Australia: reclaiming tobacco and e-cigarette control leadership

Public health advocacy is not for the impatient. Policy change is often frustratingly slow and requires walking that fine line between guiding and pushing governments and others to do the right thing. Push too hard, too publicly and you risk alienating otherwise supportive political champions. Equally, gentle or non-committal advice can lead to inaction and confusion on what policy solution is needed. Finding new and compelling ways to restate both the problem and the solution can also be challenging. But occasionally, the right evidence, the right message and (crucially) the right people align, and real public health policy advances are made.

In 2012, Australia was crowned a world leader in tobacco control when it became the first country to mandate the removal of all branding elements from tobacco packages (Chapman and Freeman, 2014). Tobacco plain packaging laws have now spread to 38 countries, demonstrating that effective policy—especially when well informed and evaluated—has a habit of catching on (Canadian Cancer Society, 2021). This is also why the tobacco industry pulled every legal and political lever possible to oppose Australia’s plain pack laws. Health policy leadership in Australia emboldens other nations to act too, which threatens the future of the Tobacco Industry.

Fast forward to 2023, and after more than a decade of treading water, Australia is poised to once again assert itself as a tobacco control trailblazer. A suite of tobacco control reforms have been announced to further limit the ability of the tobacco industry to manufacture and promote products that kill thousands every year (Department of Health and Aged Care, 2023a). Restrictions on products that are attractive and appealing to young people are on the agenda. The regulations will also introduce a higher degree of mandated industry transparency and reporting. The long-awaited National Tobacco Strategy 2023–30 has also been released, which commits Australia to a 27% or less smoking prevalence among Aboriginal and Torres Strait Islander peoples, and 5% or less smoking prevalence by 2030 (Department of Health and Aged Care, 2023b).

The biggest difference this time round is that e-cigarettes—which were a niche product when plain pack reforms were implemented—are actively undermining Australia’s tobacco control success. These products are easily accessible, inexpensive and available in a wide array of flavours, colours and sizes. They are highly appealing to young people, with disposable e-cigarettes surging in popularity (Watts et al., 2022). Having seen the damage e-cigarettes have caused, the Australian Government has announced a ban on the importation of all vaping products (Department of Health and Aged Care, 2023c). These products will only be legally available with a doctor’s prescription and can only be purchased from pharmacies. The vaping products available through pharmacies will only be available in limited flavours and in pharmaceutical-style packaging. Nicotine concentration will be capped, and disposable vaping devices will be to be banned.

This is the first time both vaping and smoking will be tackled in Australia as part of a more comprehensive package, more actively addressing supply reduction and with a specific focus on protecting young people. Vaping by young people has rapidly emerged as a global public health issue (Tehrani et al., 2022). Youth vaping rates are increasing rapidly, even in countries with strong leadership in tobacco control. In Australia, vaping among youth is more common and increasing more rapidly than use of any other drug [Australian Institute of Health and Welfare (AIHW), 2021]. The rise in youth vaping is a direct threat to the success of tobacco control, as young people who vape have three times the risk of taking up smoking (Baenziger et al., 2021). Evidence of this threat can already be seen in Australia, with a tripling in current smoking rates in teenagers age 14–17 over the past five years, from 2.1% in 2018 to 6.7% in 2022 (Wakefield et al., 2023).

The proliferation of vaping products has created public health regulatory challenges the world over (Ryan David et al., 2017). Many countries have chosen to ban e-cigarettes. Others have sought to apply demand reduction measures, such as on-pack warnings and advertising restrictions; yet there is very limited evidence of the effectiveness of these types of regulations in reducing youth vaping. This is why the Australian Government’s focus on restricting and limiting the supply of e-cigarettes is significant: it addresses the source and will go a long way towards keeping these products out of the hands of young people and people who do not smoke. Australia’s medical access model is intended to protect young people while providing a pathway for people who smoke to use products for smoking cessation. It strikes a balance between an outright ban and the introduction of another unregulated harmful and addictive consumer good into the supply chain.

Some have argued that a simple ‘rinse and repeat’ of what Australia has done with tobacco—regulating the product as a consumer good—will also turn the tide on youth vaping. Those making these arguments seem to forget that treating a highly addictive, dangerous and harm-inducing product as an everyday consumer good that is available for sale in every corner shop in Australia was never an ideal starting point. Tightly controlling the supply of vaping products to ensure that only people who smoke and want to quit have access, is once again showing policy leadership and vision.

There is a window of opportunity to prevent a new generation from becoming addicted to a harmful product that is being pushed by a global industry with an ongoing history of obfuscating and manipulating policy processes. The Australia Government has announced its intention to act with decisive and innovative policy measures. Exactly what every public health advocate works so hard for: protecting the health and well-being of Australians today, and for generations to come.

CONFLICT OF INTEREST

B.F. and R.M. hold the position of Advisory Board Members for Health Promotion International and were involved neither in the review process nor in any decision-making on the manuscript. M.J. holds the position of Editorial Board Member for Health Promotion International and was involved neither in the review process nor in any decision-making on the manuscript. B.F. has received relevant consulting fees from the World Health Organization, Heart Foundation NSW, Cancer Council NSW, Cancer Council Australia and Cancer Institute. NSW, and NSW Health and payments or honoraria for lectures/presentations to the Department of Health, The Government of Hong Kong Special Administrative. Region, the US Food and Drug Administration and BMJ Tobacco Control. She reports support to attend the Oceania Tobacco Control conference and the Australian Public Health Association conference. She was an Expert Member of the National Health and Medical Research Council Electronic Cigarettes Working Committee (paid for time). B.F. is an Expert Advisor to the Cancer Council Tobacco Issues Committee and a member of the Cancer Institute Vaping Communications Advisory Panel and the NSW CHO E-cigarette Expert Panel. These are unpaid roles. R.M. has received consultancy funding from the Cancer Institute NSW and funding for the Tackling Indigenous Smoking Impact and Outcome Assessment from the Australian Government Department of Health and Aged Care. R.M. received support to attend the Society for Research on Nicotine & Tobacco (SRNT) Annual Meeting and the Australian Public Health Association conference. R.M. is an Expert Advisor to the Cancer Council Tobacco Issues Committee and a member of the Tackling Indigenous Smoking Technical Advisory Group, the Cancer Institute Vaping Communications Advisory Panel and the NSW CHO E-cigarette Expert Panel. These are unpaid roles. M.J. receives funding from the National Health and Medical Research Council. She is affiliated with the Australian Council on Smoking and Health, the Public Health Association of Australia and the World Federation of Public Health Associations’ Tobacco Control Working Group. M.J. has received relevant consulting fees from Minderoo Foundation.