Tobacco and Vapes Bill (First sitting)

Caroline Johnson Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[The Chair]

We are now sitting in public again and proceedings are being broadcast. Before we start putting questions to the witnesses, do any Members wish to make declarations of interest in connection with the Bill?

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I am an NHS consultant paediatrician and a member of the Royal College of Paediatrics and Child Health.

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[The Chair]

Sorry about the distracting noise; we are trying to sort that out.

We will begin by hearing oral evidence from Professor Sir Chris Whitty, chief medical officer for England; Sir Francis Atherton, chief medical officer for Wales; Professor Sir Michael McBride, chief medical officer for Northern Ireland, who will participate via Zoom; and Professor Sir Gregor Ian Smith, chief medical officer for Scotland. We have until 10.25 am for this panel.

[Dr Johnson]

Q I thank the witnesses for coming along; we are interested to hear what you have to say about this Bill. For some time, I have been particularly concerned about children vaping. How will the restrictions on vapes in this Bill, particularly on colours, flavours and accessibility, help to reduce their appeal and accessibility to children?

Professor Sir Gregor Ian Smith: First of all, thank you to the Committee for inviting me to give evidence. I think this is an incredibly important step. I have been concerned—

[The Chair]

I apologise, but I think people are struggling to hear over the noise; I certainly am. Could everyone enunciate more clearly and speak a little louder?

Professor Sir Gregor Ian Smith: First of all, thank you for the invitation to provide evidence. I think this is a really important step that we can take to protect children from vaping. I am very clear in my mind that vaping has a place in helping those already smoking to stop smoking. It has a place in smoking cessation, but children, young adults and indeed adults who have never smoked should never start vaping; there are too many uncertainties about the health consequences of vaping for that to be encouraged.

In restricting children’s access to vapes and reducing the attractiveness to children of some of the vaping products currently marketed, the Bill will protect children from the potential health consequences of vaping itself and from the potential of vaping to be a gateway to the use of other nicotine products, for which there is emerging evidence. I am certain that the Bill will help to protect children from the dangers associated with starting to vape.

[Dr Johnson]

Q Thank you; that is helpful. My other question is about the difference between indoor and outdoor exposure to smoke. In this country, we have had laws preventing smoking in certain indoor spaces for many years now. How does exposure to smoke inside differ from exposure to it outside? Imagine sitting next to someone smoking on a park bench and someone smoking at a neighbouring table in a restaurant—what are the comparative health risks between those two?

Professor Sir Chris Whitty: I think the first thing to say is that second-hand smoke is a very serious problem. I think that is underestimated among the general public because, if I am honest, the cigarette industry has been very successful in muddying the waters on this.

There are three key things that really make a difference. The first is the degree of concentration of the smoke. The second is the duration of exposure—let us say you sit next to someone for half an hour; the effect is more significant than if it had been just a couple of minutes. The third is the vulnerability of the people being exposed to it. That is one of the things that this Bill will help with.

Over 88% of the population do not smoke. There are roughly 6 million smokers still. There are significantly more people in the UK, non-smokers, who have medical vulnerabilities that mean that the smoke is particularly dangerous to them, perhaps acutely. They can be exposed to smoke and have an asthma attack, and that lands them in hospital. In severe cases it could land them in a very dangerous situation. The situation may also be chronic—for example, people living with diabetes already have a disease that is going to accelerate things like cardiovascular disease. If people are smoking on top of that, it will accelerate those things still further.

Although outdoor smoking is less in terms of passive smoking than indoor smoking, in most situations if you are close to someone, exposed for a long period or vulnerable, it can have very significant health impacts. In broad terms, if you can smell smoke, you are being exposed to significant amounts of smoke, and that is one of the things that the Bill is aiming to address.

I would like to make one additional point: the cigarette industry has been extraordinarily good at trying to pretend that to be pro-smoking is to be pro-choice. Nothing could be further from the truth. Smoking is highly addictive. Most smokers wish they had never started and want to quit, but they are trapped by addiction. Their choice has been taken away deliberately by these companies as part of their policy. And if you are talking about second-hand smoke, indoors or outdoors, the person downwind or next door has no choice at all at any point. They are exposed to the risks with no advantages at all. If you are pro-choice, you should be firmly in favour of the principles of the Bill. Frank, do you want to add to that?

Sir Francis Atherton: The only thing I would add is that there is no safe level of smoking. As Chris says, if you smell it, you are breathing it in, and there is no safe level. Obviously, indoors is worse than outdoors. The dose response is a big issue, but there is no safe level. I think that is a really important point.

[Sarah Bool]

Q You mentioned that 88% of the population do not smoke, and the numbers are now declining. Can I ask why you supported a generational ban as opposed to raising the age from 18 to 21 or even 25? It is predominantly younger people whom we want to stop smoking.

