Tobacco and Vapes Bill (Fourth sitting)

Rachael Maskell Excerpts

Committee stage
Wednesday 1st May 2024 Public Bill Committees

[Mary Kelly Foy (City of Durham) (Lab)]

Q Good afternoon to you both. You have explained to us the horrors and the multitude of harms that tobacco smoke can have on an adult who smokes. Can you explain a bit about the effects that second-hand tobacco smoke has on children, who have even less choice in the matter?

Professor Agrawal: We know that second-hand smoke causes a range of diseases for children, whether that is triggering asthma exacerbations or infections, such as middle-ear infections. There is a bunch of infections that are much more likely in children whose parents, carers or siblings smoke, and they are exposed to that second-hand smoke. By treating adults who smoke and helping them quit, you will also help their children.

One thing I did not talk about earlier was the impact on poverty. Helping adults to stop smoking increases household income and reduces child poverty. Action on Smoking and Health has estimated that something like 250,000 children live in households that are below the poverty line because of adults spending on smoking. Stopping smoking has myriad benefits, whether helping children, reducing poverty or reducing health inequality. That is why this Bill is so pleasing.

Tim Mitchell: From a surgical point of view, in my practice as an ear, nose and throat surgeon, one of the commonest conditions we see is glue ear in children. That is a condition where fluid behind the eardrum affects hearing, and potentially affects speech. That is the condition for which children sometimes have grommets or ventilation tubes put in their ears. It is one of the commonest operations that children undergo. The risk of that is significantly increased in children who live in households with smokers. There are other disease pressures as well, as my colleague alluded to. It has a significant impact.

[Rachael Maskell (York Central) (Lab/Co-op)]

Q Are we missing an opportunity to create a nicotine-free generation, alongside a smoke-free generation? We heard earlier that GPs were not able to prescribe vapes. Would that help your practice and help people quit, if you had those tools in your hands when seeing your patients, to encourage them to transition from smoking, which is so dangerous, to vaping?

Professor Agrawal: The first question was?

[Rachael Maskell]

It was about a nicotine-free generation.

Professor Agrawal: Because people are addicted to nicotine, often at an early age, they find it impossible not to have some nicotine. The danger of banning nicotine altogether is that it will perpetuate smoking. People will go to the only form of nicotine they can buy, let us say, and if that is tobacco, they will just carry on smoking. I would worry about banning nicotine and all nicotine products, because it means that the 6.4 million smokers will not have anything else to go to.

[Rachael Maskell]

Q It will rise in line with the smoke-free generation. These would be people who are non-smokers, because they would be children born after 1 January 2009.

Professor Agrawal: Oh, I see. I do not know, is the answer to that question. The second question—

[Rachael Maskell]

About prescribing.

Professor Agrawal: Prescription, yes. That might be a helpful adjunct, inasmuch as it would give healthcare professionals safety in the knowledge that a product has been tried and tested and could be prescribed. If they were unsure about e-cigarettes and which to recommend to patients, having a prescribable e-cigarette could be helpful.

The only downside is that, as I am sure the Committee knows, the e-cigarette market changes at lightning speed. What is licensed one day, the very next day would not attract anybody, or nobody would want to use it. That is the only con, as it were. It certainly might have a role in helping medical professionals prescribe and have confidence in using a product that has been deemed to be safe.

[Dame Andrea Leadsom]

Q Further to that, I would like to probe a bit on that, because it has been put forward that some colleagues would prefer prescription-only vapes. However, from speaking to vapers myself and having done some visits to meet with enforcement officers and so on, it seems that users of vapes like the variety. They say, “I don’t want to vape tobacco flavour; I want to vape strawberry flavour.” There is another side to this argument, which is that you should keep different flavours in order to avoid people who are smokers going back to smoking because they are not getting enough choice. You just said that it would be good to have prescription-only vapes, but would that not fly in the face of how people use them? That is why that is not in the Bill at the moment. I do not want to set hares running where, in fact, the practical reason for not saying that vapes should be prescription-only is exactly that of consumer choice and trying to avoid people going back to smoking.

