UK Public Health 2021 Report: Vaping’s Harm Reduction Benefits Are Clear

On February 24, the UK government website published the report "Vaping in England: 2021 Evidence Update." This was the annual update report prepared by Public Health England (PHE), mainly intended to update the latest data on vaping in the UK and provide information and insights for policy and regulation.
 
The UK is one of the countries with the strongest tobacco control efforts in the world, and it was also among the first to officially support e-cigarettes as a smoking cessation tool. However, in this report, one set of data appears to have made Public Health England somewhat anxious.

PHE’s survey found that people in the UK are becoming increasingly inconsistent in their understanding of vaping’s harm reduction potential. Only 29% believe that e-cigarettes are less harmful than combustible cigarettes. Another 38% believe e-cigarettes are just as harmful as cigarettes, 18% do not know which is more harmful, and 15% believe e-cigarettes are more harmful than cigarettes. In other words, 71% of people misunderstand vaping.

As early as 2015, Public Health England had already released an independent report stating that although e-cigarettes are not 100% safe, the levels of harmful chemicals are almost negligible, and their harm reduction benefits are beyond doubt.

So the first question is: why is Public Health England worried?

The core reason is that the UK wants to ensure the smooth progress of its 2030 smokefree target. Under this goal, the plan is to phase out combustible cigarettes by 2030, enabling smokers either to quit completely or switch to lower-risk nicotine delivery systems such as e-cigarettes.

Up until 2019, the UK government’s smokefree agenda had been progressing well. Adult smoking rates continued to decline, while vaping rates rose steadily. However, in 2020, the UK’s vaping rate fell for the first time (see chart below). It dropped from 7.1% in 2019 to 6.3% in 2020, a year-on-year decline of 12%.
 
When usage declines, the next step is to find the cause. The survey found that only 29% of people believe e-cigarettes are less harmful than cigarettes. So does lower awareness lead to a drop in vaping rates?

A 2020 study from University College London (UCL) answered: yes.

The study, published in BMC Medicine, found that for every 1% decrease in the proportion of people who believe vaping is less harmful than smoking, vaping prevalence falls by 0.48%.

That leads to the next question: what caused the decline in UK adults’ awareness of vaping’s harm reduction benefits?

Another study published by UCL examined whether the 2019 outbreak of illegal vaping-related lung injuries (EVALI) in the United States changed smokers’ views of the relative harms of vaping and smoking.

UCL surveyed 3,215 smokers. Before the EVALI outbreak, 37% of respondents believed vaping was less harmful than smoking. After the outbreak, that figure dropped significantly to 30.9%. Correspondingly, the share of people who believed vaping was equally harmful rose from 39.9% to 43.8%, while those who believed vaping was more harmful than smoking increased from 12.7% to 17.2%. The EVALI outbreak directly worsened UK smokers’ perceptions of vaping.

In fact, after months of investigation in 2019, the U.S. Centers for Disease Control and Prevention (CDC) clearly stated on its official page: “THC-containing e-cigarette, or vaping, products played a major role in the outbreak.” The real culprit was vitamin E acetate in illegal THC products, a substance not found in regulated nicotine vaping products.

For this reason, Public Health England emphasized in its 2021 report: “There is a need to put greater effort into communicating the evidence on relative harms to smokers in better ways, so that they can make informed choices about the options available to help them quit smoking.”

Public understanding of vaping has become a key factor in the UK’s ability to achieve its 2030 smokefree target.