Time for Europe to rethink vaping?

Vaping has been high on the European Union’s agenda the last few months, with the European Parliament finalising its version of Europe’s Beating Cancer Plan. However, vaping can be part of the solution and save many lives, argues Bernd Mayer, professor of Pharmacology and Toxicology at the University of Graz in Austria
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By Bernd Mayer

Bernd Mayer is professor of Pharmacology and Toxicology at the University of Graz in Austria

18 Nov 2021

Vaping is a hot topic in the EU right now, with Europe’s Beating Cancer Plan coming up. So how should the EU treat vaping?

A key point to understand is that vaping is not smoking. Treating the two the same would be a mistake. It is scientifically established that vaping is less harmful than smoking. Against the background of 700,000 deaths per year due to smoking-induced illnesses, and with an alternative which Public Health England states is at least 95% less harmful, the EU must endorse vaping as a harm reduction method for smokers.

Unlike traditional cigarettes, e-cigarettes do not emit smoke, and the emission of toxic combustion products is reduced by 99%. Because of this, the lifetime risk of cancer for vapers is hundreds to thousands of times lower than for smokers. Studies also show that the cardiovascular and pulmonary function in smokers who switch to vaping improves drastically. Therefore, vaping is not associated with a clinically relevant serious health risk and public health gains when smokers switch to vaping.

Despite all this evidence, some reports are sceptical of vaping, such as the European Commission's recent SCHEER report

The SCHEER report is far from being an objective research paper. Although the judgment of relative risks is key to the harm reduction approach, the report was set up in a way that no comparison be made between vaping and smoking. This request resulted in a pointless paper, with little scientific value, completely ignorant (purposefully or not) of the concept of harm reduction. Unfortunately, some policymakers are using this report as an instrument to argue for unjustifiably harsh regulation of vaping.

“Public health has transformed its justified efforts to reduce smoking rates into an unjustified war on nicotine in the last decade”

Yet, despite so much research, vaping remains very controversial in a lot of countries. Why is that?

There are indeed severe misunderstandings in the general public about vaping and its fundamental differences from smoking. The misconceptions are manifold, but the false perception of nicotine is undoubtedly a particularly troubling example of high relevance. In 1976, Prof. Michael Russell, a pioneer in the study of tobacco dependence and the development of quitting agents, stated that "People smoke for nicotine, but they die from the tar". Nonetheless, public health has transformed its justified efforts to reduce smoking rates into an unjustified war on nicotine in the last decade.

Nicotine containing drugs like nicotine patches or nicotine inhalers are freely available over the counter and are unreservedly recommended to smokers by health authorities. However, the same authorities regularly issue warnings from nicotine in e-cigarettes. They suddenly declare this benign recreational drug, with properties similar to caffeine, as a potent toxic and addictive drug. It appears that nicotine undergoes a mysterious transformation from a harmless remedy into a deadly toxin when added to the liquids of e-cigarettes.

Vape flavours are yet another example. Most arguments promoting flavour bans are absurd. Allegedly, flavours attract kids because, in the minds of anti-vaping activists, kids are the only humans who enjoy flavours. Yet, adults like flavours in vaping as much as in ice cream or drinks. It gives them a better chance to stay away from cigarettes without being reminded of the taste of tobacco. Therefore, they are an integral part of the success of vaping and essential to preventing former smokers from relapsing.

The suggestion to ban all flavours except tobacco is bizarre. Unlike much less complex fruit flavours, for instance, tobacco flavours contain up to 70 individual substances, hampering prediction and assessment of potential adverse effects. These flavours have nothing in common with natural tobacco, in most cases, not even the taste. Liquids with tobacco flavour are certainly not "unflavoured", as claimed by some health experts. I assume that the whole issue is based on a lack of understanding from people who have never smoked or vaped.

“The EU should encourage smokers to switch from smoking by ensuring that vaping remains attractive to smokers when it comes to both cost and taste”

Some argue in favour of a ban because young children get attracted to vaping and eventually become smokers. But, on the other hand, isn’t there some merit in protecting children?

Of course, children must be protected and should not start to consume any illegal product, but youth protection is often an argument advanced to justify general restrictions of vaping. There would be reasons for concern if the emergence of e-cigarettes led to increased smoking rates of the underaged. However, the opposite occurred; smoking rates of minors have declined at unprecedented speed in the last decade.  Reduction of smoking should be the ultimate goal instead of fighting against a 95% less harmful alternative. There is no evidence at all for e-cigarettes opening a gateway to smoking for children. In contrast, the flavour ban in San Francisco resulted in rising smoking rates among teenagers.

So what would you recommend the EU do with vaping?

The EU should encourage smokers to switch from smoking by ensuring that vaping remains attractive to smokers when it comes to both cost and taste. Smoking kills half of its users, and we need to do our best to support any quitting aids available, including e-cigarettes, Snus, and other nicotine products with reduced risk. It is also essential to refrain from flavour bans and higher taxation to achieve this goal. Both measures would make vaping less appealing to smokers and therefore harm public health. The EU has the chance to eliminate smoking with the support of innovation instead of overreaching measures. This approach might not be perfect but it is pragmatic, with the potential to save millions of lives.


This content was commissioned by the World Vaping Alliance and produced by Dods

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