The Tobacco and Vapes Act – a landmark win for health

The latest tobacco control measure to reach the statute books is a major boost to health. In my years working in cancer and respiratory care as part of the leadership team at Cancer Research UK and as Chief Executive of Asthma + Lung UK, I often saw firsthand the impact of smoking for people and their families, and know just how significant this measure will be. Reform UK proposals to undo it are out of step with public opinion. 

The ‘job is not done’ is a mantra I have repeated often over the years in relation to tobacco control. One of the difficulties in sustaining momentum – apart from tackling the slick and well-funded tobacco industry – is the tendency of our health system to gravitate towards novel policy initiatives, often at the expense of finishing the job where the evidence is strongest. 

The substantial harms that tobacco use causes are extremely well documented. Since the landmark British Doctor’s Study which began in the 1950s, proving the correlation between tobacco use and an increased risk of lung cancer, the evidence of the harms has accumulated. Two in three smokers will die from tobacco use. It remains the single most important entirely preventable cause of ill health, disability and death in the UK, responsible for 80,000 deaths per year. The harms extend to the state and NHS, costing an estimated £21.8 billion in lost productivity caused by ill health and the direct costs of treatment each year. This far exceeds the £8.8 billion paid in tobacco duty between 2023-24. Smoking cessation interventions are therefore highly cost effective. 

The magnitude of the health benefits accrued by cessation are sometimes hard to keep front of mind. Sir Mike Richards, when National Cancer Director, commissioned some work to assess what interventions had made the most difference in improving cancer outcomes. Tobacco control measures won hands down. It may have taken us 75 years to move from knowing the harms tobacco causes to acting with sufficient vigour to stop them, but there’s strong evidence that when you move to reduce the availability, accessibility and attractiveness of tobacco products, you get results. 

And that’s why the act is such a win for health. The headline measure, to ban the sale of tobacco to people born after 1 January 2009, means it will never be legal for future generations to smoke. The act contains measures to tackle the marketing and promotion of vaping too. The industry has a history of quickly adapting to boost sales based on the legislative framework of the day, and that’s exactly what it has done with vaping. The proliferation of flavours, cartoon style marketing and disposable vapes more easily accessible to children has resulted in a significant increase in use by 11-15 year olds over recent years. The third key measure is a licensing scheme for tobacco retailers, to support enforcement of point-of-sale restrictions and tackle illicit sales. 

Nigel Farage has recently outlined the Reform UK position, describing the legislation as ‘a disaster for anyone who cares about personal freedom, small businesses or common sense’ which is wrong footed for a party seeking to be in step with the public mood. Tobacco control measures are popular with the public. Most smokers know the risks and want to quit. Only 16.7% of smokers in England state they are not intending to quit. They find it hard because of the highly addictive nature of nicotine, but there’s no shortage of desire. It’s also wrong-footed for a party that wants to make a pitch to some of the most left-behind places and people in our country, many of whom will have shorter, poorer lives if they start and continue to smoke. 

And can you think of anyone – barring a few tobacco industry execs – who wants more children to start smoking? Generations of smokers have been recruited as children, with four in five starting before the age of 20. In my experience even the most devoted of smokers are supportive of measures to tackle youth smoking and vaping. 

In fact, the mood has shifted further. Thanks to successive actions over decades including awareness campaigns, the ban on smoking in public places and introduction of ‘plain’ standardised packaging, 71% of adults support the goal of Britain being a country where no-one smokes. And 81% of retailers in England support the introduction of a tobacco licence. The level of support from parliamentarians of all political persuasions wouldn’t have been imaginable twenty odd years ago, when health secretaries still said ‘let them smoke’. There’s been some opposition as the legislation has made its way through parliament, with familiar civil liberty concerns raised and exemptions sought by specialist tobacco retailers, as they always are. But opposition is muted and the Overton window has well and truly shifted. The act is a moment to pause and celebrate, not least for the many clinicians, academics and campaigners who’ve made the case for change over the years.  

However, there’s no room for complacency and I’ll finish where I started; the job is not done. 11.9% of the population still smoke, which is around six million people. Smoking is now largely concentrated in poorer communities: 14.6% of those living in the most deprived decile smoke compared to 9.3% in the least. Rates are also higher among groups such as people with a long-term mental health condition, where smoking rates hover at about 25%. This is why ensuring access to stop smoking services for all those who want them remains essential – and it’s highly cost effective. Brief advice from health professionals wherever and whenever people encounter the NHS helps too, and should be sustained even as the next set of health system priorities loom into view. 

We know there is a lot of cynicism about politics and whether governments can make a difference. It is rare that there is the opportunity for a government to introduce a world-leading policy, that doesn’t cost a huge amount, and that will be remembered for generations as a moment when the dial was decisively shifted towards preventing disease and lives were saved. It’s a chance for the government to write its name into the history books for all the right reasons. Let’s hope this is a moment that is celebrated and sustained by future generations, rather than disputed and questioned by political opponents.