Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697641990798.pdf (Australia)
Senate Inquiry on Tobacco Harm Reduction Submission from Cancer Council, National Heart Foundation of Australia and Australian Council on Smoking and Health, November 2020 Content is authorised by Ms Libby Jardine, Chair of the joint Tobacco Issues Committee of Cancer Council, the National Heart Foundation of Australia and the Australian Council on Smoking and Health.
Cancer Council, the National Heart Foundation of Australia and the Australian Council on Smoking and Health are leading non-government organisations in tobacco control in Australia, formally involved in the research, advocacy and delivery of all the major reforms that have led Australia to have among the world’s lowest smoking rates.

Tobacco use is the leading cause of preventable cancer and cardiovascular death and disease in Australia.
Reducing tobacco harms is our core business, individually and through our formal alliance.

The most effective approach to tobacco harm reduction is to protect young people from smoking and support evidence-based measures for assisting smokers to quit.
If the evidence supported electronic cigarettes (e-cigarettes) as an aid to quitting smoking, overcoming nicotine addiction, and conferring a public health benefit in Australia, we would proactively support their use and expect Australian government health authorities to promote them.
However, as summarised in this submission, the evidence, where reviewed and presented systematically by independent health authorities, has consistently shown that use of e-cigarettes and other novel products poses significant health harms and risks to the Australian population, with no conclusive evidence of a health benefit.
The US Surgeon General has recently stated “there is presently inadequate evidence to conclude that e-cigarettes, in general, increase smoking cessation.” (1) Recommendations We recommend that the Committee and the Australian Senate recognises and reports that: • The Australian Government has already invested substantially in the collection, analysis and review of the evidence on e-cigarettes through rigorous, independent scientific frameworks and processes protected from lobbying and political interference.
• The House of Representatives inquired into the use of e-cigarettes in Australia in 2017 and reported in support of Australia’s precautionary position, and that the evidence (as summarised in this submission) underpinning Australia’s precautionary position has strengthened over the past three years.
Inquiry into Tobacco Harm Reduction - Cancer Council, Heart Foundation and ACOSH response 1 Tobacco Harm ReductionSubmission 194 • Australia is a world leader in public health compared with similar countries, in matters ranging from its handling of COVID-19 to smoking rates, in large part because it defers to independent expert advice and decisions protected from individual opinion, lobbying and political interference.
• Australia continues to base its public health policy on e-cigarettes and other novel tobacco products according to the findings of independent, statutory authorities and expert health and medical research institutes such as the National Health and Medical Research Council and the Australian National University (currently funded by the Australian Government to review the evidence on e-cigarettes) and the Commonwealth Science and Industry Research Organisation.
• Evidence on the risks, harms and potential benefits of e-cigarettes must be reviewed systematically and consider all the effects on the health of the entire Australian population.

• Our independent, statutory authorities and health and medical research institutes have systematically reviewed the evidence to date and concluded that e-cigarettes pose more harm than benefit to the Australian population.
• Key research findings strengthening the evidence for Australia’s precautionary position on e-cigarettes include evidence that: a) non-smokers who initiate e-cigarette use are three times more likely than non-e- cigarette users to take up smoking; b) former smokers who use e-cigarettes are twice as likely to relapse back to smoking than non-e-cigarette users; c) e-cigarettes are either ineffective as a cessation aid or no more effective than safer alternatives including those approved for therapeutic use; and d) e-cigarette use in Australia is highest in teenagers and young adults.
• Rates of e-cigarettes use in Australian children are increasing and require improved controls to protect young Australians from the harms of e-cigarette use and nicotine addiction.

• Although liquid nicotine cannot be obtained in Australia without medical authority, Australian children are obtaining e-cigarette products.

Further tightening of controls on access and all forms of promotion is required to protect the health of young Australians.
Overview Cancer Council, the National Heart Foundation of Australia and the Australian Council on Smoking and Health take this opportunity to summarise the evidence on the risks and potential benefits of e-cigarettes in Australia.

There is insufficient evidence to support the efficacy of e-cigarette use as an aid to assist people to quit smoking.

(2) There is strong evidence of e-cigarette use as a precursor to smoking combustible cigarettes in young people.
(2-4) This is the second time in three years that a federal parliamentary committee has inquired into e-cigarettes.

