Tobacco and Vapes Bill (Fourth sitting)

Preet Kaur Gill Excerpts

Committee stage
Wednesday 1st May 2024 Public Bill Committees

[The Chair]

Q154 We will now hear from Professor Sanjay Agrawal, the Royal College of Physicians specialist adviser on tobacco, and Tim Mitchell, president of the Royal College of Surgeons We have until 2.40 pm for this panel. Would the witnesses please introduce themselves for the record?

Professor Agrawal: My name is Sanjay Agrawal. I am the specialist adviser for the Royal College of Physicians. To give a bit of background, the RCP has produced reports over the past 60 years on a whole variety of facets of tobacco control. Most recently, we published a report on e-cigarettes and an evidence review that looked at the trends of e-cigarette use, safety, efficacy and regulations.

As my day job, I am a consultant in intensive care and respiratory medicine in Leicester. Perhaps it is worth saying that in my lung cancer clinics and in the intensive care unit, I see week after week, year after year the impact of tobacco on my patients. In my lung cancer clinic, I frequently have to deliver bad news about lung cancer. Oftentimes I am left sitting there, thinking, “Why haven’t we as a society and a country done more about this? We have known about the harms for the past 60 years. Why haven’t we done more?”

I am really pleased to be here today, because it feels to me that this Bill is a momentous occasion where, once and for all, we can do something for people along their whole life course, whether that is people who are pregnant and are affected by tobacco smoking or their unborn children who are affected, or people with dementia, hearing loss or sight loss—diseases in old age related to tobacco.

The RCP supports the Bill. It is really well balanced. As a clinician in the medical profession, I, along with the RCP, which represents at least 30 different medical specialties, support the Bill. We know it will prevent ill health for future generations and reduce poverty and disparity.

Tim Mitchell: I am Tim Mitchell, president of the Royal College of Surgeons of England, which hosts a number of national cancer audits, including lung cancer audits, so we are very familiar with the impacts of smoking. I and my colleagues across all surgical specialties see the impact of smoking on a daily basis. Lung cancer particularly is seen as being associated with smoking, but the risk of all cancers is increased by smoking, particularly in my field as an ear, nose and throat surgeon—mouth and throat cancer, for example. There is also a range of benign diseases, particularly those that affect blood vessels—so people who need to have coronary artery surgery or surgery to improve blood flow to the brain if they have had a stroke. Diabetics are affected, and the risk of diabetes is increased by smoking. There are vascular problems, such as with blood flow to the legs, which can result in amputations.

Aside from that, all patients undergoing surgery are affected by smoking. They may have specific disease processes affecting their heart and lungs that will have an impact on them having a general anaesthetic. Even if they do not have defined disease processes, we know that smoking affects healing. The other thing we are also very aware of is the impact of passive smoking, particularly on children.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

Q Tim, coming to you first, from a surgeon’s perspective, why do you think that it is important to decrease the rates of smoking and vaping?

Tim Mitchell: As I have alluded to, the burden of disease caused by smoking is huge, and there is no doubt that smoking is very bad for people’s health. As surgeons, we see that on a daily basis. We have talked about cancers and other disease processes. As I think you heard, the estimated cost to the health service is £2.5 billion a year, and the burden on surgeons across all surgical specialties, because of the impact of smoking, is huge.

In addition, as I said, smoking has an impact on all patients undergoing surgery under general anaesthetic. It increases the risk of complications and has an impact on wound healing, the risk of infection after surgery and, particularly, respiratory complications after surgery. It has been estimated that there may be an increase of as much as 40% in major complications after surgery in people who smoke. Decreasing the rate of smoking will have a massive impact on surgical activity.

[Preet Kaur Gill]

Q Sanjay, the Royal College of Physicians has called for regulation to protect young people from vaping while still allowing smokers to use e-cigarettes to quit. Do you think that the Bill strikes the right balance in that regard?

Professor Agrawal: I do, actually; I think that it is a very well thought-through Bill that absolutely gets the balance right. For example, we have 6.4 million people who smoke in this country. As Professor Sir Chris Whitty said today, they are doing that not out of free choice but because they became addicted to tobacco while they were children, as designed by the tobacco industry. Those 6.4 million people need a way out of smoking. I speak to patients in clinic who have successfully stopped smoking and ask them, “How did you do it?” I cannot remember the last one who did not say that they did it with vaping. We know that vaping is a very popular way to quit smoking among people who are addicted to tobacco; it allows them a sense of control about how they quit smoking.

I think the balance in the Bill is just right: it recognises that vapes are important in helping people to quit smoking, but, by the same token, we all recognise that we do not want to see our children and grandchildren—young people—take up vaping. I was listening to the Committee proceedings yesterday, and I was struck by what the group representing schoolteachers said about the impact that it is having on children’s learning. It is important that we address young people vaping and do as much as we can to reduce the appeal of vapes, as well as access to them.

The Government have already outlined other measures: for example, raising excise tax and making vapes less affordable, as well as banning disposables, which have really fuelled the rise in youth vaping. We would hope that the whole package of measures, as well as this Bill, should see a significant reduction in youth vaping.

[Preet Kaur Gill]

Q The Royal College of Physicians has also called for manufacturers to limit the production of toxic substances from vapes and for the Medicines and Healthcare products Regulatory Agency to be required to independently verify the contents of e-cigarettes. That is something I have taken a real interest in—you make a really good point. Whereas the notification scheme for tobacco tests products, the vaping scheme does not. Do you think we need to do more in the Bill to address that?

Professor Agrawal: It is important that we make sure that these products are notified well, and I know that there is a colleague speaking after me today about the MHRA process. Independent verification will be an important thing to do, whether that is part of the Bill or something that comes about as part of the consultation process that the Bill and the regulations will go through.

