As mentioned in my previous post I was in Ireland last week catching up with my colleague John Mallon.
Remarkably, given the fact that the smoking rate in Ireland was 18% in 2021 (down from 22% in 2016), anti-smoking campaigners are still officially targeting 2025 as the year Ireland will be ‘tobacco-free'.
To put this in perspective, in Scotland – where the smoking rate is currently 17% – the government wants 2034 to be the year the country becomes ‘smoke free’ so how the Irish government hopes to achieve its tobacco-free ambition nine years earlier is baffling.
It goes without saying that the Irish target in particular is unachievable which may explain why, as 2025 fast approaches, the Tobacco Free Ireland programme that was launched in 2016 seems to have lost its way.
Take for example the Public Health (Tobacco and Nicotine Inhaling Product) Bill. Legislation that was first mooted in 2014 and has been trundling its way through parliament for several years has still not been passed or implemented.
When it's finally introduced there will be a ban on self-service tobacco vending machines but no-one seriously believes that will have a significant impact on smoking rates. It’s a petty inconvenience for smokers and a small loss of revenue for pubs but easy enough to adapt to.
The sale of tobacco 'via mobile or temporary units' will also be banned (at festivals and other events) but if the widespread use of illegal drugs at music festivals is a guide I can't see see that having much effect on smoking rates either.
Of greater concern is the introduction of a licensing system for the retail sale of tobacco that will include a retail licence fee because it’s pretty obvious that politicians and tobacco control campaigners will demand that the licence fee be increased every year until it no longer makes commercial sense to sell tobacco products, although the inevitable loss of revenue to the black market may concentrate ministers' minds.
What is also clear is that tobacco control campaigners on both sides of the Irish Sea are quickly running out of ideas to reduce smoking rates that don't involve creeping prohibition or coercion, which is where vaping comes in.
In England both the government and the public health industry are largely supportive of vaping as a reduced risk alternative to smoking. In Ireland however the environment is far more hostile. In September 2019 for example:
A leading heart consultant called for a ban on vaping and warned: “It’s more dangerous than smoking and booze combined.”
President of the International Society For Vascular Surgery, Prof Sherif Sultan, described e-cigarettes as “the disaster of the century”.
He told the Irish Sunday Mirror, “We need to ban them immediately.”
I don't remember anyone else pushing such an extreme policy but calls to ban flavoured vapes have been commonplace in Ireland for years.
As I wrote here one of the first to do so was former health minister, Senator James Reilly (but more on him later).
More recently, following a series of hearings that began this time last year, the Joint Committee on Health threw its weight behind a ban on flavoured vaping products.
According to the Pre-Legislative Report on the Public Health (Tobacco and Nicotine Inhaling Products) Bill 2019:
The Committee’s focus at hearings on the issue was largely on the regulation of e-cigarettes as this legislation would introduce a new regulatory regime for the sale of nicotine inhaling products in Ireland …
Over the course of the hearings on the Bill, significant evidence came to light regarding the harms of e-cigarettes, particularly for adolescents and young adults. Evidence was also provided about growing trends of vaping among teenagers and the easy accessibility and marketing of such products, with the use of brightly coloured packaging and flavours as well as the use of online marketing to attract younger people to these products.
The Committee recommends that some of the provisions which relate to tobacco products in Part 3 of the Bill should also be extended to e-cigarette products, including regulation of sale of products from points of sale and restrictions on the sale of such products at places intended for children.
Furthermore, the Committee believes the legislation should be extended to regulate flavouring and marketing of e-cigarettes, which is not currently provided for under the General Scheme.
(See also Ireland's Health Committee wants flavoured e-cigarette ban.)
The Health Committee appears to have been influenced by two organisations - the Irish Heart Foundation and the Irish Cancer Society – both of which gave evidence to the Committee. According to the IHF banning flavoured e-cigarettes is 'an issue the charity has long campaigned for'.
Another body, the Royal College of Physicians Ireland, has also been vocal on the subject. Professor Des Cox, who is chair of the RCPI policy group on tobacco, claimed only last week that e-cigarettes are creating a "new generation of nicotine-addicted young people".
In a report published last Sunday Cox said:
“Our group has been calling for a ban on the sale of flavourings in e-cigarette liquids for a number of years now.
“It is something which would allow ex-smokers to continue to use e-cigarettes if they wish to quit smoking, but it would also not entice teenagers to the market, because it has been shown in research that flavours are one of the attractions to these products for young people.".
In response, and on behalf of Forest, John Mallon argued that:
“Banning flavoured vapes would be a monumental error because it would discourage many smokers from switching to a far less harmful product.
“It will also result in unregulated flavoured vapes being sold on the black market.
“There is very little evidence that vaping is a gateway to smoking so it’s important not to fuel unnecessary fears about a product that is overwhelmingly used not by teenagers but by adults who are trying to quit smoking.”
Meanwhile what are current smokers in Ireland to make of the advice about vaping that can be found on the Health Service Executive (HSE) website. Briefly:
We do not recommend vaping as a way to stop smoking.
Explaining the HSE’s position it continues:
We have reviewed the studies of vaping as a stop smoking support. Compared to the options we recommend, we are not confident that vaping is a safe or effective way to stop smoking. We will continue to review new studies.
E-cigarettes are not stop smoking medicines
E-cigarettes are not licensed medicines.
Licensed stop smoking medicines go through quality and safety checks before they can be sold.
There are some regulations for e-cigarettes and vaping liquids as consumer products. But the system for licensed medicines is much stricter.
If you have never smoked cigarettes, vaping offers no health benefit. If you do not smoke, do not start vaping.
Most vaping liquids contain nicotine. Nicotine is a dangerous and addictive chemical.
The risks and negative health effects linked with vaping include:
– nicotine dependence
– injuries - for example, from defective e-cigarette batteries
– poisoning and exposure to toxins
– changes to how your heart, lungs and other organs normally work
Over time these risks may cause diseases such as heart disease, lung disease and cancer.
Vaping liquid that does not contain nicotine often has other chemicals such as colours and flavourings.
These chemicals can be harmful when you inhale them into your lungs.
We are still learning about the long-term risks of vaping. This is because e-cigarettes are relatively new compared to cigarettes. We need to review studies of people who use e-cigarettes over many years before we can know the health impact of vaping.
The irony is that despite that tobacco free target, vaping is arguably under greater threat in Ireland than smoking, which brings me back to James Reilly whose retirement from politics in 2020 - after several election defeats - is possibly one of the reasons why the 2025 target has dropped off many people's radar.
For the best part of a decade Reilly waged a very personal crusade against smoking. After advocating plain packaging it was he who in October 2013 announced plans for a tobacco-free Ireland by 2025.
Even as a former health minister he tried to persuade the Government to ban smoking in al fresco dining areas.
In 2020 however Reilly retired from politics and his previous commitment to the anti-smoking cause has left a major hole, although it's arguable whether his obsession with smoking had become more of a hindrance than a help.
Another loss was Senator John Crown who shared Reilly's hatred of smoking and the tobacco industry. Crown stepped back from politics in 2016.
In 2012 Crown called for the sale of tobacco products to be banned in Ireland by 2025 and without their voices in parliament the anti-smoking drive has arguably stalled.
Or perhaps most people in Ireland feel the war on smoking has gone far enough. Vaping however may be a different kettle of fish.
See also: The Senator Crown affair (November 2012)
Why Irish health minister James Reilly should resign (May 2013)
Tantrums and tobacco: the ugly face of public health (October 2013)
James Reilly: the people have spoken (February 2016)