Tobacco and Vapes Bill – in a Public Bill Committee am 3:24 pm ar 1 Mai 2024.
We will now hear from Professor Allison Ford from the University of Stirling; Dr Rob Branston, senior lecturer at the University of Bath; and Professor Anna Gilmore, professor of public health at the University of Bath, who will talk to us via Zoom. We have until 4.25 pm for this session. Will the witnesses introduce themselves for the record?
Professor Ford:
Thank you for inviting me to attend today. I am Dr Allison Ford, an associate professor at the Institute for Social Marketing and Health at the University of Stirling. I have worked in research in the area of tobacco control since 2009. Currently I am working on a large package of work on youth vaping, looking at youth responses to vaping products and the marketing environment of those products. More recently, I have been looking at their responses to other nicotine and tobacco products such as nicotine pouches and heated tobacco. We conduct large surveys with young people across the UK. We also speak qualitatively with smaller groups of young people.
Dr Branston:
Thank you for inviting me. My name is Dr Rob Branston, and I am a senior lecturer in business economics at the University of Bath where I am part of the tobacco control research group. My interest in the tobacco industry is on the economic side, so I do research on industry taxation, responses to taxation, profitability, and responses to regulation more generally. That includes work on the illicit tobacco market. In the interests of transparency I should flag that I own 10 shares in Imperial Brands for research purposes. I do not get any financial interest from the company, but owning shares allows me to attend the AGM and ask questions that are useful in my research.
Professor Gilmore:
Hi, I am Anna Gilmore, and I am a professor of public health at the University of Bath. I apologise as I cannot be there in person. I am currently on work travel and camped out at a colleague’s house in Copenhagen. My background is in medicine and public health. My work focuses on what we now call the commercial determinants of health, which is the way in which corporations influence health. I have a particular interest in this area and therefore in the tobacco industry.
Q My question is to you, Anna. You and your colleagues have examined the ways in which what you term “unhealthy commodity industries”, such as tobacco companies, achieve their aims. Can you tell us a bit more about that, and how it relates to the measures in the Bill?
Professor Gilmore:
We do work on unhealthy commodity industries, which include tobacco, alcohol, fossil fuels and ultra-processed foods. This is increasingly an issue, because what kills us, increasingly, are the products and practices of these corporations. The products of just those four industries account for at least a third of global deaths every year.
Obviously, their aims are to maximise profits, and we now know that their practices are incredibly similar in the way in which they lobby, market, use public relations to massage reputations and buy access to Governments. That is not only a direct problem, but, in a way, a wider system problem. Those industries cause this huge harm, but they do not actually meet the costs of that harm; instead, the individuals who are affected, we as taxpayers and Governments end up paying for those healthcare costs, and so on. We know that even the tobacco industry, despite high excise rates, does not fully meet the costs of the harm it causes, and this incentivises further harm. I would love to talk in detail about that—perhaps another time.
In relation to this Bill specifically, it helps us to understand a few issues. It helps to explain why we have a problem with smoking and youth vaping, because tobacco and vaping companies will market to children and make their products as attractive as possible. We know that the tobacco industry has historically manipulated cigarettes to make them as addictive as possible. In fact, if you look at tobacco industry documents, they are quite clear on that:
“The base of our business is the high school student.”
We know that the key reason we are facing these problems with new products such as vapes is that tobacco companies were under threat. We had done a good job on tobacco control globally, and smoking rates and cigarette sales were coming down; now, globally, those sales and rates are stagnating. The industry is fighting back, if you like. That is why we are seeing a whole host of new addictive products.
What is really worrying is the emerging evidence, both from animal models and human studies, that exposure to nicotine at a young age, such as vaping in teenagers, can effectively rewire the brain and increase the risk of addiction in the long term. For these companies, it is the perfect business model: they can addict them young, and then move them on from one product to another. We need to be very concerned about that.