One thing that is really important is that this Bill passes through this Parliament, so that we stop the 350 young people who take up smoking every day from doing so as soon as we possibly can. We know that two out of three of them will die as a result of smoking. What I do not want to happen is for the Bill to be slowed down in any way by a series of amendments. We need to get this Bill and the law on the statute book. The consultation process should hopefully take care of some of the finer details, which are really important, too.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Q Thank you both so much for being here today. As you will know, what witnesses are providing are the words and the arguments to enable the smooth passage of the Bill. Professor Agrawal, you have just said that you want this to go through smoothly, as do all of us here, so what you say is incredibly important.

As physicians and surgeons, what would you not have to do if people were not smoking? Could we say you would be writing yourselves out of a job? What are some of the things that are specifically on your day-to-day list that you think would be removed if people were not smoking?

Tim Mitchell: I referred to the national cancer audits. For example, 37,000 people a year develop lung cancer, many of whom will need surgery. On the survival rate for lung cancer, fewer than 50% of people survive one year. There is a whole range of other cancers related to smoking, so the burden of that disease and the burden on the health service would reduce dramatically if we had a smoke-free society. I have alluded to other forms of surgery that are required—amputations and so forth. So the impact on society at large would be huge if we had a smoke-free society. In terms of other surgery, the complications would be avoided.

I know very much from my own personal experience how important this is. My mother died from lung cancer caused by smoking when I was seven years of age. My grandfather died from mouth cancer caused by pipe smoking when I was eight years of age. If we had a smoke-free society and there was one small boy or girl who grew up knowing and being loved by their mother or their grandfather, that would be very powerful.

However, that pales into insignificance compared with the impact that the Bill could have on society at large. Millions of people’s health would be improved. The impact on millions of families would be dramatically improved and the health of the nation would be significantly greater. We as a college fully support the Bill and, as my colleague said, we very much hope that it will pass through smoothly and get on to the statute book.

Professor Agrawal: Just to add to that, for my clinical practice in the intensive care unit, I see people with life-changing illnesses, whether that is ruptured aneurysms, heart attacks, kidney failure, the need for mechanical ventilation in people who have severe lung infections or chronic obstructive pulmonary disease exacerbations. There is also my lung cancer clinic—really, the list goes on.

One of the other things that I am often struck by in our multidisciplinary meetings where we look at things like CT scans of people who have smoked all their lives—through no free choice, by the way, because they have become addicted to tobacco through means of the tobacco industry encouraging young people to take up smoking—is that they have multi-morbidity. So as well as having lung cancer, they may have a kidney cancer, they may have heart disease, as well as COPD. If they have one of those things, we can manage that, but unfortunately, the combination makes people multi-morbid and frail, and it impacts their ability to have treatment for the most serious of those conditions.

By eliminating smoking and creating a smoke-free generation, we will transform aspects of our medical care and our NHS. We heard this morning that there is a person admitted every minute to hospital with smoking-related disease, and there are 100 people seen by GPs every hour with tobacco-related disease. So I think we can alleviate all that extra pressure on the NHS from tobacco addiction and use those resources differently.

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[The Chair]

We will now hear from Mark Rowland, chief executive of the Mental Health Foundation. We have until 3 pm for this panel. Would the witness please introduce himself for the record?

Mark Rowland: Thank you, Chair, and I thank the Committee very much for inviting me. I am really happy to be here. My name is Mark Rowland and I am the chief executive of the Mental Health Foundation, which has been around for just about 75 years—not quite as old as the NHS. I am also the co-chair of the Mental Health and Smoking Partnership, which brings together 25 or so academic institutions and charities to look at the relationship between smoking and mental health, and is organised by ASH.

[Preet Kaur Gill]

Q In popular culture, there is this pervasive myth that smoking relieves stress and anxiety, when we all know that it does not. We know how damaging thinking like that has been. There was a school in my constituency that decided to give a young person a leaflet about how to address anxiety, which I was quite dismayed to see said, “smoke a cigarette”. Do you think that this Bill addresses those concerns?

Mark Rowland: I was saying earlier on that this myth about smoking appeasing the symptoms of anxiety and stress does not come about by accident. It has been purported by the tobacco industry. The tobacco industry has deliberately commissioned research into the proposed impacts of smoking, looking for some sort of consequence for relieving long-term stress. You are absolutely right that it is not just a myth, but a pernicious myth, because it does exactly the opposite. The only thing that smoking does is relieve the immediate symptoms of nicotine withdrawal, deepening the addiction. We know now that it exacerbates the symptoms of poor mental health across the population, particularly for common mental health disorders, as well as serious mental illness. We now see that there is a causal relationship between smoking and mental health.

You asked whether the Bill does enough; the Bill does not directly address the myth. I am very grateful that this Committee has called me to specifically talk about the relationship between smoking and mental health, because it is often not in the public conversation. I feel really strongly that there is a generation who have been let down and deceived, and that has unfortunately seeped into the practice and perception of mental health professionals over the years as well. In 2008, which was the first time that smoke-free policies were made mandatory in mental health settings, we looked at the attitudes of mental health professionals compared with other medical professionals. We found that one in three had serious reservations about introducing smoke-free policies into mental health settings, versus one in 10 for other medical professions.

It has let down people who have then become addicted and experienced the poor mental health and physical health consequences. This Bill will make an important contribution. I think there is an amendment to put an insert into cigarette packages that directly takes on that myth. Given the long history of deception and misinformation, we would strongly take the opportunity to support that amendment to this Bill, so that future generations can be in no doubt that it has no mental health benefits whatsoever.

[Preet Kaur Gill]

Q Thank you. It is an amendment that I tabled based on the concerns raised by young people in a school near me. There is a generation of children who are addicted to nicotine, because there have been clear loopholes on marketing and giving free vapes. Do you think that there is enough support within communities to help children who are addicted to quit? Does that actually exist for young people?

Mark Rowland: For nicotine or smoking?

[Preet Kaur Gill]

Q Nicotine, whether by smoking or vapes.