The evidence supporting Australia’s precautionary position on e-cigarettes has strengthened over that period.
The previous inquiry recommended that Australia Inquiry into Tobacco Harm Reduction - Cancer Council, Heart Foundation and ACOSH response 2 Tobacco Harm ReductionSubmission 194 continue to update the evidence on e-cigarettes through the National Health and Medical Research Council (NHMRC), (5) and ongoing expert research.
(6) This has occurred, and is continuing to occur, with an ongoing strengthening of the evidence to support both the previous inquiry’s recommendations and the precautionary position of all federal, state and territory governments.

(7) Relentless lobbying to promote e-cigarettes, driven primarily by commercial interests and entities funded by commercial interests continues.
Fortunately, our young people’s health has to a large extent been protected by evidence-based frameworks which underpin the development of public health policy and by all nine Australian governments recognising the evidence on e-cigarettes and committing to a precautionary position.

E-cigarette use in Australian teenagers has nonetheless increased significantly over the past three years, as commercial entities continue to flout measures to protect young Australians from nicotine addiction.
It is therefore critical for the Senate to recognise that, inquiring into a complex population health matter within a non-systematic framework over eight weeks, allowing four weeks for written submissions, is no substitute for the systematic reviews underway over several years via Australian health authorities and the Australian National University (ANU).
The Australian Government Department of Health has already commissioned the ANU to comprehensively review the health impacts of e-cigarettes, through a research grant and project that commenced in late 2018 and is expected to report in detail in mid-2021.

Its preliminary analysis was published on 30 September 2020 and covers key matters in this Senate Inquiry’s Terms of Reference a) to f) through a systematic review.
The NHMRC has funded a further 13 research projects on e-cigarettes, including in relation to matters raised in this Senate Inquiry’s Terms of Reference, and has to date found the risks and harms outweigh potential benefits.

When we presented at the House of Representative Inquiry in 2017, we emphasised the NHMRC’s findings and the independent role of the Therapeutic Goods Administration (TGA).
Three years later, the NHMRC has updated and maintained its position on the evidence, the Commonwealth Science and Industry Research Organisation (CSIRO) has published a systematic review which concurred, and the TGA is reviewing nicotine scheduling, having rejected an application to exempt nicotine from Schedule 7 at concentrations of 3.6 per cent or less of nicotine for self-administration with an electronic nicotine delivery system (‘personal vaporiser’ or ‘electronic cigarette’) for the purpose of tobacco harm reduction in 2017.
(8) We trust that the Senate will recognise the ongoing work of Australia’s independent statutory health and medical authorities, and the ANU’s world-leading Centre for Epidemiology and Population Health Research, in systematically reviewing the evidence – and that the Senate will support Australia’s deferral to the evidence in the development of public health policy.
We also trust that the Senate will recognise the growing alarm among Australian parents, whose teenage children (14-17year olds) represent the second largest current e-cigarette user group by smoking status in Australia.

(9) Our response to the terms of reference follows.

We defer to the evidence, published by Australia’s leading medical and scientific research institutes and independent statutory authorities, rather than attempting a systematic review in four weeks.
We call on the Australian Government not to be distracted by the relentless lobbying of commercial interests, and tobacco industry supported front groups, but to focus on proven and evidence- Inquiry into Tobacco Harm Reduction - Cancer Council, Heart Foundation and ACOSH response 3 Tobacco Harm ReductionSubmission 194 based strategies, including those that have significantly reduced smoking in Australia over the last 40 years.
We ask that this Senate Committee does the same and endorses the evidence-based approach outlined in the World Health Organization Framework Convention on Tobacco Control.

(10) Addressing the terms of reference a. the treatment of nicotine vaping products (electronic cigarettes and smokeless tobacco) in developed countries similar to Australia (such as the United Kingdom, New Zealand, the European Union and United States), including but not limited to legislative and regulatory frameworks.
It is well documented that Australia takes a more precautionary approach to the promotion and availability of e-cigarettes than the United States (US), United Kingdom (UK), New Zealand and a number of countries in the European Union.

