03 Dec 2022 By theguardian
Australia's health minister, Mark Butler, was just weeks into the job when he realised the extent of the growing public health disaster that is youth e-cigarette use.
"We're going to deal with the same legacy of nicotine addiction through vaping that we dealt with for many decades through cigarettes," he says.
It's a bitter situation for a country that pioneered plain packaging legislation and other curbs on conventional tobacco products that have ground down rates of smoking over many years, increasingly pushing it out of almost all public spaces.
Every time Butler met state and territory health ministers, his counterparts would raise the alarm about children addicted to vaping, the impact on their health and schooling, and the struggle to block the illegal import and sale of nicotine vaping products.
It prompted Butler to meet leading tobacco control experts in Adelaide in September. There, the then director of Quit Victoria, Sarah White, said young children were calling the Quitline not because they were smoking but because they were addicted to nicotine through vaping. Butler says White "told this shocking story of a grade 7 student ringing the Quitline and saying she didn't want to vape, but she didn't know how to resist because every single other person in her class was doing it".
Simon Chapman, an emeritus professor of public health at the University of Sydney and a decades-long tobacco control advocate, was present.
"The minister chaired the meeting and stayed with us for four and a half hours," Chapman says. "None of us could ever recall a health minister other than Nicola Roxon doing that."
It was Roxon, as health minister in the Gillard Labor government, who introduced plain packaging legislation in 2012 (when Butler was a junior minister in the health portfolio).
On Wednesday, marking the 10th anniversary of that law coming into force, Butler announced that the Therapeutic Goods Administration would begin public consultation on vaping reforms.
He wants to stop illegal products entering Australia, create a regulated source of vapes with known ingredients for those prescribed vaping products to quit tobacco, and tackle the intensive marketing of the products to children through product designs, flavourings and advertising.
Rates of children vaping in Australia doubled between 2016 and 2019, and data from New South Wales indicates about 33% of 16-to-24-year-olds used an e-cigarette in 2021. Butler says educators and health practitioners have told him youth vaping rates have "skyrocketed" further since the pandemic. Significant funding will be required to develop health and educational resources to treat a generation of nicotine-addicted youth, he says.
Butler says more than 2 million people vape in Australia, "and on some estimates, there are more people vaping than smoking cigarettes".
Thanks to Roxon's world-first tobacco plain packaging reforms, fewer than 11% of Australians smoke, down from 16% a decade ago. In 2016, the global tobacco company Imperial Brands reported to investors that Australia was "the world's darkest tobacco market" due to the legislation. But now, thanks to the explosion in vaping, Imperial Brands is advertising roles in Australia for sales managers.
One job ad says the company is "increasingly focused on developing a leading portfolio of next generation products" - that is, vapes. Similarly, Philip Morris International has been advertising "exciting" roles in the Northern Territory, NSW and Queensland for "innovative" people who want to work with retailers to help the brand move towards a "smoke-free future" focused on electronic products.
Butler is particularly perplexed by how easily children can buy vapes from convenience stores and other retailers. Many of these are not produced by tobacco companies but are cheap products imported from China. In Australia, it is illegal to sell vaping products to children, whether they contain nicotine or not. Nicotine vaping products are only legal for adults when they are prescribed by a doctor to assist in stopping smoking.
"I think it's disgusting," Butler says. "We're talking [about] very, very young children. Not someone who maybe looks like an adult. Young children are being sold these products, marketed deliberately to them.
Chapman says that in his 45 years of working in tobacco control, he has "never seen such flagrant, open contempt for the law" as stores selling vapes to children and teens.
"Imagine what would happen if thousands of rogue pharmacists decided to give the middle finger to the need for prescriptions to access antibiotics or codeine and handed them over to anyone who wanted them," he says.
"That's what those selling nicotine vapes are doing, with the useful idiots in fringe vaping advocacy groups oxygenating demand."
Roxon would not be drawn on the previous government's responsibility for growing nicotine addiction among young people, after the hard-won gains against conventional tobacco products.
"After the recent lost years, it's excellent to see the commonwealth stepping out strongly to tackle substantial harm to Australians," she says.
"The vast majority of Australians using vapes have never smoked - and are now at serious health risk from the heating and inhalation of tobacco and numerous chemicals, often unidentified and untested.
"It is now time to stop comparing vaping to smoking - vaping is dangerous in its own right. To properly protect children and young people from the explosion of vape use, we need a commensurate explosion of effort, with the states joining the commonwealth to take urgent action."
The TGA's public consultation process is open until 16 January. Asked why the government needs to consult when public health experts have long called for changes such as a blanket ban on the import of vaping products without a prescription, Butler says: "This is a relatively short consultation period, so we're not losing much time here, and it's good governance, good practice, to consult."
But lobby groups for vaping and big tobacco will also be able to make submissions.
"I'm very confident that the people running that consultation, particularly the head of the TGA, Prof John Skerritt, is well alive to the views that industry will put forward about this," Butler says.
"But we need to consult because there's not a simple response to this. We've got to respond to this issue across a range of fronts, not just through health portfolios but we are also going into policing and into border control.
"I'm determined to see Australia reclaim its position as a world leader on tobacco control because, quite frankly, lives are at stake."
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