What is perhaps most relevant is the overwhelming evidence that these companies will fight the legislation at every stage. We refer to this simply as block, amend, delay: they will try to block the legislation; if it goes further, as it is doing now, they will push to amend it and weaken it; and then they will push to delay it, including through litigation. Once it is implemented, they will also work to circumvent it and find loopholes, so we need to ensure that the legislation is watertight. We know that from past work we have done, such as with the ban on menthol, when the industry tried to introduce menthol cigarillos as a replacement for cigarettes by bringing in menthol accessories such as menthol cigarette papers and filters.
In terms of recommendations, I would say that you really need to be on guard against the arguments of the tobacco industry. Having looked at these over many pieces of legislation and in many jurisdictions, we can tell you that the tobacco industry’s arguments do not come true. They may be plausible on the surface, and I am happy to talk about them in more detail, but they do not come true. We also need to be aware of the third parties and front groups through which the industry operates. The tobacco industry has lost its credibility, so it works through third parties—organisations such as the Institute of Economic Affairs, and often through retail groups. I urge you to be cautious about who is approaching you, and to ask who really funds them. We need to be aware of amendments, too. I think we can be certain that the industry is working quite quietly this time, because, over the past few years, it has claimed to have changed. I think we need to be careful of the amendments that are coming in. Push against any industry efforts to delay the legislation. I would also urge you to be really cautious with any evidence or data that is presented to you, because we know from our past work—we did detailed work on standardised packaging when that came in, for example—that the industry will manipulate the evidence and data in its favour. Finally, I urge you to make the legislation as watertight as possible.
Q On that, do you think that Government regulation in the Bill is sufficient, and will it improve public health?
Professor Gilmore:
Yes, absolutely. I think the primary legislation is important for the smoke-free generation and to help address smoking, particularly among young people, and to de-normalise smoking. We know from past measures that de-normalising smoking can be important. What is useful are the powers to introduce secondary legislation. We are dealing with quite a lot of uncertainty in this area, and evidence is emerging all the time. What is useful is the ability to introduce some legislation and then further legislation later depending on the impacts and as new evidence emerges.
What is key is getting that secondary legislation right. Obviously, it has the potential to reduce smoking and vaping. There is some balance to be had on vaping because we need to reduce vaping in never-smokers, particularly young people, but still allow e-cigarettes to be available for smokers who are using e-cigarettes to quit. It is important to remember that they are obviously not the only quit product. It is important that we do not lose sight of the role of pharmaceuticals, which are actually more important, but there are some smokers who do quit with vaping products. There is that balance. I am happy to talk in detail about some of the things that I think could or should be in those secondary regulations, if that helps.
That is great—thank you.
Q Thank you all very much for being here today. Are any of you able to talk through the economics of the smoking industry, the vaping industry and, in particular, the illicit vaping industry? Do any of you have information on that?
Dr Branston:
I can speak to at least some of your questions, so thank you for them. I think the starting point for understanding the tobacco industry is to understand that it is incredibly profitable. It is profitable like almost no other industry that we currently face. Not only are those profits large in total—I can tell you the world’s six largest cigarette manufacturers made profits totalling about $55 billion in the most recent year that I was able to track, which was 2018—but they make large profits in the UK. I last estimated that for 2022, and it was about £900 million annually. Equally, they make a large amount of profit for each unit sold. Their profit margins are in the region of 70%, meaning that for every £100 they get to keep, having paid all excise duty, £70 of that is just pure profit. The actions of the industry are entirely guided by wanting to maintain and expand those profits going forward.
The interesting facet is that big tobacco currently does not make much, if any, profit on its new-generation products, which include e-cigarettes and other products, such as heated tobacco products. The vested interest of big tobacco is to maintain the status quo. The issue of profitability in e-cigarettes is more difficult to talk about for the private companies because many of them are based in China and do not publish their accounts, so it is difficult to tell how much, if any, profit they are making. Ultimately, companies cannot continue in existence if they are losing money, so it is a reasonable presumption that they are making some levels of profit, because they want to continue selling these products. Hopefully that gives you some background.
Q That is helpful. Do you have any information—a guestimate—of what the illicit vape industry is worth?
Dr Branston:
I would not like to speculate on that because, as we heard earlier today, the illicit sector has increased significantly in the past two years. It is difficult to work out what is licit and what is illicit, so I think it would be inappropriate to speculate. Given the number being sold, however, it would be reasonable to think that a significant amount of money is being made by those illicit products.