Mark Rowland: The commitments that were made in relation to the long-term NHS plan—the five-year forward view for mental health—were really important, but our NHS colleagues say that they are not well-funded. We are roughly £10 million to £20 million short of completing the opt-in in mental health settings. It is currently an opt-out, and that has been hugely successful. About nine in 10 inpatient services are now adopting the smoking cessation offer, but you are right to say that it has not extended anywhere near far enough in terms of community settings.

Community mental health services, for example, have only had a pilot for smoking cessation. It is on an opt-out as well, but there are only seven pilot sites. It is relatively cheap; £10 million to £20 million could expand community smoking cessation to mental health services and integrate it within that. That would be a really smart thing to do.

We can also see that most people who experience distress, depression or anxiety will go through talking therapies. There is a really big opportunity there—my wife is a therapist—but there is no standard mechanism for therapists to check smoking status as they are coming forward to help. One of the things on which we have really accrued evidence, through Cochrane and systematic reviews, is the mental health benefits of stopping smoking. We think there is much more that could be done at those access points, such as talking therapies. Why not think about a holistic approach to stopping smoking alongside the psychological talking therapies assistance that is being offered to about 1.6 million people? There is more to do.

In relation to young people, I think that could be added to that component in child and adolescent mental health services as well to understanding. Let us have a whole picture of what our young people are facing, because we know that the causes of mental ill health are often multi-varied, so we need to understand what the causes are and also what the coping mechanisms are. One of the reasons we are so passionate about this Bill is that what smoking does is provide an out for young people and adults to be able to really look at the emotional distress that they are experiencing and manage those difficult emotions in a healthy, life-affirming way, so there is much more to do.

[Dame Andrea Leadsom]

Q Thank you so much for being here this afternoon. It is incredibly helpful. Can I ask you the chicken-and-egg question? Does smoking make you depressed, does depression cause you to smoke or is it both? I think you are possibly saying both.

Mark Rowland: I think five or 10 years ago we would probably have said that it is more likely that, if you are depressed or anxious, you will reach for a cigarette to appease the emotional distress in the short term. The work from academics at the University of Bristol has found that there are now good population studies looking at the impact of smoking leading to a first instance of mental health problems and the fact that there is a causal relationship between smoking and mental health. We are already facing, as this Committee will be aware, a mental health crisis in this country, and 23% of the health burden is a result of mental ill health—one in four in any year, one in six in any week. The efforts to reduce smoking will, we think, have both an impact in reducing prevalence and in reducing acuity of mental ill health.

On the chicken and the egg, it is difficult to disaggregate exactly for many people, but we know that both are a real issue. We talk about this cycle of smoking increasing the risk of poor mental health and poor mental health increasing the chances of smoking and the number of cigarettes someone smokes. People with mental health problems smoke far more, and that addiction then exacerbates psychiatric symptoms. Those psychiatric symptoms also then lead to increased poverty and increased chances of being unemployed, and that leads to poorer mental health. It is a complex picture, but we are really starting to see the causal drivers of mental ill health.

I will finish by saying that this Government should be applauded for introducing this progressive, bold and far-sighted piece of legislation. We have called for a long time for a cross-Government approach to mental health, and we would have been calling for exactly this type of legislation in that approach to give young people—give us all—a fighting chance for better mental health, so that we can reap all those benefits.

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[The Chair]

Q We will now hear from Dr Laura Squire, the chief healthcare quality and access officer for the Medicines and Healthcare products Regulatory Agency. We have until 3.25 pm for this session. Will the witness please introduce herself for the record?

Dr Squire: Good afternoon. My name is Laura Squire, and I am the chief healthcare quality and access officer for the Medicines and Healthcare products Regulatory Agency. The objectives of the MHRA are to protect public health and, in connection with that, we have a number of different roles connected with e-cigarettes. We have no role at all with tobacco.

[Preet Kaur Gill]

Q Can you briefly describe the regulatory approach taken by the MHRA regarding vaping products? Will this Bill change anything that you currently do?

Dr Squire: Yes, I can. We have three very distinct roles connected with vaping products. The first is in connection with medical products, which we talked about earlier and I can explain a bit more. That is something that might be prescribed for someone to give up smoking. We have a very different role on consumer vapes—the sort of things that you will find in your local vape shop. For all those products, we also have a role in monitoring their safety once they are on the market.

I will start with the role for vapes as medical products. The Human Medicines Regulations 2012 govern that and define what a medical product is, which is essentially a substance used for preventing or treating disease in human beings or diagnosis. MHRA is responsible for regulating medical products; that includes nicotine-containing products that are used in a therapeutic way, and which would help people give up smoking. That would include the licensing of electronic cigarettes that allow the inhalation of nicotine. In addition, where an e-cigarette is in a reusable form, it needs to conform with the UK’s Medical Device Regulations 2002.

To explain that a little bit more, as with all medical products, before a medical nicotine-containing product can be marketed in the UK we do a robust assessment of that product. We always say that no medicines are entirely without risk, and the question that we ask ourselves as regulators is, are the risks outweighed by the benefits of that product for the patient who is using it? This is done by the examination of evidence provided by the manufacturer of the quality, safety and efficacy of that product. We have mentioned earlier this afternoon the possibility of licensing e-cigarettes. There was one product licensed in 2015, which was an electronic nicotine inhaler. It was never marketed in the UK.

The evidence is really clear—and a lot of people have said it—that e-cigarettes are less harmful to health than tobacco, and that nicotine-containing e-cigarettes can help people stop smoking for good. That was restated very clearly in the recent report by the Royal College of Physicians, which advocates cigarettes being offered as part of a treatment pathway by the NHS. Treating those products as medical products and licensing them would enable that. For that reason, we continue to encourage manufacturers to come forward to us to seek licensing as a medical product. Quite recently—a couple of years ago—we put out some really detailed guidance, because we recognise that not all manufacturers of e-cigarettes would be particularly familiar with the Human Medicines Regulations, so there is specific guidance out there at the moment. The Bill does not change any of that; we would continue doing the same thing.