Australia’s precautionary approach is supported by the evidence and has been recommended by Australia’s independent statutory health and medical authorities.
(2-3,5) In our view, consideration of selected international approaches to e-cigarette controls is of limited benefit, given: • Australia’s extraordinarily low smoking rates, particularly among young people (who are most aggressively targeted by the tobacco industry and other e-cigarette entrepreneurs); • Australia’s global standing as a leader in tobacco control policy (the reason for the outstanding successes in reduced prevalence); and • The integrity and effectiveness of Australia’s world-leading statutory authorities on medical research and therapeutic goods, which have already provided precautionary advice on e-cigarette use and availability specific to Australia.
Contrary to some claims, developed countries similar to Australia (such as the UK, New Zealand, US and Canada) do not have lower smoking prevalence than Australia.

(11-14) These countries introduced evidence-based reforms in tobacco control such as advertising bans, smoke-free legislation, graphic health warnings and plain packaging later than Australia.

(15) Australia also has a strong record in reducing youth smoking rates as well as extremely low and decreasing current youth smoking rates to protect.
Daily smoking rates among 14-17 year olds have decreased from 11.2% in 2001 to 1.9% in 2019.

(16) This is a critical consideration, in view of the documented harms and increasing use of e-cigarettes in young people in these similar countries.

(17-18) E-cigarette usage rates in teenagers and young adults in Australia are increasing and on current trends will continue to increase unless more effective controls are put in place.
(16) Any relaxing of access to e-cigarettes and increasing use among older populations risks increasing youth uptake and related smoking; evidence shows use of harmful substances in youth is correlated to use in older age groups.

(19-20) Our organisations are greatly concerned about this risk to young Australians.
Given this, we challenge the logic of comparing what some other countries are doing – rather than applying the evidence – by a parliamentary inquiry relating to public health policy in Australia.

Australia has for decades deferred to statutory processes and evidence review to inform public health policy.

This includes analysis of all the evidence, within systematic frameworks, applied to the Australian population and Australian policy settings.
A key strength of the ANU’s review is that it is reviewing international evidence on e-cigarette use in relation to the health and characteristics of the Australian population.
Inquiry into Tobacco Harm Reduction - Cancer Council, Heart Foundation and ACOSH response 4 Tobacco Harm ReductionSubmission 194 In our view, the most effective and efficient way to capture a global snapshot of e-cigarette use and regulation is to defer to the World Health Organization, which advises, inter alia that:(21) • Countries with low smoking rates, particularly in young people, should be cautious about promoting e-cigarettes; • Policy makers should be guarded against “unproven health claims”; and • Public health policies relating to e-cigarettes should be “protected from commercial and other vested interests”.
It is the evidence, not observations about what some other countries have chosen to do, which should inform public health policy in Australia.

Any departure from this would set a dangerous precedent.
b. the impact nicotine vaping products have had on smoking rates in these countries, and the aggregate population health impacts of these changes in nicotine consumption; Gateway to smoking The ANU has reviewed international literature on patterns of e-cigarette use and reported that in countries where e-cigarettes are available as consumer goods, such as the US, e-cigarette use is becoming increasingly common, particularly among youth.
(2) Recent data indicates that 10-20% of US high school children report recent use of e-cigarettes,(2) which has been described by the US Surgeon General as an ‘epidemic’.

(22) In 2018, the CSIRO also conducted a review on the rates of tobacco smoking in countries where e-cigarettes are available and reported that there does not appear to be a consistent relationship across countries between e-cigarette use and smoking rates.
(3) Higher rates of smoking in women are generally associated with higher rates of ‘ever-use’ of e-cigarettes.

(3) The CSIRO review found strong and accumulating evidence that e-cigarette use by young people leads to an uptake in smoking combustible cigarettes.

(3) A positive association was found between the initiation of combustible smoking following use of non-nicotine as well as nicotine containing e-cigarettes.
(3) Preliminary analysis by ANU reported that people 30 years or under who had initiated e-cigarette use were around three times as likely as those who have not used e-cigarettes to try smoking combustible cigarettes and transition to regular tobacco smoking.

(2) An international review also found a positive association between e-cigarette use and transition from never smoking to smoking combustible cigarettes among youth and young adults.

(4) These reviews confirm a “gateway” effect.


