to blow the whistle on the connection between smoking and lung cancer. Given that proud record, for the RCP to come out positively about the relative benefits of vaping is highly persuasive. That is not to say, however, that the growing body of evidence is definitive. What it does say is that there is a case for giving vaping the qualified benefit of the doubt now, rather than waiting years or even decades for categorical conclusions to be made. This is, of course, the opposite approach to that taken by Australian tobacco harm reduction policy- makers and leading advocates. A PUBLIC POLICY CASE FOR LEGALISED NICOTINE VAPING Australia has led the world in tobacco harm reduction. As a country, national tobacco control measures and programmes have had great success over decades in lowering the national smoking rate, complemented by State and Territory regulation and programmes. The most recent wave of tobacco control was the introduction of plain packaging in 2012, a measure that in 2017 has been adopted in the United Kingdom, and is in the pipeline for a number of other countries. Plain packaging has been complemented by Commonwealth excise rises justified as driving smokers to quit, and a wave of state and territory legislation further restriction smoking in public places, and in motor vehicles. 1 file:///D:/Videos/Downloads/Nicotine%20without%20smoke_0.pdf 3 Public attitudes to smoking have also greatly changed since the first restrictions on cigarette advertising were imposed in the early 1970s. Smoking is seen for what it is: a dirty and dangerous habit, with high risks to users of lung cancer and a broad range of respiratory and cardio-vascular diseases, reducing both the length and quality of life. Furthermore, the dangers of passive exposure to tobacco smoke have been documented and proven, driving the extension of smoke-free regulation around Australia. What was once considered a normal social activity is now shamed, demonised and repressed, with good reason. Prevailing social attitudes now reject smoking, although there is understanding for smokers who are determined to get their nicotine fix. Generally smoke-free legislation has passed with little or no public opposition, and even though in many cases it has been applied too broadly – such as to private spaces like cars – it is widely accepted. Those who advocate the liberalisation of ENDS and smokeless tobacco products do not want to turn back the clock. What they seek is that policy responses to tobacco control and tobacco harm reduction stay abreast of positive innovations that complement existing measures. Likewise, no-one should be suggesting open slather on ENDS and smokeless tobacco products. Any product that contains chemicals and dangerous substances, even in low quantities, involves risk. What is sought

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