The second role is our role on vapes as consumer products, which as I have said is different. The MHRA is the competent authority for the notification scheme for e-cigarettes and refill containers, and that covers Great Britain and Northern Ireland. The e-cigarettes covered by the Bill and by the notification scheme are not medical products, and that is very important. It means they are not entitled to make medical claims, so we do not test them for that.

The role in consumer products and the notification scheme is given to us by the Department of Health and Social Care and it derives from the UK’s Tobacco and Related Products Regulations 2016, which were designed to put in place some product standards for e-cigarettes such as nicotine strength, the size of the tank and so on. The checks we undertake for that are really just to make sure that the data fields have been completed, and that a fee has been paid for those products. In contrast to medical products, we do not do a full assessment of the safety, quality and efficacy of those products, nor would we undertake a consideration of whether the benefits of those are outweighed by the risks. Our competent authority role does not include the testing of those products either.

[Preet Kaur Gill]

Q Just on that point, the notification scheme is essentially a paper-based process, so anyone sitting in Germany, say, or anywhere in the world, if they want to supply the United Kingdom, simply has to fill out a form, send you a notification form and pay the fee. No physical products are examined or tested to make sure that they are compliant with what is required before they can be sold. Do you think the MHRA should be given the powers to use the notification fee for more than just the administration of the scheme, and request some sampling and testing of products—of course, not all—before they go on the market? I say that because we have seen the evidence of the increase in illicit vapes and we have heard from trading standards as well on that volume increase.

Dr Squire: Sampling and testing can be done—it is done by trading standards—but you are quite right that that is not before it goes on the market. I think at the moment it is difficult for me to say what the Bill should or should not be. The policy sits with the Department of Health and Social Care, and as we work through the process of consultation and putting the regulations in place, we will continue to work closely with them on what that means for the notification scheme and our role in it.

I was going to talk about our post-market surveillance role, which covers everything. There are requirements for manufacturers of both medical and consumer e-cigarettes regarding post-market surveillance; they have to ensure the safety and quality of their products when they are being used in the intended way. Those requirements include reporting to the MHRA. They are much more stringent for the medical products.

The MHRA yellow card system is a spontaneous reporting system, which anybody can use to report a problem with a product. In 2016, we extended that to enable people to report on e-cigarettes as well. Our vigilance team, when they get those reports in, look at them all to identify any safety concerns, and if a concern is identified they work with trading standards to enable them to do what they need to do, which is sometimes taking the product off the market. They do not just use the spontaneous reporting; they use other parts of intelligence, including literature review, to take these products off the market.

What we are thinking about at the moment is the challenges, particularly with spontaneous reporting, of identifying longer term effects or effects that have a longer lead-in time. That is something our safety and surveillance teams are really thinking about.

[Preet Kaur Gill]

Q In terms of your notification process as a regulator, of course there is enforcement, with trading standards removing products, but do you have the powers, and have you used your powers, to remove products from that notification process?

Dr Squire: At the moment, no; it does not allow us to take things off the register, although I notice in the Bill there is something about exceptions to publication. At the moment we cannot do that, but the exceptions to publication in the Bill—again, this is DHSC legislation rather than ours—look as if they might give an opportunity for that.

[Preet Kaur Gill]

Q It seems to me that there needs to be some sort of triangulation between trading standards’ enforcing and removing illicit products from the market and your register. Surely, given your role, you should have the powers to be able to pull that product off the register.

Dr Squire: Yes. There is a lot of triangulation and a lot of work with trading standards, and the evidence we have gained through the notification is used to support them to do their enforcement activity. But you are quite right that we cannot take things off the actual notification list at the moment, though the Bill has some exceptions to publication.

[Preet Kaur Gill]

Q If a product is not compliant—if it is illicit, illegal and so on—does it stay on your register? What happens?

Dr Squire: Nothing happens on the register, but trading standards will take it off the market. Trading standards take that enforcement activity. We provide them with support from an intelligence perspective and with expert input, and with things such as telephone support if they are doing operations, so we do work very closely with them. The key objective, when these products are found, is to get them out of the shops.

[Preet Kaur Gill]

Q Does that mean that you communicate with every trading standards department in the country and get them to go out and remove the product? Is that how it is done?

Dr Squire: That depends on where it starts. They get their own intelligence as well, so they would lead on enforcement operations. That is their role, not ours, within the UK tobacco products regulations. They do that and they ask for our help to support them, and we will give them intelligence when we do that.

[Dame Andrea Leadsom]

Q Thank you very much for being here this afternoon. Can you talk us through the work you do with some vape companies in order to take non-compliant vapes off the market?

Dr Squire: The work that is done with vape companies to take products off the market would be done by trading standards.

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[Trudy Harrison (Copeland) (Con)]

Q We have heard various accounts of the impacts of vapes on children and young people—that there are limited direct consequences of vaping on children and young people’s bodies, but plentiful and multiple different indirect impacts of that behaviour in schools and such like. I am starting to hear that it almost feels like an unbearable choice between whether we protect children and young people from vaping, or prevent older people from being able to stop smoking through the use of vapes. I am struggling with making that choice; I can see both sides of the argument. Do you have a view? Could you help the parliamentarians here to understand the choice we are faced with?

Dr Squire: The Bill helps in all ways. The Bill is very clear on tobacco and, as I say, we do not have a role on that, but the proposal is to put more requirements on vapes, and in our experience more requirements add to the barrier to something getting on to the market, which is helpful. One of the problems we have with e-cigarettes is their availability.

I am not sure I see the choice between the two. We are seeing here a Bill that, as people have said before, is balanced. It recognises that vapes are useful for people who already smoke, and it puts in some very big restrictions on people who already smoke, but it also tightens the rules around vapes. I think that is what gives it the balance, which is helpful. The problem, which others are more qualified than I am to talk about, is: if we did not have vapes at all, where would people who smoke go? It is not a good answer, but if you do not smoke, don’t vape. That has been said a number of times, and we definitely agree with it.

