Tobacco and Vapes Bill (First sitting)

Alex Barros-Curtis Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Tristan Osborne (Chatham and Aylesford) (Lab)]

Q This is a question specifically on vapes. You mentioned earlier that because it is a new product, there is a lack of scientific consensus on the medium to long-term effects. Are we going to see publications around this over the next five to 10 years—maybe sooner? Presumably there have been clinical trials on these products. Can you tell me perhaps the difference between the two? I accept fully the tobacco legislation; my concern is the evidence base for the vapes, and the potential for a cobra effect, where we might see people go back to tobacco-based products because they are cheaper to purchase. The second piece of evidence for this is that in the Regulatory Policy Committee report it says that it expects a 12% reduction in vaping, in a similar trend to tobacco-based products. Is that a reasonable assumption, given that there has been a long-standing public awareness of tobacco, versus perhaps a lack of awareness around the complexities of vaping products?

Professor Sir Chris Whitty: Would Sir Michael like to go first?

Professor Sir Michael McBride: Yes. Thank you for the important question. You are quite right that the evidence on the potentially harmful effects of vapes is still developing, and we are not at the stage that we are with our knowledge of tobacco. Certainly, as we have said already, the harmful effects of vapes are, and are likely to be, significantly less than those of tobacco, but are unlikely to be zero. This is an area in which there is ongoing research. The World Health Organisation has raised concerns about the potential impact, particularly in children, in terms of brain development. I know you will hear more about that later from other panellists. That is something that we will obviously need to continue to keep under review. The Bill provides us with the opportunity to introduce further measures, should that be required.

However, in all this there is a need for balance. Obviously, the Government—and certainly the Northern Ireland Assembly, when they will be debating this in the coming weeks—will wish to ensure that there is a balance between ensuring that vapes are accessible to individuals to assist cessation of smoking and help them to quit, but also that we are guided by the evidence to ensure that any legislation that is introduced is proportionate. That is incumbent on all of us at this time. Certainly, should further evidence of harmful effects become available, there is the opportunity and flexibility within the Bill to look at this again.

Professor Sir Chris Whitty: I would add only that it took us some decades to work out the extraordinary impact of smoking. Much of that tends to be cumulative over time, so you do not see the major effects of someone starting to smoke in their 20s till they are in their 50s, 60s and 70s. What we do not want is to be looking back in 20 years’ time and saying, “We knew these were addictive; we knew that people were smoking things.” Things that go into the lungs are much more dangerous than things you eat, for a variety of reasons. Just basing it on lab studies is not a safe way to proceed. I think all of us were therefore thinking that the sensible thing to do, while maintaining vapes as a smoking quit aid, is to avoid a situation where people who are currently not smokers take up vapes, because they will definitely get addicted—the nicotine is there, and there is a high chance in our view that they will have harms, although the size of those harms is currently difficult to put an exact number on over time. Some people come to extreme harms quite quickly, actually, but those numbers are fortunately relatively small.

[Mr Alex Barros-Curtis (Cardiff West) (Lab)]

Q Building on what my colleague and yourselves are talking about, specifically on vaping, I am trying to drill into your confidence levels on the flexibility in the legislation, which you have been talking about. As has been indicated—you have all talked very eloquently about it—there is not as much of an evidence base when it comes to vaping, for all the reasons you have outlined. If we think of a new car or a new product in the market, it will go through a lot of testing before it is put out there, in order to ensure it is safe. I recognise that in that regard, the genie is out of the bottle. However, the evidence underpinning vaping, as regards the integrity and safety of public health, is not as rigorous. Therefore, should the Bill not go further in terms of putting in more stringent requirements in that regard, until we have confidence in the impact on public health across all our four nations?

Professor Sir Gregor Ian Smith: It is very difficult to disentangle the evidence about vaping, because so many of the people who are currently vaping are either current or ex-smokers as well. To do some form of longitudinal study that actually gets to develop the evidence base for any potential harm that is caused by vaping is difficult—although there are attempts to try to do that, such as through the Our Future Health study. At this moment, I think the provisions within the Bill represent a proportionate and reasonable approach with the flexibility that exists within it to be able to respond as new evidence develops, either towards or against the harms that are associated with vaping. I think it is proportionate in that it maintains vaping as a potential tool in the armoury to help people to stop smoking, but similarly it is proportionate in stopping the abhorrent marketing of vapes to children, which Sir Chris has already mentioned, and in allowing the position, which I think is correct, that if you have never started vaping or smoking, you should not. The proportionality of the provisions just now is heading in the right direction, but with the ability to flex as future evidence emerges.

[The Chair]

We have one more question, which I am afraid is probably the last one to this set of witnesses, from Liz Jarvis.

--- Later in debate ---

[Euan Stainbank]

Q Do you believe that there is a substantial health impact on people working in certain sectors who unavoidably encounter second-hand smoke in the course of their employment? What impact will the measures in the Bill have on that?

