‘Quit or Die’ Smoking Policy May Not Work

Several Asian countries appear on the edge of adopting anti-smoking policies that may do more harm than good. Less than a month after Singapore’s announcement that cigarettes in the island republic will be sold only in standardized plain packaging, Malaysia and the Philippines are reportedly considering the same measures. And since Thailand also passed a bill late last year, there is now a race to become the first market in Asia to roll out the policy.

However, Australia, the first country to introduce plain packaging for cigarettes in 2012, and the only one where long-term data exists on policy effectiveness, is currently reviewing its approach to tobacco control, which health experts and politicians say is not working despite the fact that the average price of a packet of cigarettes is the most expensive in the world at A$35.20.

More Australians are smoking today than in 2013, according to the review, which found that its “quit or die” approach, consisting of plain packaging, high taxes and a ban on e-cigarettes has failed demonstrably.

Smoking, according to the World Health Organization, is “one of the biggest public health threats the world has ever faced,” killing more than 7 million people annually. It is expected to kill half of its users, the WHO says. Although more than 6 million of those deaths are the result of direct tobacco use, another 890,000 are the result of non-smokers being exposed to second-hand smoke.

Education alongside credible alternatives to smoking is the answer, not censorship. As an indication of the lack of awareness of the risk of smoking, smoking rates are higher in disadvantaged communities despite the cost according to the US Centers for Disease Control and Prevention. The poverty-stricken, people whose education stops after secondary school and blue-collar workers start smoking earlier, smoke more and smoke longer than their better-educated peers.

Governments must make it easier for smokers to quit, not harder. The US CDC recommends educating health care providers to consistently identify smokers, advise them to quit, and offer them cessation treatments. In addition, health insurers should cover and promote evidence-based treatment and removal of barriers to treatment access. Government tobacco control programs, including increasing prices, implementing comprehensive smoke-free policies, anti-tobacco media campaigns and enhancing access to quitting assistance can also help to reduce tobacco-related diseases and death.

Vaping – e-cigarettes – are another alternative for those who can’t quit. And yet, in parts of Asia, as in Australia, it is a criminal offense to buy, possess, or use e-cigarettes containing nicotine, which despite their considerable drawbacks are regarded as useful in the campaign to withdraw from traditional smoking.

Vaping is considerably less harmful than traditional smoking, because nicotine is the primary agent in both regular cigarettes and e-cigarettes, although vaping is still harmful to health. They are also addictive. Although the long-term health effects of e-cigarettes are still unknown, the US National Academy of Science, Engineering and Medicine conducted a recent comprehensive study that provides growing evidence that the short-term health risks are substantially less than those of continued smoking for adults who are unable or unwilling to quit.

It is hard to imagine that Hong Kong’s recent decision to outlaw the import, production, sale or promotion of e-cigarettes – but still permit use – will achieve anything but send people back to smoking, or fuel an underground vaping black market.

Policy-makers around the world should be watching with interest as Australia’s new parliamentary consultation comes to a close in the wake of an investigation by the Australian Criminal Intelligence Commission, which found that plain packaging has failed to reduce smoking.

Now Ireland is looking to introduce massive brand restrictions and health warnings on alcohol, while health activists are calling for similar treatment of confectionary and high-calorie foods. France and the UK have implemented similar brand restrictions. In Chile, cartoon characters have already been removed from cereal packs in an effort to combat obesity.

Under the ban, citizens can smoke their current stock at home but once that runs out, replenishing supplies will risk hefty fines or even prison time. With Chinese mega-city Shenzhen just over the border, where 95 percent of the world’s e-cigarettes are manufactured, it looks as though law enforcement will have their hands full.

Commitment to these punitive measures directly contradicts the UK Royal College of Physicians advice that vaping has "huge potential to prevent death and disability from tobacco use." Not only that, but evidence shows it is helping to lower smoking rates. Public Health England reports that e-cigarettes, or vapes, can help at least 20,000 smokers to quit every year.

Instead of joining the UK, US and Canada in permitting and encouraging vaping, Hong Kong is, in effect, abandoning the country’s smokers to die or become criminals, when they should be supporting their efforts to quit.

Unlike cigarettes, vapes don’t release tar and carcinogens through combustible tobacco. They turn nicotine solution into vapor, allowing smokers to satiate cravings while mimicking the action of smoking and without exposure to dangerous toxins. As the debate continues in Australia, a report by the McKell Institute, an independent, not-for-profit policy body, has now found that, “legalizing vaping has enormous potential to improve public health, particularly for disadvantaged smokers who are disproportionately affected by smoking-related diseases.”

Not only is a hardline, censorship approach shortsighted, it’s also potentially dangerous. There is evidence to suggest that tougher laws on smoking and e-cigarettes could encourage illicit trade and even the funding of terrorist organisations. KPMG’s findings show that illicit tobacco consumption in Australia has already grown from 11.5 percent to 15 percent since plain packaging took effect; without branding, there’s very little difference to the consumer between store-bought taxed tobacco and tax-free illicit tobacco.

Last year, in Hong Kong, seizures of smuggled cigarettes were up more than 50 percent over 2017. In Malaysia six of every 10 cigarettes smoked are illegal (making it the top market for illegal tobacco worldwide). In a region where illegal tobacco and organised crime have a thriving relationship, hardline policy could well make things worse, critics say.

Plain packaging has negative consequences that extend far beyond the product consumers themselves, according to researchers, who say that plain packaging destroys brand power, which makes it harder to survive for small, local businesses that cannot afford to compete on price. The federal government of Canada considered and rejected plain packaging in the late 1990s according to the Montreal Economic Institute but in 2011 increased the size of the compulsory health warning from 50 percent to 75 percent of the space on cigarette packages, a measure that reduces, in a roundabout way, the distinctiveness of cigarette brands.

Thus given the evidence, Australia’s policy review is a step in the right direction. It appears that nanny-state punitive interventions are ineffective and that supporting smokers to quit through evidence-based policy is a safer alternative.

Jojo Furnival is an Australia-based contributor.