[Preet Kaur Gill]

Q How many products that have gone through the notification process have been deemed illicit and have therefore been removed by trading standards?

Dr Squire: I think I have some figures about that— can I write to you? I do not have them in front of me, but I think they are quite high numbers. We have about 67,000 on the list at the moment, and quite a high proportion have come off as a result of the activities of trading standards.

[Preet Kaur Gill]

Q It is the process that we are trying to understand. You have a register and a notification process—

Dr Squire: Yes.

[Preet Kaur Gill]

But because we are not testing a product before it comes to the market, we are allowing a lot of illicit substances to come in and flood the market. Do you think that companies submit data about their products and say, “Yes, they will meet the regulations,” so that they can get their European community identification, but then actually send to the market products that are potentially illicit and have high nicotine strengths?

Dr Squire: Yes, so the product that goes on to the market is not the product that is on the notifications—yes, that does happen. That is why I think it would be helpful to have the exceptions that are coming in through the Bill in order to take some of those products off the market.

[Preet Kaur Gill]

Q Do you think those exceptions are strong enough?

Dr Squire: What the exceptions are is not defined yet. The ability to make exceptions is in the Bill, but what the exceptions are would be a Department of Health and Social Care policy decision, and we will work with it on the development of those regulations.

[Preet Kaur Gill]

Q Have you ever asked a Secretary of State to use powers to recall or remove products from the register?

Dr Squire: Have we?

[Preet Kaur Gill]

Yes.

Dr Squire: No, I do not believe we have.

[Preet Kaur Gill]

Q Where you were given the role of being the register in the notification process, it says that the powers can sit with the Secretary of State, and I am just wondering, given that we have a growing number of illicit substances, how that information has been shared with the Secretary of State so that they can utilise those powers. I appreciate that we have in the Bill the opportunity to try to look at whether we should be testing products. I suppose my other question to you is this: what happens if, after a product has been notified, the company decides to send notifications of other products? Is it allowed to do so even though it has already supplied illicit substances?

Dr Squire: There is illicit and there is non-compliant—those are two different things. If a company provided something that turned out to be non-compliant, provided that what they then send us is compliant, there is no reason why we should stop that. I have tried to bring the contrast between the levels of control that we have on medical e-cigarettes and the levels of control that we have on notification. The notification scheme is just that and was designed as just that. The MHRA does with it what we are required to do under the tobacco rules, and that was assigned to us when we left the EU. The strengthening that comes through these regulations—or through the Bill, which will then lead to the regulations—is something that the Department of Health will develop, and we will work with it on that. However, I am not sitting here saying that this is an absolutely robust system that keeps everybody safe. That is why the Bill is important.

[Preet Kaur Gill]

Thank you.

[The Chair]

If there are no further questions, I thank our witness. We will move on to the next panel.

Examination of Witness

Mr David Lawson gave evidence.

[The Chair]

We will now hear from David Lawson, director of Inter Scientific Ltd. We have until 3.45 pm for this session. Will the witness please introduce himself?

Mr Lawson: Hello, my name is David Lawson. I am director of Inter Scientific. I am also director of another company called Ventus Medical, which sits on the other side of regulation in the development of pharmaceutically regulated nicotine-containing products.

[Preet Kaur Gill]

Q In 2023, your company identified shops selling vapes with illegal capacities and nicotine strengths. What have you found through some of your work?

Mr Lawson: We looked at stores in Liverpool, Manchester and London. We did this with a few different media outlets—the BBC, Sky News and The Guardian. We found that you could buy illegal products quite easily on the market and that they were available in almost every store you go into. Some of those were post office stores that were selling those products, so there was no way for customers to determine which products would be legal or illegal.

We were able to expand on testing in relation to trading standards, and we found that around 77% of products that we tested exceeded the 2 ml limits in the Tobacco and Related Products Regulations 2016, which set the UK limit on volume. Some 33% of products contained more than 20 mg/ml of nicotine, so over the legal limit for nicotine, but 19% of products that were marketed as being nicotine-free contained nicotine, generally at the full maximum strength for the UK. Overall, 78% of products tested were deemed to be illegal in accordance with TRPR 2016.

[Preet Kaur Gill]

Q Were those vapes being marketed to children or to adults, or was it a mixture?

Mr Lawson: I think it is quite easy to characterise the products. They are generally quite large in size. They normally have cartoon figures on them, such as Rick and Morty from Netflix. A lot of them are branded with cartoons like that— sometimes The Simpsons are used. Generally, they have flavours characterised by trademarked brands, such as Skittles. These are all prohibited under the tobacco and related products regulations as they resemble food products, but they also exceed tank volume and nicotine content, too.

[Preet Kaur Gill]

Q In your opinion, does the Bill do enough to address the sale of vapes with illegal capacities and nicotine strengths? Will it give Government the powers they need to address future trends in this area?

Mr Lawson: From the products we have tested, 78% of those are already deemed illegal based on the tobacco and related products regulations, which are the current regulations in the UK, so enforcing those regulations more stringently would have removed most of the products that people are now using. Implementing new regulations on top of regulations that are not currently enforced may not be effective in reducing the number of those products being sold on the market.

[Trudy Harrison]

Q I am the very proud mum of four daughters, aged between 21 and 25. When I think back to them as teenagers, I do not think they would have found a unicorn, a cartoon character or a bubble gum flavour particularly trendy—when they were four or five, yes—so I do not buy the idea that teenagers are attracted to such things. I worry that whatever we manage to do to avoid cartoon characters or bubble gum flavours being prevalent just will not work. For example, cigarettes are still attracting many young people, which is why the Bill is needed. I think they taste absolutely revolting, but that is not putting children off. What are your thoughts on what needs to be done to prevent teenagers from finding vapes attractive?