Professor Sir Chris Whitty: I might ask Michael to come in. I can have the first go and Michael might want to come in after that, because this is a critical point. Historically, the cigarette industry, despite what it claims, has always targeted children. It always deplores it in public, but if you look at its internal documents you discover that that is what it has been aiming to do. Most people, the great majority, start as teenagers before they are 20—you are, of course, correct. To refer back to Dr Johnson’s original question, the same thing is now being done with vaping and exactly the same playbook is being followed. You get people at their most vulnerable and you addict them. That is the aim.

However, were we to stop at, let us say, 21, the cigarette industry, which is extraordinarily good at regrouping around whatever regulations are in place, would simply regroup around 21. To go back to my very first point about addiction, if you are a 21-year-old and you start, you become addicted and then you wish you had stopped. That does not change the fact that your choice has been taken away. So the logic of saying 21, 25 or 30—various people have looked at various ages—is no better than the logic of the current situation.

The advantage of the current model, which was first put forward by Conservative Prime Minister Mr Sunak, to whom we should all pay great tribute on the basics of the Bill, was to ensure that current children are not addicted and do not have their choice taken away, but that rights are not taken away from existing smokers. That is the reason why this particular model was chosen. Michael, do you want to add to that? You are on mute.

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[The Chair]

I call Caroline Johnson—apologies; I should have called you before the Minister.

[Dr Johnson]

Q The current advice, which was reiterated by the chief medical officer in the last session, is that if you do not vape, do not vape, but that if you smoke, vaping may be a better alternative. How will the measures in the Bill make it easier or harder for that message to be conveyed to the public who smoke?

Hazel Cheeseman: That will be a really crucial question as this Bill progresses, and it was touched on by the chief medical officers. The nature of this Bill is that we are taking powers across a range of areas, which we know will help us to prevent the uptake of vaping among children, which we are all concerned about. We are restricting the marketing of vapes and the way they are branded, and taking powers around the design of products and in relation to flavours. It is important that those powers, as was discussed in the last session, are broad in the Bill and defined through further consultation and regulation, giving us that flexibility to shape policy going forward. We know from our experience in reducing smoking among children that the things that will work are reducing the appeal, reducing the availability and reducing the affordability of products. The Bill, alongside the excise tax that is planned for 2026, will take us a long way on that journey to addressing those aspects and reducing the appeal among children.

We also want to ensure that products remain available for adult smokers to switch to. We know from our own research that adult smokers have very inaccurate views at the moment about the relative harms from vaping compared with smoking. Part of the issue is the way in which products are branded and pushed in people’s faces when they go into every corner shop up and down the country. That prevents the understanding that these products might be valuable for smoking cessation and promotes the idea that they are a kind of lifestyle choice for teenagers. Removing the branding and the displays in shops will allow the message that these products could be valuable to help people stop smoking, and will allow that message to land more easily than it currently does. That will hopefully realign those misperceptions and get us back to the position that we were in in, say, 2019 or 2020, where these products were being used as a smoking cessation tool and not really being used by other groups in the population. If we can get back to that, that would be the ideal scenario. Hopefully, the legislation takes us a bit closer to that.

[Dr Johnson]

Q How do you think the Bill will address health inequalities? We have heard that smoking is more prevalent among poorer individuals than among richer individuals. Will the Bill help address that?

Sheila Duffy: We see that socioeconomic inequalities and smoking rates are closely patterned. ASH Scotland’s work with low-income communities in Scotland suggests that people regret beginning tobacco, but find it hard to move away from it. It also identified the dangers of less regulated novel products such as e-cigarettes in enticing their children and grandchildren into the kind of addiction that they themselves so regret. One of the real strengths in the Bill is the ability to bring some of these tobacco-related products into the kinds of control and regulation that we have fought so hard over decades to get for tobacco products.

[Sadik Al-Hassan]

Q Do you think the introduction of a generational ban on smoking could cause an increase in the use of other nicotine products, such as vapes or smoke-free tobacco?

Hazel Cheeseman: The purpose of the legislation is to reduce smoking. The Department’s projections in the impact assessment clearly show that, even on conservative estimates, it will achieve that goal over time. So the question then is, does that lead to displacement into other products? Given that the legislation is comprehensive in relation to tobacco products, it is to be hoped that it will not lead to displacement into other kinds of tobacco products, but it might lead to some displacement into other nicotine products. As the chief medical officer said in the previous session, it is unlikely that nobody will take up smoking in the affected age group. Some people will; some of the 15-year-olds who will be affected by this legislation have already tried smoking. So we need there to be a legal nicotine product that those people will be able to use, with the restrictions that are coming into place in relation to vaping and other nicotine products in this legislation. One would not expect the overall consumption of nicotine to be greater than it otherwise would be, if that makes sense, but there may be some displacement into other nicotine products as we transition away from smoked tobacco and from tobacco being used widely in that group.