The association between e-cigarette use and subsequent tobacco smoking would, in our view, explain the aggressive promotion of e-cigarettes by tobacco companies and the marketing techniques designed to appeal to younger people.

(23-24) E-cigarettes come in a vast range of flavours including fruit, confectionary, chocolate and other varieties that appeal to children and young adults.
The targeting of young people is out of step with (unsubstantiated) claims that e-cigarettes are a cessation aid or harm-reduction alternative for heavily addicted, long-term smokers – most of whom are in significantly older age groups.

The ANU review found that current patterns of use in Australia are largely inconsistent with short term use of e-cigarettes for smoking cessation.
Patterns are more consistent with Inquiry into Tobacco Harm Reduction - Cancer Council, Heart Foundation and ACOSH response 5 Tobacco Harm ReductionSubmission 194 people using e-cigarettes in addition to combustible cigarettes, substitution of combustible tobacco smoking with e-cigarettes and uptake of e-cigarettes by people who have never smoked.
(2) E-cigarette health impacts The NHMRC CEO statement advises that “e-cigarettes may expose users to chemicals and toxins, such as formaldehyde, heavy metals, particulate matter and flavouring chemicals, at levels that have the potential to cause adverse health effects”.

(5) Similar findings were reported by the CSIRO review in 2018.

(3) Due to the lack of long-term studies, the magnitude of adverse health effects and the quantity of e-cigarette use required to trigger adverse health effects is unknown.
(3) Propylene glycol and glycerin are often added to e-liquids as humectants, and when overheated can produce dangerous levels of the carcinogens formaldehyde and acetaldehyde.
(25-26) Health harms associated with inhaling vaporised nicotine, and nicotine exposure more broadly, include: • Acute myocardial ischemia which contribute to Coronary Vascular Disease; • Respiratory disorders through effects on the lungs and central nervous system; • Risk of kidney disease due to loss of renoprotective mechanism; and • Immunosuppression including delayed wound healing and increased infection.

(27) Nicotine is the drug in tobacco, and in novel tobacco products, that causes addiction.
(28) Nicotine can also directly contribute to both the onset and growth of various forms of cancer,(29-30) as well as compromise the effectiveness of cancer treatments, including chemotherapy and radiotherapy.

(31) Due to the infancy of e-cigarettes to the market, controlled studies on the long-term safety and health effects associated with e-cigarette use and exposure to second-hand vapour are limited.

It should be noted that it is too early for conclusive evidence on the health harms of e-cigarettes.
c. the established evidence on the effectiveness of e-cigarettes as a smoking cessation treatment; In 2017, the NHMRC CEO statement on electronic cigarettes reported that “there is currently insufficient evidence to conclude whether e-cigarettes can assist smokers to quit”.

(5) Reviews by the ANU, CSIRO and the National Academies of Sciences, Engineering, and Medicine (NASEM) have further supported this position.
(2-4) These reviews have reported that the quality of studies examining the effectiveness of e-cigarettes for smoking cessation is low,(4) and concluded that there was insufficient evidence to support e-cigarettes as a cessation aid.
(2,4) While there is some evidence that nicotine containing e-cigarettes may increase quit rates,(32) the few randomised controlled trials conducted were small and the quality of evidence was low, and the use of e-cigarettes was generally accompanied by intense behavioural counselling.

No brand of e-cigarettes has been approved as a cessation aid by the Therapeutic Goods Administration.
In 2019, the Royal Australian College of General Practitioners advised that the strongest evidence base for efficacy and safety is currently for approved pharmacological therapies combined with behavioural support.

(33) There are also concerns that using e-cigarettes, especially nicotine-delivering, may significantly delay the decision to quit smoking,(34) and subsequently prolong exposure to nicotine through ongoing exclusive use or dual use with combustible cigarettes.
(2) Inquiry into Tobacco Harm Reduction - Cancer Council, Heart Foundation and ACOSH response 6 Tobacco Harm ReductionSubmission 194 E-cigarettes should only be made available as a smoking cessation aid if they are approved by the Therapeutic Goods Administration.

There should in any event be very strict controls on all forms of marketing and promotion, direct and indirect, of these products.
d. the established evidence on the uptake of e-cigarettes amongst non-smokers and the potential gateway effect onto traditional tobacco products; There is strong and growing evidence that e-cigarette use leads to tobacco smoking among never smokers, particularly among youth and young adults.