Mr Lawson: I am not sure we can ever prevent any youth getting access to vapes—that is an impossibility. Youth are known to engage in risky behaviours, so they will drink alcohol under age and engage in risk-taking behaviour. What we can do is limit the drivers that bring youth to using vape products, such as flavours that are appealing or cartoons they are familiar with. These are small factors that play into the overall picture as to why somebody may pick up a vape when they did not previously smoke. That needs to be balanced with the question of adults quitting smoking. If you restrict flavours to only tobacco flavour, as we see in the US pretty much at the moment, adults are then limited to flavours that remind them of smoking, and that is probably less likely to reduce the smoking prevalence in the population.

--- Later in debate ---

[Mary Glindon]

Q The UK Vaping Industry Association, which represents the vaping sector but not any of the tobacco companies that produce vapes—I note that John Dunne, the CEO, is in the Gallery today —has suggested that the Government should include a vape retailer and distributor licensing scheme in the Bill. The industry has itself developed a comprehensive framework for such a scheme, which it claims is designed to, once and for all, deal effectively with the issue of underage and illicit vaping sales. Would that be a big step forward to cut out illicit vape sales?

Mr Lawson: The evidence I have seen is mainly from Spain, where tobacconists must be registered and licensed before they can sell products. In Spain traditionally, vape products have been sold only through licensed tobacconists. More recently, you can see them in convenience stores. I think we are seeing issues in Europe beyond the UK where products are now being sold illegally. Where they are sold in licensed outlets, you generally see much better compliance with the regulations. Obviously the licence can be removed, so it is a deterrent to the retailer to selling any of the products. That would be a good step in the right direction.

[Preet Kaur Gill]

Q You mentioned that your company is doing testing of products. One of the things that we heard just before your evidence was that what comes into the UK market obviously is not tested before it comes out, and we know that the illicit and non-compliant market is growing hugely. Can you talk us through what you do when you test your product? Where does it go?

Mr Lawson: The main driver behind testing has been to support trading standards in taking enforcement action against illegal products in the market. The testing has therefore focused on two main areas. One is the tank volume, the 2 ml, and the other is the nicotine strength, the 20 mg/ml, so the testing looks entirely at whether products are simply complying with the regulations. I did hear some of the last answers, but there is a very simple step: when it is applied, the MHRA notification scheme works fairly well. Most of the products that we test are not on the notification system—they are not on the MHRA’s portal. There is no check from a retailer or an importer that the products must be on that portal, so there is a bit of an issue there; you can effectively bypass the entire notification process by importing products and selling. Additionally, if the products do not contain nicotine, they are not subject to MHRA regulations.

[Preet Kaur Gill]

Q How are those products coming into the market?

Mr Lawson: They are being illegally imported. The majority of products are not produced in the UK; I would imagine that most products, if not every product produced here, would be compliant. These are products coming in from Shenzhen in China, generally. They are being illegally imported and illegally sold, so the question around taking enforcement action against the manufacturer may be fruitless, because you will not be able to enforce penalties against a Chinese manufacturer.

[Preet Kaur Gill]

Q Are they imported illegally in bulk?

Mr Lawson: I assume so. I am not sure whether Kate Pike from trading standards has given evidence, but trading standards has been involved in seizing quite a lot of products, particularly in Manchester, where there are container-loads coming straight in from China.

The other thing to mention is that vaping has been around in the UK for 14 or 15 years. It is only in the past two years that youth use has been a concern. This has come from the US, where youth use has been a concern for five or six years. The US has implemented new regulation that has prohibited almost all flavours. What we see now is a circumvention of products from the US to the UK, so these large tank sizes, cartoons and characterising flavours are products that were in, or were generated in, the US market and which are now coming to the UK, because the UK is a bit more of an open market for products to be sold. We can see that happening in Europe and some other countries as well, where products are now being trickled into the countries that have less stringent enforcement action.

[Preet Kaur Gill]

Q We heard yesterday that with tobacco, you have track and trace. Do you foresee that if we had a track and trace system for vapes, it should largely address some of this?

Mr Lawson: My personal opinion is that if the current regulations were enforced thoroughly, most of the issues we see today would not be a problem. If we go back two or three years, I would say that almost all products on the market would be compliant. We did not see large tanks or these characteristic products that are now illegal. If the Tobacco and Related Products Regulations 2016, which are the current UK regulations, were implemented or enforced properly, we would see a huge reduction in youth use, because those products that appeal to the youth would not be on the market.

[Dame Andrea Leadsom]

Q Thank you very much for coming today. Would you support an excise duty on vapes?

Mr Lawson: I am not sure that that is an appropriate question for me. I am a scientist, rather than a policymaker.

--- Later in debate ---

[The Chair]

We will now hear from Professor Allison Ford from the University of Stirling; Dr Rob Branston, senior lecturer at the University of Bath; and Professor Anna Gilmore, professor of public health at the University of Bath, who will talk to us via Zoom. We have until 4.25 pm for this session. Will the witnesses introduce themselves for the record?

Professor Ford: Thank you for inviting me to attend today. I am Dr Allison Ford, an associate professor at the Institute for Social Marketing and Health at the University of Stirling. I have worked in research in the area of tobacco control since 2009. Currently I am working on a large package of work on youth vaping, looking at youth responses to vaping products and the marketing environment of those products. More recently, I have been looking at their responses to other nicotine and tobacco products such as nicotine pouches and heated tobacco. We conduct large surveys with young people across the UK. We also speak qualitatively with smaller groups of young people.

Dr Branston: Thank you for inviting me. My name is Dr Rob Branston, and I am a senior lecturer in business economics at the University of Bath where I am part of the tobacco control research group. My interest in the tobacco industry is on the economic side, so I do research on industry taxation, responses to taxation, profitability, and responses to regulation more generally. That includes work on the illicit tobacco market. In the interests of transparency I should flag that I own 10 shares in Imperial Brands for research purposes. I do not get any financial interest from the company, but owning shares allows me to attend the AGM and ask questions that are useful in my research.