Professor Agrawal: Maybe I was not clear. I do not think that we should have just prescription-only vapes. It would be an adjunct to all the other vapes out there to give that choice to people who want to use vapes to quit and access all those flavours and different types of vapes. There are several different types of vapes as well as the flavours and so on, and that choice has driven people who smoked to use them to help them to quit. They can do it themselves, they have the hand-to-mouth movement—a whole combination of things attracts them to vapes to help them to quit smoking. Having only one product would be a disaster.

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[Dame Andrea Leadsom]

Q Would it be reasonable for those of us who are suspicious about, for example, the marketing of vapes to children to suspect that the reason we do not see vape companies coming forward to try to license a medicinal prescription vape is that the products and the manufacturing processes are not good enough, and it would be very hard to meet the bar for a medicinal product, or would that be unfair?

Dr Squire: I would be speculating if I said that. It takes time and money to collate the dossier to prove the products’ quality. The products are not necessarily worse, but they have to go through quite a process to prove it, so I think it is that, rather than anything else.

[Rachael Maskell]

Q I have just one question, which is a particular concern of mine. Vapes are a delivery product for a liquid. I am concerned about the illicit market, which is now utilising vapes for Spice, cannabis and a new generation of synthetics as well. Is there work going on to produce testing kits, so that the liquid can be tested? I understand that testing kits would have to go through a regulatory process with you as well. If not, why not? Surely we need to get ahead of the curve in keeping people safe from a new generation of illicit drugs.

Dr Squire: I think that would probably be under the consumer products regulations. If it was testing the actual product, that is not something that the MHRA would do as it is not a medical product. What we test is medical products and whether they are safe, effective and made to the right quality, but testing part of the device—

[Rachael Maskell]

Q But the testing kit would have to come through you?

Dr Squire: It would depend on what it was defined as. I think we could be going into the medical device regulations. I am thinking on my feet, but I would say that a testing kit to test a product would probably not be “for a medical purpose”. It probably would not be under the medical device regulations because the testing kit itself does not have a medical purpose, but it is quite a fine line. We would need to look at the actual testing kit and its purpose.

[Dr Johnson]

Q I want to make sure I have it clear in my head. If someone wants to license something as a medicine or a medical product, they have to go through the more complicated, more expensive process and show you that it is safe, properly made and works as it says it will, and that the risks are outweighed by the benefits of the product. If they want to list something as a product for sale, do they just tell you that they are going to do it and you do not test any of those things?

Dr Squire: No, they are under different pieces of legislation.

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[Dr Johnson]

Q This is very interesting evidence. I want to ask you about flavours. I note that more recently we have started to see flavours among the nicotine pouches that you have just described. I introduced a ten-minute rule Bill last year to ban disposable vapes, because I am concerned about their attractiveness to children and their environmental impact. As part of that, I met representatives of the vaping industry, who told me that the reason they have flavours is essentially to maintain an addiction.

If a person uses a standard stop smoking device, such as a nicotine patch or nicotine gum, the natural history is that they smoke, they use the said gum or patch, they wean themselves off the gum or patch, and then they are no longer a customer providing the industry with revenue. If a person uses vapes, however, they have a choice of flavours that help to maintain the addiction. One thing we have seen with the Bill, which contains powers for the Government to potentially regulate the flavours, is that people are using the argument that it will prevent smokers from stopping smoking. They are trying to argue that flavours do not attract children, but the evidence says otherwise. Do any of you have any comments on that?

Professor Ford: It is true that the flavours are part of the appeal of these products for young people. That appeal is made up of a whole marketing mix of things, and flavours are one element of that. We know that adults like flavours as well, and they might help some adult smokers to migrate away from tobacco, so that is also a factor.

The concern is the vast number of flavours that are available—there are thousands. The way they are described is also an issue. In our pack analysis, we looked at how all the flavours are described: you have a basic flavour such as strawberry, or a flavour blend, but you also have what we call flavour concepts, which do not denote a flavour at all. We had examples such as tiger blood and koala drool. I do not know what they taste like, but they are certainly not flavours that I am aware of.

We believe that those descriptors are tapping into this youth culture and youth slang—some other kind of imagery. They go beyond the factual content of a flavour. One easy way to help to restrict the appeal around flavours would be to restrict those flavour descriptors in the first instance. I think it is great that the Bill would contain the power to go on to restrict flavours if that is the right thing to do.

