Without expressing any opinion otherwise on the recent ban of disposable vapes, the general "trendiness" of vapes, or vaping on transport specifically, I do think it is important to clarify the actual comparison of social harm done by cigarettes vs. vapes.
Cigarettes, as I'm sure everyone is aware by now, are addictive and cause cancer. The addictive component is caused by nicotine, but the carcinogenic component is tar. Nicotine, by itself, does not have major heath effects aside from the usual problems caused by addiction in general. The idea of e-cigarettes, heated tobacco, vaping, etc. is to isolate one from the other. The product still has nicotine and hence can satisfy a nicotine dependency, but does not have tar and hence is not carcinogenic, or indeed very harmful at all aside from the usual problems with inhaling smoke particles. In effect, it is a much more potent and very annoying nicotine patch.
Now, there is no doubt that inhaling smoke is not something we should be recommending people do. If the alternative is inhaling carcinogenic smoke, however, the calculus does change. Moreover, many studies have shown that vaping is much more effective than nicotine patches in terms of preventing relapse in smoking addicts, which is why it is a highly effective addiction harm reduction solution (i.e. a solution that does not aim to get rid of the addiction entirely, which is usually highly resource intensive, unlikely to succeed and causes great suffering, but instead reduces to a minimum of the (disability adjusted) life years lost due to the addiction).
In order for vaping to be an effective harm reduction solution, several things need to happen:
- it needs to be legal and obtainable (obviously), and some might argue more accessible (as not everyone that needs it can access a doctor or other addiction management resources to obtain a recommendation to use vapes);
- its health risks need to be well understood by smokers and non-smokers alike;
- its use needs to be less stigmatised in society than smoking is.
One will notice that items 2 and 3 both require some sort of public outreach with positive coverage of vaping. This may naturally be highly uncomfortable to many, but unfortunately the general public is not known for its understanding of nuances such as "A is better than B but worse than C".
With regard to the health risk posed by vaping, there has not been the same kind of long term study that smoking has been subject to, so its long term effects cannot be absolutely ascertained. However, with the result of short term trials and understanding of the biochemistry going on inside vapes and tobacco, most studies put an upper bound on the average DALYs lost through vaping at at most 5% of those lost through tobacco within the same population. That is, to take a simple example, if a person smoked and as a result keeled over at 40 instead of age 80, then if the same person was vaping, the earliest they are likely keel over as a result of vaping is 78. (There are, of course, statistical nuances here.)
It is a matter of heated academic debate to what extent this is a significant effect, but unquestionably, destigmatisation and wider availability of vapes will lead to a larger number of people vaping than would otherwise have been smoking, especially among younger populations. However, given the massive difference in lethality, from a public health point of view even if vaping advertisements and propaganda convinced everyone everywhere to vape, it would
still save lives. This is of course also a highly undesirable outcome, but the fact is that less people would die than currently do!
The main situation in which this social benefit would not come about is if circumstances attracted new people to vape, but at the same time failed to convince any smokers to switch to vaping. There are certainly good points to be made about vaping companies using flavours and packaging to target children and exclude adults (although even if vaping companies convinced all 15-year olds to smoke, that would still save lives given that more than 5% of 15-year-olds smoke currently!), however it does transpire that the grown adult smoker can sometimes be more childish than children. Trials in the US have shown that middle-aged adult smokers are much, much more likely to switch to flavoured vapes than non-flavoured vapes. So, undoubtedly to the shock and horror of every parent and school on this planet, it is possible to argue with a straight face that these goofy packaging and flavourings do still save lives and are a net social good, despite this not being the primary intention of vaping companies. Of course, I imagine that the discussion surrounding say Peter Rabbit themed vapes may be a bit different.
I had the opportunity to pose the question of harm caused by vaping attracting children and teenagers to an American professor advising the government on economic policy relating to addiction management last summer. The answer was as follows:
There is no way in hell vaping becoming more popular will kill anyone, because the risk between smoking and vaping is simply so imbalanced. Any attempts to restrict the growth of the number of youths who vape has to be done by addressing the root cause of why they want to get addicted to something in the first place.
As with many things in life, it does appear that restriction of a bad thing is not something that works, period, and a softer approach must be taken.
