Legalising vaping in Australia: a report by the McKell Institute
Posted on March 9, 2019
The report finds that 'legalising vaping has enormous potential to improve public health, particularly for disadvantaged smokers who are disproportionately affected by smoking-related diseases'.
The McKell Institute is an independent, not-for-profit, public policy institute dedicated to developing practical policy ideas and contributing to public debate.
Report co-authors: Dr Alex Wodak AM, Conjoint Associate Professor Colin Mendelsohn.
Full report available online here.
In spite of a substantial fall in the smoking rate over several decades, nearly three million or 15.2% of Australian adults still smoke tobacco. (1) Smoking remains the leading preventable cause of death and illness in Australia. (2) Smoking is especially prevalent in disadvantaged populations such as Indigenous people, low-income groups and those with mental illness or substance use and is a major contributor to health and financial inequalities.
The long-term decline in smoking rates in Australia has slowed considerably since 2013. (1,3) Many Australian smokers are unable to quit in spite of Australia having the highest cigarette prices in the world, plain packaging and strict tobacco control laws. Ever-increasing tobacco prices place a huge financial burden on low-income smokers and are almost certainly contributing to a growing illicit tobacco industry. New and effective strategies are needed.
One option being widely used overseas is vaping (using an e-cigarette). Vaping is a reduced-risk alternative to smoking for adult smokers who are unwilling or unable to quit. (4) Vaping delivers the nicotine smokers are addicted to along with the hand-to-mouth ritual smokers enjoy, but without most of the harmful toxins present in smoke. (4) Australia imposes a de facto ban on vaping and is increasingly out of step with other similar countries, such as New Zealand, the United Kingdom, the European Union, Canada and the United States. Smoking rates are declining faster in many countries where vaping and other reduced-risk nicotine products are legal and readily available. Ironically, it is illegal to possess nicotine liquid for vaping in Australia without a prescription from a doctor although smokers can readily purchase higher-risk cigarettes from supermarkets and most corner shops.
Vaping is not risk-free, but long-term use is estimated by several reputable authorities to be no more than 5% as harmful as smoking. (4-6) There is convincing scientific evidence that vaping helps some people quit smoking, including a recent, large randomised trial which found that vaping is nearly twice as effective as conventional nicotine replacement therapy. (7) Vaping is now the most popular quitting method in the United Kingdom, (8) the United States (9) and the European Union. (10)
Vaping provides another quitting strategy at no cost to the public purse. Smokers who switch to vaping can expect substantial improvements in health as well as large financial savings, of special importance to low-income groups. Fears of vaping being a gateway to youth smoking, renormalisation of smoking and uptake by non-smokers have not materialised to any significant extent in over 10 years of overseas experience so far. (4,5)
Legalising vaping has enormous potential to improve public health, particularly for disadvantaged smokers who are disproportionately affected by smoking-related diseases.
We recommend that vaping products should be primarily regulated as consumer goods rather than as a therapeutic, medicinal or tobacco product. Regulation should aim to maximise the benefit for adult smokers while reducing any potential risks to users and harm to the wider population, especially young people who have never smoked. Regulation should be proportionate to the risk of vaping.
The authors strongly recommend that Australia’s successful tobacco control policy continues and is supplemented by two changes: first, ending the de facto ban on vaping; and second, re-introducing appropriately funded mass media campaigns and supporting counselling to increase quitting rates.
Full report and media
1. Australian Bureau of Statistics National Health Survey: First Results, 2017-18. Catalogue no 4364 0.55.001.2018.
2. Australian Institute of Health and Welfare Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. BOD 4. Canberra: AIHW. 2016.
3. National Drug Strategy Household Survey (NDSHS) 2016: detailed findings. Drug Statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW. 2017
4. McNeill A, Brose LS, Calder R, et al. Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England. 2018.
5. Royal College of Physicians Nicotine without smoke: Tobacco harm reduction. London: RCP. 2016.
6. Nutt DJ, Phillips LD, Balfour D, et al. Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res 2014; 20 (5): 218-225
7. Hajek P, Phillips-Waller A, Pfzulki D, et al. A randomised trial of e-cigarettes versus nicotine replacement therapy. New England Journal of Medicine 2019;
8. West R, and Brown J. Smoking Toolkit Study. Smoking in England 2019
9. Caraballo RS, Shafer PR, Patel D, et al. Quit Methods Used by US Adult Cigarette Smokers, 2014-2016. Prev Chronic Dis 2017; 14 E32
10. Directorate-General for Health and Food safety. Attitudes of Europeans towards tobacco and electronic cigarettes, Special Eurobarometer 458. 201