(2-3) As mentioned, never smokers who use e-cigarettes are three times more likely to try smoking combustible cigarettes and transition to regular tobacco smoking than those who have not used e-cigarettes.
(2) In 2018, the NASEM reviewed the evidence and also concluded that e-cigarette use increases the risk of using combustible cigarettes.

(3) The evidence supporting the ‘gateway’ effect is unequivocal.

Furthermore, former smokers who use e-cigarettes are nearly twice as likely to relapse and resume current smoking as those who had not used e-cigarettes.
(2) E-cigarettes represent a risk factor for initiating tobacco smoking, current smoking, and relapse to smoking for several behavioural and physiological reasons.

The transition from use of e-cigarettes to combustible smoking operates through developing addiction to nicotine and users seeking other forms of inhalable nicotine.

(3) E-cigarette use also mimics behavioural and sensory aspects of smoking, resulting in associated e-cigarette habits and making the move to combustible smoking more natural.
(35-36) e. evidence of the impact of legalising nicotine vaping products on youth smoking and vaping rates and measures that Australia could adopt to minimise youth smoking and vaping; It is important to separate the discussion of measures to minimise youth smoking from the discussion of measures to reduce youth e-cigarette use.
Australia has an enviable, well-documented record in protecting its youth population from the harms of smoking, which has seen daily smoking rates in 14-17 year olds decline from 11.2% in 2001 to 1.9% in 2019.

(9) This achievement is due to the implementation of evidence-based tobacco control policies.
Long-term research has generally concluded that education, family and social influence, overall societal acceptance of smoking, accessibility and affordability, and advertising restrictions have combined to reduce youth smoking over the past 20 years.

Targeted interventions to restrict access to products that specifically appeal to young people (e.g.

in packaging or flavouring) have also been effective.
(37-39) Our organisations have called for a strengthening of evidence-based measures to protect young people from smoking, in submissions to the Australian Government’s Thematic Review of Tobacco Control Legislation and the development of the next National Tobacco Strategy.
Recommendations include amending the federal Tobacco Advertising Prohibition Act 1992 to prohibit social media and online promotion of tobacco and e-cigarettes products and third-party product endorsements as well as a comprehensive approach including appropriate regulations, sustained antismoking campaigns and evidence-based smoking cessation support.
Inquiry into Tobacco Harm Reduction - Cancer Council, Heart Foundation and ACOSH response 7 Tobacco Harm ReductionSubmission 194 The de-normalisation of smoking has had a profound effect on reducing youth smoking rates in Australia.

(40) E-cigarette use mimics tobacco smoking and risks re-normalising smoking behaviours in the community.

E-cigarette usage rates are highest in young adults and teenagers aged 18–24.
Children aged 14–17 are the second largest group current e-cigarette user group by smoking status in Australia.

(9) As evidence from systematic reviews supports the gateway effect,(2-3) tighter controls and enforcement on the availability of e-cigarettes are required to protect Australian children from the short- and long-term harms of smoking prompted by e-cigarette use, dual use and the direct harms of e-cigarette use.
While tobacco harms are predominantly associated with long-term use as the result of addiction that occurs at a young age, there is significant evidence of short-term harm from e-cigarettes, including from acute health episodes, poisoning and injury from malfunctioning devices.

(3) The CSIRO review reported that carcinogenic compounds and carcinogenic metabolites arising from e-cigarette use are demonstrated to be present in e-cigarette users.
(3) E-cigarettes pose multiple risks which is particularly alarming in relation to youth in Australia, who were at extremely low risk of harm from any tobacco or nicotine products before e-cigarettes came onto the market.6 These points are unlikely to be made by any commercial interests submitting to this Inquiry or individuals or groups whose sole interest is the promotion of e-cigarettes based on unsubstantiated claims or ideological positions on harm minimisation.
The NHMRC statement refuted the opinion that e-cigarettes are less harmful and reported that there is insufficient evidence to quantify the reduction in risk when e-cigarettes are used instead of tobacco cigarettes.

