For years the UK has served as a forward-thinking exemplar of Tobacco Harm Reduction (THR). Public Health England and the Royal College of Physicians is the source of the oft-cited (though not uncontroversial) claim that e-cigarettes are 95% safer than cigarettes and the UK is home to the HQ of the prestigious Cochrane library which produces the gold-standard reviews that have consistently reported that the use of nicotine e-cigarettes surpasses the efficacy of ‘usual treatment’ (NRTs) for the purposes of smoking cessation. In stark contrast to the adopted language of many health organizations in North America, National Institute for Care Excellence guidelines encourages practitioners of stop smoking services to make e-cigarettes available, and the National Health Service voices qualified support for their use for smoking cessation by adults. E-cigarettes are even sold in commissaries on hospital grounds and, in a world-first, the British government committed to handing out e-cigarettes free of charge to smokers from ‘vulnerable communities’ to support smoking cessation.
In addition to this (perhaps unusually) balanced rhetoric on THR, regulation creates additional incentives for health-positive substitutions. To date, there have been no restrictions on e-cigarette flavors and e-cigarettes have been exempt from the excise taxes applied to combustible products. This policy mix is premised on the observations that e-cigarettes are vastly safer than conventional smoking and, as in other countries, e-cigarette use is positively associated with both quit rates and successes.
That’s not to say e-cigarettes are exempt from regulation. Minimum legal sale age restrictions prohibit the sale of e-cigarettes to under 18s (the age of majority in the UK). The nicotine content of UK e-cigarettes is capped (20mg/ml). And upon leaving the EU, the UK wrote into law regulations from the TPD limiting the volume of e-cigarette devises and e-liquid bottles to 2ml and 10ml. It’s not a perfect framework, but collectively, and especially compared with the regulatory landscape of other nations, the UK’s regulations may be viewed as a reasonable attempt to balance the opportunity to support transitions away from combustible cigarette use among adults who smoke, with measures to discourage youth experimentation and prevent nicotine dependence.
In October 2024, however, the Starmer administration introduced an e-cigarette tax in an effort to ‘reduce the number of non-smokers and young people that vape… [and] to raise revenue to fund vital public services such as the NHS and smoking initiatives…’. Does the introduction of an e-cigarette tax represent a volte-face in e-cigarette policy?
I think not. First, the tax (2.20GBP per 10ml) is far smaller on a unit-of-nicotine basis than the federal tax applied in Canada, or many of the state-level taxes applied in the US. In fact, the UK’s adopted tax basis represents 5% of the rate applied to a similar amount of nicotine in combustible cigarette form; directly proportional to the government’s relative risk assessment. Moreover, His Majesties Revenue and Customs (HMRC) plans to ‘introduce an increase in tobacco duty to maintain the financial incentive to choose vaping over smoking’. This, again, is in line with the goal of ensuring that ‘the introduction of the duty does not make smoking more attractive’. Such nuances distinguish the UK’s policy from the taxes adopted in many other countries which often afford little consideration for the possible (some would say likely) unintended consequences; namely consumer demand shifts to other more harmful products. Indeed evidence from the US confirms that taxing e-cigarettes may prompt some consumers to return to combustibles. Simultaneously increasing the tax on combustibles may negate this response.
Like regulators everywhere, UK legislators are trying to thread the needle; creating policies that maximize potential benefits and minimize risks and costs. As Thoms Sowell (1986) reminded us, seldom is it possible to do both. Thus, ‘there are no perfect solutions, only tradeoffs’. As the Starmer administration considers other proposals including a prohibition on e-cigarette advertising and sponsorship and a restriction on e-cigarette flavors, THR advocates may hope that, if enacted, a similar degree of nuance will be applied.
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