UK Public Health England 2021 Report: Vaping Harm Reduction Is Beyond Doubt

On February 24, the UK government website published the report "Use of E-Cigarettes in the UK: Evidence Update 2021." This is an annual update report managed by Public Health England (PHE), primarily updating the latest data on e-cigarette use in the UK to provide information and insights for policies and regulations.
 
The UK is one of the best-performing countries in tobacco control globally and was the first to officially support e-cigarettes as a smoking cessation tool. However, in this report, the UK Public Health Department appears somewhat anxious due to a set of data.

The UK Public Health Department's survey found that the public's perception of the harm reduction potential of e-cigarettes is increasingly inconsistent, with only 29% believing that e-cigarettes are less harmful than cigarettes. Additionally, 38% believe that e-cigarettes are as harmful as cigarettes, 18% are unsure which is more harmful, and 15% believe that e-cigarettes are more harmful than cigarettes. In other words, 71% of people misunderstand e-cigarettes.

As early as 2015, the UK Public Health Department released an independent report stating that while e-cigarettes are not 100% safe, the harmful chemical content is almost negligible, and the harm reduction potential of e-cigarettes is beyond doubt.

So, the first question is, why is the UK Public Health Department anxious?

The core reason is that the UK wants to ensure the smooth progress of its smoke-free goal for 2030. According to the UK's smoke-free goal for 2030, the plan is to eliminate combustible cigarettes by 2030, allowing smokers to completely quit or switch to lower-risk nicotine delivery systems, such as e-cigarettes.

Up until 2019, the UK's progress towards its smoke-free goal was smooth. The adult smoking rate continued to decline, and the e-cigarette usage rate steadily increased. However, in 2020, the e-cigarette usage rate saw its first decline (as detailed in the chart below), dropping from 7.1% in 2019 to 6.3% in 2020, a year-on-year decline of 12%.
 
A decline necessitates finding reasons. Surveys found that only 29% of people believe e-cigarettes are less harmful than cigarettes. So does low awareness lead to a decline in e-cigarette usage?

A 2020 study from University College London (UCL) answered: Yes!

A study published by University College London in BMC Medicine pointed out that for every 1% decrease in the public's perception of e-cigarettes as less harmful than cigarettes, the usage rate of e-cigarettes decreases by 0.48%.

So the next question becomes, what has caused the decline in the public's perception of the harm reduction potential of e-cigarettes in the UK?

Another study from University College London investigated whether the outbreak of illegal e-cigarette-related lung injuries (EVALI) in the U.S. in 2019 would change smokers' perceptions of the harm of e-cigarettes and cigarettes.

University College London surveyed 3,215 smokers, and before the EVALI outbreak, 37% of respondents believed e-cigarettes were less harmful than cigarettes; after the outbreak, this proportion significantly dropped to 30.9%. Correspondingly, the belief that e-cigarettes are equally harmful increased from 39.9% to 43.8%. The belief that e-cigarettes are more harmful than cigarettes increased from 12.7% to 17.2%. The EVALI outbreak directly led to a deterioration in smokers' perceptions of e-cigarettes in the UK.

In fact, the U.S. Centers for Disease Control and Prevention (CDC) clearly stated on its official page after months of investigation in 2019: "Illegal e-cigarette products containing tetrahydrocannabinol (THC) played a major role in the cases." The culprit was vitamin E acetate found in illegal THC products, while legitimate nicotine e-cigarettes do not contain this substance.

Based on the above reasons, the UK Public Health Department emphasized in the 2021 report: "There is a need to focus more on effectively communicating harm reduction evidence to smokers so that they can fully consider various options to help them quit smoking."

The public's correct understanding of e-cigarettes has become key to the UK's goal of achieving a smoke-free status by 2030.