Professor Gilmore: Hi, I am Anna Gilmore, and I am a professor of public health at the University of Bath. I apologise as I cannot be there in person. I am currently on work travel and camped out at a colleague’s house in Copenhagen. My background is in medicine and public health. My work focuses on what we now call the commercial determinants of health, which is the way in which corporations influence health. I have a particular interest in this area and therefore in the tobacco industry.

[Preet Kaur Gill]

Q My question is to you, Anna. You and your colleagues have examined the ways in which what you term “unhealthy commodity industries”, such as tobacco companies, achieve their aims. Can you tell us a bit more about that, and how it relates to the measures in the Bill?

Professor Gilmore: We do work on unhealthy commodity industries, which include tobacco, alcohol, fossil fuels and ultra-processed foods. This is increasingly an issue, because what kills us, increasingly, are the products and practices of these corporations. The products of just those four industries account for at least a third of global deaths every year.

Obviously, their aims are to maximise profits, and we now know that their practices are incredibly similar in the way in which they lobby, market, use public relations to massage reputations and buy access to Governments. That is not only a direct problem, but, in a way, a wider system problem. Those industries cause this huge harm, but they do not actually meet the costs of that harm; instead, the individuals who are affected, we as taxpayers and Governments end up paying for those healthcare costs, and so on. We know that even the tobacco industry, despite high excise rates, does not fully meet the costs of the harm it causes, and this incentivises further harm. I would love to talk in detail about that—perhaps another time.

In relation to this Bill specifically, it helps us to understand a few issues. It helps to explain why we have a problem with smoking and youth vaping, because tobacco and vaping companies will market to children and make their products as attractive as possible. We know that the tobacco industry has historically manipulated cigarettes to make them as addictive as possible. In fact, if you look at tobacco industry documents, they are quite clear on that:

“The base of our business is the high school student.”

We know that the key reason we are facing these problems with new products such as vapes is that tobacco companies were under threat. We had done a good job on tobacco control globally, and smoking rates and cigarette sales were coming down; now, globally, those sales and rates are stagnating. The industry is fighting back, if you like. That is why we are seeing a whole host of new addictive products.

What is really worrying is the emerging evidence, both from animal models and human studies, that exposure to nicotine at a young age, such as vaping in teenagers, can effectively rewire the brain and increase the risk of addiction in the long term. For these companies, it is the perfect business model: they can addict them young, and then move them on from one product to another. We need to be very concerned about that.

What is perhaps most relevant is the overwhelming evidence that these companies will fight the legislation at every stage. We refer to this simply as block, amend, delay: they will try to block the legislation; if it goes further, as it is doing now, they will push to amend it and weaken it; and then they will push to delay it, including through litigation. Once it is implemented, they will also work to circumvent it and find loopholes, so we need to ensure that the legislation is watertight. We know that from past work we have done, such as with the ban on menthol, when the industry tried to introduce menthol cigarillos as a replacement for cigarettes by bringing in menthol accessories such as menthol cigarette papers and filters.

In terms of recommendations, I would say that you really need to be on guard against the arguments of the tobacco industry. Having looked at these over many pieces of legislation and in many jurisdictions, we can tell you that the tobacco industry’s arguments do not come true. They may be plausible on the surface, and I am happy to talk about them in more detail, but they do not come true. We also need to be aware of the third parties and front groups through which the industry operates. The tobacco industry has lost its credibility, so it works through third parties—organisations such as the Institute of Economic Affairs, and often through retail groups. I urge you to be cautious about who is approaching you, and to ask who really funds them. We need to be aware of amendments, too. I think we can be certain that the industry is working quite quietly this time, because, over the past few years, it has claimed to have changed. I think we need to be careful of the amendments that are coming in. Push against any industry efforts to delay the legislation. I would also urge you to be really cautious with any evidence or data that is presented to you, because we know from our past work—we did detailed work on standardised packaging when that came in, for example—that the industry will manipulate the evidence and data in its favour. Finally, I urge you to make the legislation as watertight as possible.

[Preet Kaur Gill]

Q On that, do you think that Government regulation in the Bill is sufficient, and will it improve public health?

Professor Gilmore: Yes, absolutely. I think the primary legislation is important for the smoke-free generation and to help address smoking, particularly among young people, and to de-normalise smoking. We know from past measures that de-normalising smoking can be important. What is useful are the powers to introduce secondary legislation. We are dealing with quite a lot of uncertainty in this area, and evidence is emerging all the time. What is useful is the ability to introduce some legislation and then further legislation later depending on the impacts and as new evidence emerges.

What is key is getting that secondary legislation right. Obviously, it has the potential to reduce smoking and vaping. There is some balance to be had on vaping because we need to reduce vaping in never-smokers, particularly young people, but still allow e-cigarettes to be available for smokers who are using e-cigarettes to quit. It is important to remember that they are obviously not the only quit product. It is important that we do not lose sight of the role of pharmaceuticals, which are actually more important, but there are some smokers who do quit with vaping products. There is that balance. I am happy to talk in detail about some of the things that I think could or should be in those secondary regulations, if that helps.

[Preet Kaur Gill]

That is great—thank you.

[Dame Andrea Leadsom]

Q Thank you all very much for being here today. Are any of you able to talk through the economics of the smoking industry, the vaping industry and, in particular, the illicit vaping industry? Do any of you have information on that?

Dr Branston: I can speak to at least some of your questions, so thank you for them. I think the starting point for understanding the tobacco industry is to understand that it is incredibly profitable. It is profitable like almost no other industry that we currently face. Not only are those profits large in total—I can tell you the world’s six largest cigarette manufacturers made profits totalling about $55 billion in the most recent year that I was able to track, which was 2018—but they make large profits in the UK. I last estimated that for 2022, and it was about £900 million annually. Equally, they make a large amount of profit for each unit sold. Their profit margins are in the region of 70%, meaning that for every £100 they get to keep, having paid all excise duty, £70 of that is just pure profit. The actions of the industry are entirely guided by wanting to maintain and expand those profits going forward.

