New Zealand's controversial policy to reduce smoking, with bans and low-nicotine cigarettes, is attracting worldwide attention. But what's really going on? Vejpkollen takes a deep dive into a strategy that has strong roots in harm reduction - where e-cigarettes and vejping play a central role.
Vejpkollen is monitoring E-cigarette summit London 2022
Reporter: Stefan Mathisson
Ultra-low nicotine cigarettes. Generational ban on buying them and only a few shops allowed to sell smoking tobacco. As Vejpkollen previously reported New Zealand's radical measures to reduce smoking have attracted worldwide attention.
"But it is very important that everyone understands the background. It's about harm reduction and a deliberate strategy to promote e-cigarettes, products with a relatively lower risk of harm compared to cigarettes. Without this, no one would have dared to think about effectively banning cigarettes" says Ben Youdan, political consultant and former director of Action on Smoking and Health in New Zealand.
"People wanted safer nicotine"
The foundations for a 'Tobacco Endgame' in New Zealand were actually laid 12 years ago. In 2010, a parliamentary inquiry set a date of 2025 for a 'smoke-free New Zealand'. The goal was to reduce the proportion of smokers in the population to below 5%.
"But the study also found that many New Zealanders wanted access to more and safer ways to use nicotine. This was taken on board. Harm reduction has since been an important part of the New Zealand anti-smoking strategy" says Ben Youdan, when he presents the New Zealand strategy at the E-cigarette summit 2022 in London.
Low risk profile
E-cigarettes and Swedish snus were some examples that the report highlighted as important tools in the strategy. At the time, e-cigarettes were a relatively unknown product.
"But local researchers convinced policymakers of its relatively low risk profile compared to smoking. Moreover, it was judged that the absolute risks were likely to be low" says Ben Youdan.
Regulation of e-cigarettes
The next 10 years saw the launch of what would become one of the world's toughest cigarette legislations. As the country sharply increased taxes on smoking tobacco, restricted marketing and regulated the appearance of packaging, e-cigarettes were allowed to take their place alongside cigarettes, without much regulation.
When the authorities later measured e-cigarette use in 2018, it turned out that the strategy had had an impact. And by a wide margin, according to Ben Youdan.
"We saw a steady decline in smoking rates across the population. At the same time, we saw a rapid increase in vejp use once the products were on the market. I've been working in tobacco control for over 20 years and couldn't believe my eyes when I saw this. It was clear that there was a link between the measures and the switch to vejpning, although we could not prove a clear causal link. We saw it particularly among young people and among the Mauri indigenous population, groups that have long had high proportions of smokers" says Ben Youdan.
Tougher rules since 2021
Since 2021, New Zealand has built a regulations also on e-cigarettes. This means that e-cigarettes are subject to an 18-year age limit, require registration and systematic feedback on health effects to health authorities. Not unlike the system in the EU, UK and Sweden. But it also meant restrictions on flavorings and that e-cigarettes could not be sold anywhere or anyhow.
"For example, regular shops are not allowed to sell anything other than closed systems with a maximum nicotine content of 20mg/ml. They can also only be flavored with tobacco and menthol flavors. Specialist shops, those whose main income is from vejp products, are allowed to sell all flavors and devices and slightly higher nicotine levels. Ben Youdan.
High uptake among young people
At the same time, the authorities invested in extensive stop-smoking campaigns and funded websites that provided information on e-cigarettes as harm reduction and as an effective tool for quitting smoking.
"Overall, e-cigarettes are more heavily regulated than cigarettes today. Despite this, we see a large uptake among young people. But this has been at the expense of smoking. Today, less than 1% of young people smoke daily. Around 10 percent vejpar. " states Ben Youdan.
Low nicotine cigarettes
The 12 December 2022 New Zealand took the next step to reduce smoking in the country. A decision to force nicotine levels in cigarettes to extremely low levels, as well as a ban on the sale of cigarettes to those born after 2008, was passed in December 2022. The measure has had a major impact in the media around the world. But Ben Youdan is not sure that the new legislation is the right way to go.
"If we look at the trends we have seen in recent years, it is clear that we are already on the right track, if we just keep doing what we are doing. Smoking will be below 5% by 2025. Among young people, 1% smoke daily, while 10% vejpar. We already have a smoke-free generation and the explanation for this lies in a clear strategy where e-cigarettes, i.e. harm reduction, have been given a central role" says Ben Youdan.
Highlighting unnecessary risks
Therefore, de-nicotinizing cigarettes and introducing a controversial ban is not necessary to reduce smoking, says Ben Youdan. He describes it more as a matter of principle, fraught with political prestige.
"The result is a measure that could have unforeseen consequences, not least for older people who still want to smoke. It will be a coercive measure, which is not really needed," he says.
Ben Youdan also highlights the risks of a black market, which will grow as long as there is a demand for 'regular' cigarettes.
Harm reduction is key
But it is the lack of communication about the strategy as a whole that is of particular concern Ben Youdan. He misses the big picture, especially when news of the "cigarette ban in New Zealand" spreads around the world.
"I think we should be very open when we talk about the reasons behind New Zealand's smoking success. We need to highlight the real reasons. That is, tough legislation on cigarettes combined with harm reduction. That is what has made these measures possible. Otherwise, there is a risk that other countries will follow suit, without understanding the background, and things could get really bad." Ben Youdan.
The ban impossible without alternatives
Also the Prime Minister of New Zealand Jacinda Arden has clearly stated that vejping and e-cigarettes are the basis for the decision to introduce the new age restriction, as well as the requirement for low-nicotine cigarettes.
"We have seen that smokers now have a viable alternative to nicotine. It is this development that allows us to take the next step in phasing out cigarettes from the market" said Jacinda Arden in a statement 2021when the government tabled the proposal that has now become law.
"Politicians around the world are missing the point"
However, despite the Prime Minister's clarity, according to Ben Youdan It is all too easy for the media and politicians to simply miss an important message. The simplified version is more easily digestible, especially as there is a divided opinion on the role of harm reduction in the fight against smoking.
"I recently read an article about our new law in an Australian newspaper. It didn't mention harm reduction or e-cigarettes once. It was all about the crackdown, low nicotine levels in cigarettes and the different age restriction. There is a risk that politicians in other countries will miss the point and be tempted to introduce legislation that is unlikely to work." Ben Youdan.