(5) E-cigarettes expose users to chemicals and toxins at levels that have the potential to cause health effects including solvents such as propylene glycol, glycerol or ethylene glycol, which may form toxic or cancer-causing compounds when vaporised.
Evidence of the direct health harms of e-cigarettes is also strengthening,(41) and is a critical consideration in any discussion about e-cigarette availability where there is a risk that e-cigarettes could become more widely available.

It is also important to re-emphasise that the most effective broad measure for reducing youth smoking rates is to reduce smoking rates in the overall population.
(41) Nicotine addiction has been driven by marketing and social normalisation, through its long-term availability as a legal substance, mass-produced, glamourised and mass-marketed as a chic adult behaviour decades before the extent of health harms was understood.
(42) Moreover, smoking and nicotine addiction are unique in drug control, in that tobacco products are legal, addiction predominantly occurs at a young age, and most health harms accrue when the products are used legally as intended by the manufacturers.

Therefore “harm minimisation or reduction” in drug control as a generic term and concept in relation to tobacco harms is a special case.
It should be noted in the context of this Inquiry that ‘harm reduction’ in relation to tobacco is much broader than some of the limited definitions used and applies to all evidence-based measures implemented hitherto.

Notably, recommendations on the concept and ideology of harm reduction related to illegal narcotics and amphetamines do not apply in relation to the evidence on tobacco control.
Disability adjusted life years lost to the misuse of narcotics and amphetamines in Australia occurs predominantly from one-off, short-term incidents such as overdose, injury, violence, mental illness and associated trauma.

(43) By contrast, the most effective way to “reduce” tobacco and nicotine harms at a population level is to reduce smoking rates.
Australia’s major successes to date have been predominantly driven by protecting younger generations from smoking and nicotine addiction – the cohort targeted by e-cigarette entrepreneurs.
Inquiry into Tobacco Harm Reduction - Cancer Council, Heart Foundation and ACOSH response 8 Tobacco Harm ReductionSubmission 194 The key to reducing the harms of smoking and e-cigarettes in Australian youth is to reduce usage in the older/adult population, further restrict access to the products and, in the case of tobacco control, invest in established and evidenced-based interventions such as hard- hitting antismoking campaigns.
(41) f. access to e-cigarette products under Australia’s current regulatory frameworks; Current laws and regulations underpinning access to nicotine used for e-cigarettes are well- documented.

The sale, possession or use of nicotine e-cigarettes without medical authority is unlawful in every jurisdiction in Australia.
Controls on nicotine apply under state and territory legislation in accordance with how it is classified under the Poisons Standard (the Standard for the Uniform Scheduling of Medicines, or SUSMP).

Liquid nicotine is a Schedule 7 Dangerous Poison that may be handled only by licensed or authorised persons.
When it is in preparations for human therapeutic use, it is classified and treated as a Schedule 4 Prescription Only Medicine that may be used or supplied only as permitted by a medical practitioner under state or territory law.

Nicotine e-cigarettes cannot be sold for therapeutic purposes in Australia because none have been approved by the Therapeutic Goods Administration and registered on the Australian Register of Therapeutic Goods.
The importation, exportation, manufacture and supply of unregistered therapeutic goods is a criminal offence under the Therapeutic Goods Act 1989 (Cth).

Liquid nicotine for e-cigarettes, and nicotine e-cigarettes, may be imported by individuals for personal use as an unapproved therapeutic good, but only in accordance with a prescription from a local registered medical practitioner.
Outside Western Australia, where the sale of devices resembling cigarettes is prohibited, there is no regulation of e-cigarette devices.

States and territories have consistently and progressively strengthened their position to protect public health from the harms of e-cigarettes as the evidence has strengthened.
(7) It should be noted that commercial interests in the retail sector claim that recent proposed changes in nicotine scheduling as a poison will threaten their viability and deprive them of an essential business opportunity.

(44) However, the niche retailers actively selling and promoting nicotine for use in e-cigarettes are trading unlawfully.
The proposed re-scheduling of nicotine will clarify the existing prohibitions on the sale, possession and use of nicotine e- cigarettes under state and territory law.

It will not alter access to these products as permitted under current regulatory frameworks.