The interesting facet is that big tobacco currently does not make much, if any, profit on its new-generation products, which include e-cigarettes and other products, such as heated tobacco products. The vested interest of big tobacco is to maintain the status quo. The issue of profitability in e-cigarettes is more difficult to talk about for the private companies because many of them are based in China and do not publish their accounts, so it is difficult to tell how much, if any, profit they are making. Ultimately, companies cannot continue in existence if they are losing money, so it is a reasonable presumption that they are making some levels of profit, because they want to continue selling these products. Hopefully that gives you some background.

--- Later in debate ---

[The Chair]

Q We will now hear from Professor Ann McNeill from King’s College London and Professor Robert West from University College London. Before we begin, I thank the witnesses for their flexibility in accommodating our rearranged schedule. We have until 4.55 pm. Would the witnesses please introduce themselves for the record?

Professor West: I am Robert West, professor emeritus of health psychology at University College London. I have been working in the field of tobacco and smoking since 1982. Most of my work involves clinical trials and large-scale surveillance of things such as smoking, vaping, quitting and so on.

Professor McNeill: Good afternoon, everyone. My name is Ann McNeill. I am a professor of tobacco addiction at King’s College London. Sheila Duffy yesterday referred to me as just a psychologist. I wasn’t quite sure what she meant by that. Just for the record, my first degree was in psychology and zoology and my PhD was on dependence on smoking. That included biomarker research, which I think was the context in which she made that comment, but for nearly 40 years—not quite as long as Robert—I have devoted my career to reducing the harmfulness of tobacco smoking and covered prevention, cessation and harm reduction.

I welcome the Bill, but I have a few comments on it. The smoke-free generation will, if properly enforced, remove smoking as the anomaly that it is, because we should not have cigarettes in our society, given that they are so uniquely dangerous. It will not do anything directly for the 6.4 million smokers that we have heard about. However, the Bill has helped to put smoking back centre stage in terms of its unique harmful properties. There has been a lot of noise about vaping over the past few years, so it is really good to be discussing smoking and its unique harmfulness.

It is really important, moving forward, that the Bill is in the context of a comprehensive tobacco control strategy, for which there continue to be mass media campaigns about the dangers of smoking and other smoking control strategies. That will really help to drive down health inequalities, given that we know that smoking is higher among the more disadvantaged. We have heard about that during these hearings.

To add to what Mark Rowland said, because mental health is an area I have worked in quite a bit, most of the 15 to 20-year life expectancy gap is because of the fact that people with mental health conditions are more likely to smoke. But the reason I mentioned smokers is that I think we have got to be really careful not to have any unintended consequences from the Bill that keep smokers smoking or drive people who are vaping to relapse to smoking. Though I welcome things such as putting electronic cigarettes behind the counter in shops and removing some of the packaging and branding of e-cigarettes, one area we do need to be careful of is flavours, because we know from research that they are important for smokers when they are trying to stop.

[Preet Kaur Gill]

Q Robert, can you talk about the UCL smoking and alcohol toolkit studies’ findings on public views on smoking cessation and measures in the Bill?

Professor West: Yes. Probably even better is the ASH survey, particularly in relation to public views on the policies being proposed. What is interesting about both surveys is that, as many of you will be aware, there is widespread support for what some in years gone past might have seen as quite a draconian Bill that phases out smoking. That is testimony to how far we have come with the policies we have adopted, with credit to successive Governments—all Governments have kept their foot on the accelerator in addressing the issue, and it has paid off. Probably for the first time in any country in history, we are in a position where this is a serious, viable option in terms of public sentiment.

If you have not had a chance to look at the smoking toolkit study, go to smokinginengland.info. The study gives you a month-by-month analysis of key parameters, including things such as vaping and vaping in particular age groups. I do not want to bang on about vaping too much, because the key thing is smoking; but as is often the case with what they call a diffusion of innovation, when you look at the data you will see an acceleration and things look as though they are going in a terrible direction, and then at some point other factors kick in. For the last couple of months, vaping rates, particularly among never-smokers—the key people we are interested in—and young never-smokers have plateaued. We do not know whether the rates would go up again, but I think that means that if we can put a lid on it through the Bill, there is a very good chance that we could get the vaping rates down again.

[Preet Kaur Gill]

Q Ann, do the measures in the Bill equitably benefit all people affected by tobacco and vaping products?

Professor McNeill: As I mentioned in my opening comments, the people affected by the Bill will be people who are vaping and/or smoking, people who might take them up, and people around them. It will certainly drag down smoking uptake. My main issue is around encouraging people who smoke to stop, given that more people from disadvantaged groups smoke. As long as we maintain the focus on smoking with the Bill and provide support for smokers to stop—that includes vapes, which are effective tools—then yes, it can drive down the health inequalities caused by smoking.

[Dame Andrea Leadsom]

Q Thank you both very much for being here. As I have said to other health professionals, what you say can be incredibly helpful in allowing the Bill to pass through smoothly, because people make some very big challenges, namely that this is all just about freedom of choice, vaping is fine and there is nothing wrong with it. With that in mind, I would be grateful if you could try to ensure that you give us material with which to address some of those challenges.

Professor McNeill, we heard earlier that there is no evidence on what happens to a baby born addicted to nicotine or what the impacts are for that baby. I was advised that you might have a view on that.

Professor McNeill: We can certainly ensure that we provide written evidence afterwards. The more concerning issue is some of the other constituents that go through to the foetus, such as carbon monoxide, which can have a devastating effect on the baby. On vaping in relation to pregnancy, we have seen in research that when people have used vaping, it is an effective tool for stopping smoking, which is really important, and it does not have any more adverse effects than nicotine-replacement therapies. My concern would be about smoke constituents more than nicotine addiction, which is highly unlikely if nicotine is used during pregnancy. I hope that makes sense.