Dr Branston: Can I add that these are profit-seeking companies? They will do what they can to continue to make the profits that they are making. The profits are as addictive as the products that they make, so it is not in any way surprising to me that they design their products to be as appealing as possible to consumers, as well as being as addictive as possible to consumers.

[Rachael Maskell]

Q I want to come back to the point about advertising. Should the legislation bring tobacco advertising and vaping advertising into line so that the same standards are applied across all products?

Professor Ford: That is something to consider. As I said in my previous answer, it is the whole marketing mix of the current vaping products that has led to the rapid rise in youth use. That includes not only the packaging, the retail displays, which we have spoken about, and the flavours, but the actual product design: the price, the promotion, the price promotion, the images on social media, the posters in the shop window—there are a lot of youth cues and messages in some of those—the accessibility, because of the wide variety of retailers that sell these products, and the user imagery. We find when we speak to young people that they associate vapes not with cessation, but with social vaping.

It is important for the Bill to be mindful of all of the marketing mix, and I would put sponsorship in there as well. We know that there has recently been investment from tobacco companies in outdoor advertising for their vapes, and we are seeing a lot of sponsorship of nicotine products at music festivals and music events and in the sports sponsorship that I mentioned earlier. It is really important to be mindful of all those marketing avenues.

[Rachael Maskell]

Q You have talked about alternative products. We know that the industry is very adept at switching products to avoid regulation. Should we be creating a nicotine-free generation alongside a smoke-free generation, so that people who have never smoked will also not have access to nicotine products?

Professor Ford: We do need nicotine products on the market, because we know that they can be helpful for adult smokers.

[Rachael Maskell]

Q But these people have never smoked, because, having been born from 1 January 2009, they would not have been introduced to smoking. That would be unlawful.

Professor Ford: Given the potential harm that nicotine can cause to young people, and the fact that generally everyone is in agreement that if you have never smoked, you should never vape, yes. I do not see an argument why we would need young people to use nicotine. That is my personal view.

Professor Gilmore: I would support that. These measures have been put in place in some cities in the US in Massachusetts and California, where they have implemented both smoke-free and nicotine-free generations. They have not been evaluated yet, but I know that other cities are now implementing the same policies, so I think they must have been going reasonably well. I am in touch with colleagues in the US to try to get any evidence from those measures as they emerge.

You are right: nicotine, as I mentioned, is harmful to the developing brain, so ideally we should be aiming for smoke-free and nicotine-free generations in future, in line with the smoke-free generation legislation, while making sure that current smokers are able to quit using nicotine. But that is recreational nicotine, not pharmaceutical nicotine.

[Mary Kelly Foy]

Q I think a lot of people will be quite shocked at the statistics that you have just outlined to us on the profits big tobacco is making and the shocking tactics it uses to keep users addicted, ultimately killing half the people who buy its products. I know that this is not in the Bill, but would you support a “polluter pays” levy, so that at least the tobacco industry could give something back to society for the harm it is causing at an individual level, by killing people, and at the societal level, at the expense of our NHS? Do you think that that could be added to the Bill? I do not want to put you on the spot with that question, but in principle would you support a levy on the tobacco industry?

Dr Branston: Absolutely. I would very much welcome that. It is obscene that the industry can make so much profit by killing up to two thirds of its long-term users. Addressing that profit incentive will go a long way to stopping the interest that the industry has in selling these deadly products. As you know, those products cause massive costs to society, so I think it is entirely reasonable that the companies make a bigger contribution.

In that regard, I know that the excise tax that is currently levied on tobacco products is not directly paid by the tobacco firms—it is passed on to smokers who are addicted to those products—so the “polluter pays” levy is an idea that I would strongly support. I encourage others to do so as well. Not only does it have the economic advantage of raising money that could be used to address the harms caused by smoking, but it would restrict the industry’s ability to price its products as it is currently able to. We know that it uses clever pricing tactics to make tobacco both affordable and profitable for the industry. On every level, a “polluter pays” levy would be a win-win for society, so I absolutely support it.