The Australian Retailers Association has actively distanced itself from the pro e-cigarette lobbyists in the retail sector.
(45) g. tobacco industry involvement in the selling and marketing of e-cigarettes; and The tobacco industry is by far the dominant player in the global e-cigarette and other novel tobacco products market worth USD$11.73 billion in 2019.
(46) An expected growth rate of USD$29.5 billion over the next four years has been reported, with the major stake held by multinational tobacco companies and brands including Altria Group Inc., British American Inquiry into Tobacco Harm Reduction - Cancer Council, Heart Foundation and ACOSH response 9 Tobacco Harm ReductionSubmission 194 Tobacco, Imperial Tobacco, Japan Tobacco Inc., JUUL Labs Inc., Nicopure Labs LLC, NJOY LLC and Philip Morris International.
(47) In the US, UK and New Zealand, the e-cigarette market is valued collectively at AUD$17.5 billion.

(48) In the US, where tobacco control policies are weakest, the tobacco industry has invested in and acquired multiple e-cigarette brands,(49) engaging in aggressive marketing tactics similar to those use to promote tobacco products before advertising restrictions were phased in.
(50) In the US, UK and the European Union, policy decisions on e-cigarette availability and marketing favourable to tobacco companies and other commercial interests have been linked to aggressive industry lobbying of government officials.

(51) In the UK, the industry has lobbied government officials to allow industry to work directly with local councils and schools to promote e-cigarettes, and to loosen regulations around e-cigarette advertising, bans, flavours and nicotine levels post-Brexit.
(52-53) In New Zealand, tobacco companies have similarly lobbied government officials to include their products in cessation services for low income populations.

(54) In Australia, the tobacco industry has actively sought to change or subvert public health protections in place to protect Australians from the harms of e-cigarettes and novel nicotine products.
These ploys include social media driven attempts to influence policy,(55) attempts to relax the rules on nicotine scheduling as a poison,(56) and attempts to directly lobby Australia’s most senior politicians,(57) including via tobacco-funded retail associations.
(58) Article 5.3 of the WHO Framework Convention on Tobacco Control, to which Australian is a Party, requires that, “in setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law”.
(59) This is based on a longstanding principle that commercial interests are driven by commercial motives and public health policy is evidence-based and focused solely on the health of the population.

h. any other related matter.

A matter for the Senate to consider is the damage to public health consistently caused by the unrelenting commercial and ideological lobbying to promote e-cigarettes, which drains much needed focus and funding from interventions that are effective.
The lobbying becomes more aggressive as the evidence supporting Australia’s precautionary position strengthens.

(2-3,5) The current evidence is clear and strengthening that making e-cigarettes available as a consumer product would cause more harm than benefit to the Australian population.

(2-3,5) An additional harm that cannot be scientifically measured – but is significant – is the constant distraction that the commercially and ideologically driven lobbying to promote e-cigarettes causes.
It is essential that the Australian Government continues to focus on evidence-based strategies that have been proven to reduce the prevalence of smoking in both adults and children and reduce the burden of tobacco-caused disease on the health system and the community.
These strategies include well-funded and sustained antismoking campaigns, further prohibitions on the marketing of tobacco products, expansion of smoke-free public places, systemic provision of support for smoking cessation through the health system, and Inquiry into Tobacco Harm Reduction - Cancer Council, Heart Foundation and ACOSH response 10 Tobacco Harm ReductionSubmission 194 special programs for disadvantaged communities.
New and novel nicotine delivery devices that are being relentlessly advocated by the tobacco and related industries are a massive distraction from activities that have reduced smoking significantly in Australia over the past 40 years.
We ask that this Senate Committee continues to commit to a comprehensive approach to tobacco control as recommended by the World Health Organization Framework Convention on Tobacco Control and commit also to the evidence to inform public health policy in relation to potentially harmful products, as presented by independent health authorities protected from lobbying and political interference.
This year around 90,000 Australians will die from cancer and cardiovascular disease combined, a number set to increase as our population ages and grows.

(60) Tens of thousands more will die from indirect events associated with cancer and cardiovascular disease.
Our collective mission to reduce this number through interventions ranging from primary prevention to end-of-life patient care should not be continually undermined by the distractions caused by commercial groups and lobbyists with no involvement in chronic disease control other than aggressively promoting commercial consumer products.

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