Tobacco and Vapes Bill (First sitting)

Euan Stainbank Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Sarah Bool (South Northamptonshire) (Con)]

My mother has some shareholdings in British American Tobacco, but that links to my parents’ having worked for Imperial Tobacco 50 years ago.

[Euan Stainbank (Falkirk) (Lab)]

I am an officer of the responsible vaping all-party parliamentary group.

[Dr Zubir Ahmed (Glasgow South West) (Lab)]

I declare an interest as an NHS transplant and vascular surgeon. My wife is a lung cancer doctor.

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[Sadik Al-Hassan]

Q Comparatively, how addictive is nicotine in tobacco and vapes compared with other products? I seem to remember that it is harder to get off nicotine than methadone. Is that true?

Professor Sir Gregor Ian Smith: I am not sure we have the data or the evidence to back that up, but I have certainly heard people claim that in the past about the addictive nature of nicotine. One of the important aspects of this issue is the very rapid re-emergence of that addiction by small exposures after people have managed to quit. Certainly we should be in no doubt about the addictive nature of nicotine and the risks—going back to the harmful effects of passive smoking or being in the company of people who smoke—associated with the re-emergence of that addiction and of people’s tobacco smoking habits. That is something very real. Therefore, the best protection is never to start in the first place. If we can prevent people from taking those first nicotine products and prevent the addiction from forming in the first place, there is obviously a much greater chance that they are not going to suffer the health consequences.

[Euan Stainbank]

Q It is clear, from the comments made about display and advertising, that child vaping is an issue that needs to be tackled; I think it is an issue that many of our constituents and many people in the country recognise. Especially for adult smokers, do you believe that there will be any impact from the display and packaging restrictions on the effectiveness of vapes as a tobacco cessation tool?

Professor Sir Chris Whitty: Our view is that the benefits of preventing people who are not currently vaping, particularly children, from vaping through what is proposed in this Bill significantly exceed that risk. However, that risk exists; we all accept that. To go back to a previous point I made, that is why having these powers gives us the advantage that if, as a result of where we get to—remembering that this change will come after consultation and there will be secondary legislation going through Parliament—it looks as though we have gone too far, it will be possible to ease back. Our view, though, is that at this point in time, and subject to what the consultation shows, the net benefit in public health terms is positive for the prevention of children starting smoking, over any risk for adults.

The area of greatest uncertainty is on flavours. There is some genuine debate around that, with a range of different views from people who are quite seriously trying to wrestle with this problem—rather than doing marketing masquerading as wrestling with this problem—but in all other areas, most people think that the benefit outweighs the risk.

[Dr Ahmed]

Q Thank you, Sir Chris—your anecdote about the vascular war resonates strongly with me as a practising vascular surgeon; many of my patients leave hospital with fewer legs than when they entered. The comment I want to make is on the chronic disease burden. As you all know, there is a rising epidemic of chronic disease in our country, and it will probably require various public health measures to get back under control. I wonder if I could ask you to comment on how you feel this legislation might impact on the chronic disease burden on the NHS going forward, not only in the short term but in the long term?

Professor Sir Chris Whitty: I will give a view, and I think Sir Gregor will want to add to it. It will make a very substantial difference. The thing to understand is that not only does cigarette smoking cause individual diseases, but many people as they go through life have multiple diseases from smoking. They will start off with heart disease, for example, as a result of smoking, and will go on to have a variety of possible cancers, and they might have chronic obstructive airway disease, and they will end up potentially with dementia. All of these would have not happened at all or would have been substantially delayed had they not smoked. Of course, this is heavily weighted towards areas of deprivation, people living with mental health conditions, and other areas where I think most people would consider it really unjust in society. All of us, and anybody who has looked at this in public health terms, would say that if you could remove smoking from the equation, the chronic disease burden would go down very substantially, and be delayed, and the inequalities of that burden of disease would also be eroded. The arguments for this are really clear.

To give some indication of the numbers involved, we have thousands of people every year—millions over time—going into hospitals and general practices only because they are smoking. Had they not smoked, they would not have to use the NHS, and they would not have the chronic disease burden that disbenefits themselves, disbenefits their families and, of course, because of the impact on wider society, disbenefits everyone else as well. Undoubtedly this Bill—if it is passed by Parliament—will reduce that burden and have an enormous impact.

Professor Sir Gregor Ian Smith: Thank you for raising this as a question, because it is a very important point to understand. I will speak to the experience in Scotland. The Scottish burden of disease study published by Public Health Scotland suggests that from now to 2043 we are going to see a rise of 21% in overall burden of disease across our society in Scotland. That burden of disease is very much weighted towards a number of conditions such as cancer, dementia including vascular dementia, cardiovascular disease, and others. There is no doubt in my mind that smoking contributes to those.

Chris’s point about the multimorbidity that people experience is really important in this context. There are more people in Scotland who experience multimorbidity under the age of 50 than those who do over the age of 50, and much of that is related to smoking. Anything that we can do to reduce that burden of disease on people will not only make their own lives so much better, but make them more productive—they will be able to spend more time with their families, they will be economically active for longer, and they will also use health services less. So there is both a compelling health argument and an economic argument here on the preventive nature of stopping smoking and stopping people from beginning to smoke, which is really important to understand in the context of that projected increase in the burden of disease.