Professor Gilmore: I would support that 100%. If I go back to my response to the earlier question about how we have a system problem, that is the sort of measure that can help us to address that system problem. Dr Branston and I have published on the idea of “polluter pays” or using a price cap system, so there is some evidence out there, and some evaluations or modelling of the impacts it might have and the revenue it would bring in. I would really support that.

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[Rachael Maskell]

Q I would like to ask one further question, if time will allow, about the locations where people can vape. Smoking has now been banned in indoor places, cars travelling and cars with children present. Would the same impact around deterring people from vaping occur if the same statutory requirements were put in place?

Professor Gilmore: Smoke-free legislation had a number of impacts. It was primarily there to protect non-smokers from the effects of second-hand smoke, which we know is harmful, and it was successful in that: we evaluated it and showed reductions in admissions to hospital for heart attacks, asthma and so on. We know far less about second-hand vape, if you like, but smoke-free legislation also de-normalised smoking. I think that having vape-free public places would go towards de-normalising vaping, which is also really important, particularly among younger people.

The other thing, of course, is that the more you vape, the more nicotine you are taking in and the more you are addicted. If you can do it in public places and in workplaces, you can get more and more addicted; some ex-smokers have said to me that they find that a problem, because they can just keep vaping in some places, so they are now using more nicotine than ever before. I suppose it is theoretically possible that if they were not able to vape, they might shift back to smoking, but I do not think they would: we do not have any evidence for that and I do not think that that even really makes sense. Certainly, in terms of de-normalising vaping and reducing addiction, there would be benefits.

[The Chair]

There are no further questions. I thank the witnesses on behalf of Committee members.

Examination of Witnesses

Professor Robert West and Professor Ann McNeill gave evidence.

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[The Chair]

Rachel Maskell. Yours will probably be the last question.

[Rachael Maskell]

Q I want to follow on from that theme on advertising and to take your opinion about advertising, promotion and sponsorship. We have seen the vaping industry very much following the lines of how the tobacco industry evolved in the way that it is very adept at promoting its products. Should there be a ban on advertising as there is for tobacco? First, for simplicity, so everyone knows what the rules are, and secondly, for effectiveness—that is, to discourage a new generation of vapers?

Professor McNeill: My view is that there is a bit of a danger if we put smoking and vaping on exactly the same footing. One problem we have behind the perception about the relative risks of the two products is that, for example, fewer than one in 10 smokers knows that vaping is a lot less harmful than smoking, so I would be wary of putting them on exactly the same footing. It is important that we try to distinguish the relative risks through what we do. I think we can further reduce the advertising of e-cigarettes, particularly, as I have said, in shops, because that seems to be one area where young people can buy these products that are heavily promoted, and the branding is in itself a form of advertisement.

Professor West: I agree. I think the key thing is the messaging in the advertising. It is already the case, if I understand it right, that you are not allowed to advertise e-cigarettes as a fashion item or leisure product.

[Rachael Maskell]

Q They are on football shirts. When we pressed a company that came to our Select Committee, they said, “This is a public health message.” They did not have “do not smoke” on the shirts, so I did not buy that, because they are trying the same tactics.

Professor West: That, in a way, is a question of implementation. I agree with you. Just putting a brand on a shirt is not a message saying, “This can help you stop smoking.” If they had put, “Use this to help you stop smoking” on the football shirt, maybe it would be a different thing. Ann’s point is also a very important one.

The weirdest sort of miscommunication that we have had over recent years is that as evidence has accrued that e-cigarettes are less harmful than smoking, the perception that they are more harmful than smoking has increased. Obviously, there is a whole bunch of things going on, but it is a deterrent. Not only do we know this from the surveys, but I have been talking to a lot of people—intelligent academics even—who say, “Why would you switch to e-cigarettes? They are just as harmful as smoking.” We are not getting that message across.

Whatever we do in relation to indirect messaging that might create a sense of equalisation or equality between e-cigarettes and smoking, we have a big comms job to do to make sure the message gets across that it is not the only method of stopping smoking, but it is an important one that a lot of people can use even if they do not, for example, use stop smoking services.

[The Chair]

Mary Kelly Foy has the final question.