Dr Ian Walker: The impact of the Bill will reach every sector, on the face of it. Obviously the aim of making a smoke-free UK will impact everybody in whichever sector, but I think you are probably referring specifically to increasing smoke-free places, or places where smoking is not allowed. For people who are exposed unavoidably by their working environment, of course this will be good news and a good expansion.

As you heard from Sarah, we did not quite get to hospitality in the Bill, but it will be interesting, as we go through consultation, to review the evidence and understand the sentiment. Clearly, people working in hospitality are likely to be exposed to smoke in their work environment, even if that is outside. The Bill makes important steps in increasing the number of smoke-free places and reducing exposure to tobacco smoke.

Sarah Sleet: As the CMO said earlier, it is about the duration as well as the density of smoking. If you work in hospitality in those outdoor spaces, the duration will clearly be longer; if you work on a coach concourse, you will be exposed for longer. It is really important to remember that.

Another issue is inequality. There is a concentration of working lives that are more exposed to second-hand smoking, which is exacerbated by inequality.

[Mr Barros-Curtis]

Q Some of the evidence that has been submitted referred to the gateway effect and how there is perhaps not the evidence to suggest that there is a transition from one to the other. Are your organisations still concerned about the increase in vaping among groups who have not previously smoked cigarettes?

Sarah Sleet: That is a tricky one. We know that a lot of people who use vaping to stop smoking end up dual-using for a while. Some then move on to just vaping, and some eventually move completely away from it. We seriously need a comprehensive programme for nicotine cessation and smoking cessation to support people on that journey and make sure that people who go on that journey do not come back in. We heard earlier from ASH Wales about some really good measures that have been put in place, but without that wider context it is hard to cement the behaviour needed to move completely away from it. We need to think broadly about the whole support structure to help people to get off smoking and eventually to move away from nicotine altogether.

Dr Ian Walker: I agree. The real killer in the room, if you like, is cigarettes and tobacco. There is no safe way of consuming tobacco. The alternative of smoking versus vaping is very clear; even though we do not know the long-term health implications of vapes, we know that you are much better off vaping than smoking. Having said that, of course we do not want young people and never-smokers to vape either.

The power of the legislation is its double-pronged approach: preventing people from ever smoking in the first place by raising the age of sale by one year every year, and putting in place a comprehensive package of measures alongside that to control vaping, particularly the access to vaping and the appeal of vaping for young people, to reduce uptake in those communities. All those things together, alongside—you will forgive me for saying this—the investment that will be required for smoking cessation services and to support enforcement by Border Force, HM Revenue and Customs and retailers, will be important components of the Bill’s ability to drive the change that it can make.

[Jim Dickson]

Q Thank you for all your work to advocate for smoke-free legislation. Can I ask you about differential smoking rates across the country? Which parts of the country are likely to benefit most from this legislation as we see a decline in smoking rates and in tobacco use more generally?

Sarah Sleet: Health inequalities relating to lung disease are profound. The three conditions with the biggest gap in health outcomes between rich and poor are lung conditions: asthma, COPD and lung cancer. All three are profoundly affected by smoking, and smoking is concentrated in socially and economically deprived areas. Those in the poorest part of the country are twice as likely to smoke as those in the richest part of the country.

It is even more profound in certain segments. We heard that young mothers are four times more likely to smoke in poorer parts of the country than in richer parts. If we can drive down smoking, particularly among young people, the impact will be greatest in those areas that are most in need of help and support. This is probably one of the biggest things that can be done to tackle health inequalities. For that reason, I think the Bill is probably the most important public health measure being passed through Parliament in a very, very long time.

Dr Ian Walker: Thank you for the question, which I think is a really critical one. At CRUK, we have done a lot of research and work on cancer inequalities, which are part of broader health inequalities and which generally mirror similar trends. We know that people in the most deprived communities have higher incidences of cancer. They typically present at a later stage, they typically engage less with screening, they typically have worse outcomes and they typically do not get optimal treatment —it is a pretty difficult story right along the pipeline. The reasons behind that can be very complex and involve lots of different things.

Despite all that, the one thing we do know is that higher smoking rates, particularly among children and young people in the most deprived communities, are a really significant contributor to health inequalities. It is very clear from the evidence that the most deprived communities across the UK are the ones that suffer most from the impacts of tobacco.

This Bill is clearly not a magic switch—it will not change those things overnight—but it sets us on the pathway to fundamentally reversing some of those inequalities and to reducing some of the cancer inequalities that we see across the UK. Alongside the important measures in the Bill, a really clear, targeted set of actions around health marketing interventions in those communities and the effective funding of cessation services where we need them most will contribute to reducing health inequalities much more quickly and much more effectively. Again, it is a very positive story in terms of the potential impact on health inequalities.