The last thing to remember is that our experience of disease can sometimes be cumulative. As Sir Chris alluded to, people who have developed diabetes for other reasons but who smoke as well, will have accelerated disease as a consequence. Removing as much as we can, step by step, the risks that are associated with the development of that accelerated disease—you will have seen it very clearly in your role as a vascular surgeon—has to be a step that we take to maintain both the health and the economic prosperity of our nation.

Professor Sir Chris Whitty: The numbers that I was looking for—

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[Mary Kelly Foy]

Q I notice in your submission that you have a recommendation:

“The government should make good on their pledge to publish a ‘roadmap to a smokefree country’…with a strong focus on tackling inequalities.”

I am from the north-east region, where we have high deprivation and high smoking prevalence. It is the only region that has a clear vision—if you like—and declaration from Fresh and the directors of public health for how to achieve a smoke-free country. Could you explain a bit more why we need that vision and that strategy going forward?

Hazel Cheeseman: The legislation is fantastic; it is world-leading and brilliant, and it will really set us on that path toward being a smoke-free country. However, it will not be the last word in how that is achieved. We have 6 million smokers across this country, and we need to ensure that all of our agencies are lined up to do the job that they need to do to help those people stop smoking—the NHS, local government and integrated care boards across the system need to have the right approach. We also need to ensure that the funding is there to do that too. The Government have committed to the funding in stop-smoking services in local government, but we also need to see funding in mass media campaigns. The chief medical officer was talking earlier about people’s waning understanding of the harms of second-hand smoke. One way to address that would be to go back on TV and radio and explain to people what the harms of second-hand smoke are. That package of measures alongside this legislation would really help us to accelerate progress.

The Bill will massively raise the saliency of the harms of smoking with the public—there is no doubt about that. There has been, and there will continue to be, a strong public debate on the measures in this Bill. By really riding the wave of that public understanding through that coherent strategy and that investment, we could really see smoking rates start to drop, particularly in those disadvantaged populations where we continue to have persistently high levels of smoking.

[Euan Stainbank]

Q By restricting vaping products in this Bill in the same ways that tobacco products are currently restricted—be that packaging, display or potentially flavourings, as we discussed with the CMOs earlier—do you think that this will lead to greater misconceptions by the public and, quite crucially, current smokers about the relative harm between the two products?

Suzanne Cass: We obviously have an issue when it comes to the understanding of and the misconceptions around the harms of vaping. In particular, the most worrying stats are among smokers considering them as harmful as or more harmful than tobacco. That is that a significant issue. This legislation allows us to reset the clock and promote these products as smoking cessation products, using health professionals to promote them and getting the right language around them. Rather than their being seen as a recreational toy, they can be seen as a product that is going to help people to quit smoking. When it comes to the positioning of these products, it is essential to readdress those misconceptions and re-place this product.

On standardised packaging, what we did with tobacco was put it in the ugliest packaging you could ever imagine. We are not talking about that when it comes to vaping products; we are talking about plain packaging—something that is informative but not necessarily attractive to young people. There is a big difference between something that is repulsive and something that is not attractive. That is where we see the difference, and that is where we see this legislation coming into its own and allowing us to reset and to have that different conversation.

Hazel Cheeseman: I am sure we will tease more of it out through the consultation process that will follow this legislation, but some of the early research that has been done has indicated that you can, to some extent, have your cake and eat it on this. If we remove some of the attractive branding elements on packaging, which we know appeal to children, that does reduce the products’ appeal to children, but it does not damage their appeal to adult smokers and it does not damage harm misperceptions. We can progress with this legislation, via the consultation and looking properly at the evidence, to make sure that we get the balance right.

There are also provisions in the Bill to allow public health bodies to do marketing and public health messages around vapes as a smoking cessation tool. It will be important that the Department of Health and Social Care and the Advertising Standards Authority work with public health bodies to make sure that they have the right guidance to be able to do that and to give smokers directly the right information about how vapes can be used as a cessation tool.

[The Chair]

Thank you. I am afraid this will probably be the last question before the next panel of witnesses. Tristan Osborne, we have about two and a half minutes left.

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[Sadik Al-Hassan]

Q Is there any research into passive vaping risks to bystanders, who do not have a choice if someone is vaping next to them?

Sarah Sleet: As I said earlier, the research evidence around vaping harms is currently very poor. There has not been enough. It takes a long time to build up evidence of things that are generally very progressive rather than having an immediate impact, so we will have to wait. We need to put that in place, and we are going to have to wait to get that evidence back.

We have had anecdotal reports from our beneficiaries and those who contact the organisation about places—particularly in closed spaces, but sometimes outside—where there is a concentration of vaping. It is that classic thing where you go through a door and suddenly everybody around you is vaping immediately outside it. We get reports that that exacerbates people’s asthma and sometimes their COPD, but they are anecdotal. We really need the evidence base to support what is happening.

Dr Ian Walker: The only thing that I would add specifically from a cancer perspective is that although there is very little long-term evidence, because the products have not been around long enough and the cumulative effects have not been seen yet, what we do know, based on the current evidence, is that vapes are far less harmful than cigarettes. You heard the advice earlier that if you smoke it is better to vape or take other nicotine products, but if you do not smoke you should not vape, because we do not know yet what the long-term effects will be. In particular, we are very light on evidence on what the impact of vaping will be on bystanders.

[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.