E-Cigarette Summit 2022

On the 9th December 2022 at the Royal College of Physicians, London, Professor Ann McNeill of 英国伦敦大学 - 伦敦国王学院 opened the 10th E-cigarette Summit.?As Professor McNeill referenced herself, in 2013, when the first E-cigarette Summit was delivered, adult vaping was at 3%. Compare this with today, where the number of adult vapers has increased to 8-9%.?At the same time, adult smoking rates were at 19% in 2013 and today sit at the lowest level on record of between 13-15%.?

Whilst there is no direct cause and effect, it has been referenced by numerous studies, including the Office for National Statistics Adult Smoking Habits in the UK 2021 that ‘Vaping devices such as e-cigarettes have played a major role in the decrease in smoking prevalence in the U.K’.?Despite these positive trends, the relative health inequalities between smokers and non-smokers continue to be acute, as well as the continued misperceptions about the relative safety of vaping vs. smoking. So the importance of the 10th E-cigarette Summit, the esteemed presentations from those within industry, academics, regulators and scientists are as important today, as they were then.

The summit then heard from the opening keynote speaker, Professor Sanjay Agrawal, Professor of Respiratory Science and Chair of the Tobacco Special Advisory Group, Royal College of Physicians. Professor Agrawal referred to the history of the Royal College of Physicians (RCP), which began with Henry VIII in the 1500s who under the advice of his physician, established the RCP. The purpose of the RCP was to regulate medicine in the City of London, and subsequently across the rest of England.

From these early years, many hundreds of years later, the RCP in 1962 produced their report named ‘Smoking and health’. This report for the first time objectively linked tobacco smoking with disease, specifically lung cancer as well as a variety of other diseases.?In addition to this, it also suggested how the country could tackle tobacco control, and laid out the early pillars of tobacco control policy.?To support the RCP views, in 1971 Action on Smoking and Health (ASH) was formed. Since its conception, ASH has gone on to lead and support tobacco control around the world ever since.?Notably, in 2015 the RCP looked at the evidence of the time and concluded that e-cigarettes should be used in tobacco harm reduction.

Later that morning Dr Jamie Hartmann-Boyce, part of the Cochrane Tobacco Addiction Group, presented the latest update from the Cochrane evidence on e-cigarettes for quitting smoking (Nov 2022).?The work presented by Dr Hartmann-Boyce was supported by Cancer Research UK (CRUK) the 英国牛津大学 and the NIHR (National Institute for Health and Care Research) (NIHR).?The Cochrane review, or specifically this update, sought to compare 1. using Nicotine e-cigarettes versus Nicotine Replacement Therapy (NRT) 2. Nicotine e-cigarettes versus behavioural support only/no support and 3. Nicotine e-cigarettes versus non-nicotine e-cigarettes.?Around point 1 specifically, the evidence found that at 6 months or more, a greater number of people, successfully quit smoking when they were using nicotine-containing e-cigarettes than NRT. For the first time with this update, these results were made with ‘high-certainty evidence’.?Evidence around points 2 & 3, also found that quitting using e-cigarettes was more successful to quit attempts at 6 months or longer than their comparator treatments.

Liam Humberstone, Engagement and Stewardship Lead of the Independent British Vape Trade Association and Technical Director of Totally Wicked took the opportunity to reflect on the last few years of Vaping.

From 2019/2020 where the sector experienced misplaced collateral damage as a result of the EVALI outbreak in the United States, which was subsequently found to be a result of consumers using illicit THC/vitamin E acetate-containing products, which should not be used in vaping devices. Through to the obvious impact of the COVID-19 pandemic whereby traditional bricks & mortar vape stores were forced to close, creating the associated growth in e-commerce, convenience & grocery sectors.?Post this period, Mr Humberstone went on to draw parallels around the latest growth in single-use devices. Whilst looking aesthetically different, these devices were structurally and fundamentally very similar to their early counterparts, which had formed a fundamental part in the early years of the e-cigarette sector's conception and success.?Over the last 12-15 months, this latest generation of single-use products has certainly driven a real explosion in consumer demand, fuelled by this simple, yet consistent, low entry point device, which has proved hugely popular to the UK smoker (￡671m, Nielsen 52 week, total coverage to 19th Nov 2022).?

Challenging the hypothesis that these latest single-use products are merely fueling a youth vaping epidemic, Mr Humberstone presented age-verified data through a leading website (totallywicked-eliquid.co.uk), which demonstrated that the most popular age group for these single-use products is the 31-35-year-old group.?In addition, he went on to illustrate that despite the common suggestion that many of the modern flavours were only attractive to youths, this was simply unfounded.

The data presented from this website illustrated that many of the flavours often lorded as ‘youth flavours’ were the most popular choices for adult vapers aged 31 and over e.g. Watermelon Ice, and Cotton Candy Ice being the 2 most purchased flavours for vapers between 51-55 years of age.?Following the presentation of this data, Mr Humberstone went on to project what the future held around regulation and his pleas to stakeholders and policy makers.

From TPD3, the potential impact of the EU Excise Review, and the review of Tobacco and Related Products Regulation, it is incredibly important that this is grounded in the available science and fact base.?In his view, prohibition would be a catastrophe as we already see the negative and perverse consequences of policy enacting this.?The danger of misinformation is evident daily and only serves to drive vapers back to smoking.?Furthermore, and despite the positive impact of single-use products, he went on to caution around balancing this with the required age verification protocols to ensure that these products are only accessed by adult vapers/smokers, but in summary concluded by reminding the summit that there is never a time to smoke rather than vape.

The final keynote speech came from Deborah Arnott, Chief Executive of ASH.?Set up in 1971, and principally funded by the British Heart Foundation & Cancer Research UK (CRUK) Action on Smoking and Health (ASH) does not have any direct or indirect link to or receive funding from Big Tobacco, E-cigarette or Pharmaceutical businesses.?She went on to give us a poignant reminder of the interference that industry can play on science and policy.?She outlined how years after the harms of smoking had been discovered, Big Tobacco overtly and covertly funded academic researchers to manufacture doubt on the science.

In 2006 a federal court judgement required big Tobacco to pay for and place corrective adverts in the U.S., but it took over 10 years of fighting through the courts before they ran in 2017. The court battle only ended this week (Dec 22) when they were finally forced to place the same adverts at the point of sale.?This demonstrates her view that Big Tobacco industry funding for Tobacco & Nicotine industry research is unacceptable, and she reminded the summit of the World Health Organization , Framework Convention of Tobacco Control (FCTC) article 5.3, which outlines that it is critical to establish measures to limit the interactions with the tobacco industry and ensure the transparency of those interactions that occur.?However, and importantly, she outlined that this is not a point to justify excluding those whose views we disagree with, but more so we must encourage such views to come forward, and for us to listen to them.?

She applauded the role of the 10th and previous E-cigarette Summits in ensuring respectful dialogue and thoughtful analysis of the science to support the development of the most effective health strategies to end smoking-related death and disease.?This was a powerful reminder of how 10 years on the E-cigarette Summit has and continues to strive to deliver genuine, science-based evidence to further smoking-related policy and the positive role that e-cigarettes have and can continue to deliver in pursuit of this.

Reference: The E-Cigarette Summit UK, Dec 9 2022. Royal College of Physicians, Regents Park, London