Sheila Duffy: Dual use is a real concern in Scotland. Nearly 43% of people are dual-using cigarettes and e-cigarettes. The international longitudinal cohort evidence clearly shows a higher risk of progression to using combustible tobacco for young people that start vaping. I think this legislation has the real potential to move us away from that.

Suzanne Cass: We also have to remember that the killer in the room is tobacco. The generational ban is the most crucial part of this legislation that we need to push forward. Therefore, we need to keep our eye on the ball when we are looking at the health impact, and the potential public health impact, of this Bill, and to make sure that we focus on driving down that tobacco use.

Naomi Thompson: Just to reiterate what Suzanne has said, tobacco is the issue. The impact of tobacco was repeated multiple times in the previous session. If young people start, they continue, and they find it very difficult to stop. Therefore, if we can sort that, it is a great first step. There may be a small move towards other nicotine products, but we can work on that. Tobacco is the one that kills.

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[The Chair]

We have the third panel of witnesses from now until 11.25 am. We will hear evidence from Dr Ian Walker, the executive director of policy at Cancer Research UK, and Sarah Sleet, the chief executive officer of Asthma and Lung UK.

[Dr Johnson]

Q What effect do you think vapes have on the health and the lungs of young people? Do you think the Bill will help to reduce the take-up of vaping in children?

Sarah Sleet: In general, there is very little evidence around vaping, and we need a really considerable effort to get the evidence in place, but we do know that nicotine in general is not healthy for children, and vaping nicotine products will not be good news. We have some evidence about the harms that it causes—we know that nicotine in particular is very problematic for very young children and developing brains—but we do not have the same level of evidence base that we have with tobacco. That is why this Bill and the precautionary approach that it takes in terms of restricting children’s access to vapes and the attractiveness of vapes to children is very important.

[Dr Johnson]

Q Smoking is a huge cause of cancers. Do you expect that this Bill will reduce the number of cases of cancer and increase the age of people who get cancer across the country?

Dr Ian Walker: First, thank you very much for the opportunity to be here. I start by thanking Parliament for boldly introducing this Bill; it is genuinely world leading. I have spoken to organisations across the world that are envious of the position we find ourselves in. That is a very important question, and the answer is absolutely yes—I think this Bill will be very important in reducing the number of cancers caused by smoking tobacco. We know that there is no bigger thing we could do to actually influence that going forward for the next generation and generations thereafter.

As you have heard this morning, we know that we still have 6 million people smoking across the UK, and we know that we can expect hundreds of thousands of cases of cancer caused by smoking over the term of the next Parliament. As we move towards a truly smoke-free generation over the next 20, 30 or 40 years, we will absolutely expect to see the number of cancers caused by smoking—and, alongside that, the number of other illnesses associated with smoking—reduce.

[Andrew Gwynne]

Q Can you tell us about the evidence of the impacts of second-hand smoking on cancer in your case, Dr Walker, and on asthma and lung conditions in your case, Sarah? What difference do you think that the measures outlined in the Bill will have on those conditions?

Dr Ian Walker: To start with smoking and cancer, the links between passive smoking and cancer, particularly lung cancer, are very clear. It is fair to say that there is less evidence around different scenarios that you might predict through this Bill, such as different outdoor environments and so on, but that is more because those studies have not necessarily been done. It is an important point to make that there is an absence of evidence, rather than evidence of absence.

You heard from the CMO of England this morning that if you can smell cigarette smoke, you are exposed to it. The direct risk, then, is linked to how long you are exposed to it, how concentrated the environment is, how close you are to it and so on. Nevertheless, passive smoking is harmful—not just for cancer, but for vulnerable people with many other conditions as well—so we are very much supportive of the introduction of smoke-free places and the ability to restrict people smoking in particular outdoor spaces.

Sarah Sleet: When it comes to people with lung conditions, second-hand smoke is incredibly important; it is a well-known, severe risk factor for people with lung conditions. About one in five of us in the UK will experience a lung condition—there are around 7 million people with asthma and about 1.6 million people living with chronic obstructive pulmonary disease. Those are two major conditions that are profoundly affected by second-hand smoking, and are clear risk factors in terms of deaths from asthma and people being hospitalised with exacerbations, so it is incredibly important that we deal with the issue of second-hand smoking. People said earlier that there is no choice about second-hand smoking, and yet it profoundly affects those with lung conditions. It is incredibly important that we ensure that we protect those vulnerable people as far as possible.

When it comes to the discussion about how far we should go in terms of smoke-free and vape-free places, we would consider going further than what has been suggested already and looking at other areas to make smoke-free. I know there has been discussion about hospitality and trying to balance the potential economic impact that has been talked about if we make the outside of hospitality places smoke-free. However, we think, given the balance between the public health impact and what we have seen with smoke-free indoor spaces and its impact on business, we could go further and should go further, there.