Q We have seen youth vaping treble between the ages of 11 and 17 in just the last three years. It has already been mentioned that the vaping and tobacco industry seeks to prevaricate and keep hold of its young customers in a number of ways. Can you tell us some of the ways in which it will argue during the passage of the Bill? Do not forget that we are trying to get you on record today giving us some answers that we can then put to colleagues who challenge us because the sector has given them some lines to take. What should we be looking out for, and what should we be saying to our colleagues?
Dr Branston:
I am fairly sure that the first thing it will say is that this is a charter for the illicit market and will lead to a big explosion in the rate of illicit tobacco in particular. I know that the industry always trots out that line whenever a tax increase, or any other regulation, is suggested. However, the facts simply do not support that line of argument. When the age of sale was increased from 16 to 18 in 2007, the rate of illicit actually went down in 2007-08. Illicit tobacco is driven by a whole host of reasons. It is very complicated, but ultimately it is an issue of enforcement, as we heard before. We need to ensure that we have the rules in place to make sure that products on the market comply with the law and all the regulations therein. I do not feel that illicit is a particular concern at this stage.
The idea of the generational ban is that it will only increase by one year every year. We are not going to suddenly outlaw a habit that millions of people currently have. It is something that many young people will be unable to do going forward, but they are not currently smokers, so we do not have to worry about all those people wanting to buy these products. The fact that they are banned will go a long way towards addressing the issue in and of itself.
The new excise duty due to come in on e-liquid will go a long way to addressing some of the concerns on illicit vapes. Having the products within the excise system means that more enforcement powers will be available, which will in itself help to reduce the rate of illicit. We can be reasonably confident that there will not be a big wave of illicit products in the future.
Q Professor Ford, do you want to add anything on what we should be looking out for?
Professor Gilmore:
I am happy to speak on that if it helps. The model that we developed to understand how the industry argues about policy is called the policy dystopia model, because the industry will argue for a whole host of dystopian outcomes: “The regulation will not work”; “There is no evidence”; weirdly, “It will increase youth smoking”; “It will increase illicit”, as Dr Branston has said.
The other key thing the industry will always claim is that it will be bad for business, but it will never admit that it will be bad for its own business, which is obviously its key concern. It is always trying to claim that the negative impacts will be on others, such as retailers. We are seeing those arguments now: “It is impractical”; “It is untested”; “It will be impossible to enforce”—that is the other favourite argument; “It reduces freedoms”.
Those are the typical industry arguments. It might present them quietly itself, but it acts directly less and less—increasingly, it acts through the third parties I flagged. I would be careful of all those arguments, and of approaches from people who might seem credible but, very often, have industry links behind them or are meeting with industry and simply believing those arguments without question. Generally, the arguments have some plausibility, but they have never materialised with any previous policy. They simply have not come true.
On illicit cigarettes, it is worth remembering that the tobacco industry has a very long history of orchestrating the smuggling of its own products on a vast scale, which is well documented through its own documents, which it had to release through litigation. That may sound counter-intuitive, but the more expensive the product, the less is sold; the cheaper the product, the more is sold. If the product is illicit and the excise duties on it are not paid, it sells more cheaply and more is sold. That also enables the industry to make the illicit argument: if there are illicit products on the market, it makes the illicit argument stronger.
It is also worth noting that the last time we looked at rates of illicit and published on that, the biggest share of the illicit cigarette market in the UK was the tobacco industry’s own products. At best, that means that it is failing to control its supply chain. It makes a big song and dance about counterfeit and illicit whites, but there remains a problem with the tobacco industry’s own products ending up in the illicit market. That is really important to bear in mind.
Q I have a question for Professor Ford. Can you describe for us how the packaging of vapes attracts young people to purchase them, and how the visuals advertising vaping that young people might see on social media or sports kits, for instance, might attract them and influence their desire to purchase them?
Professor Ford:
Packaging in the UK just now is doing two things: first, it is communicating a message to young people, and secondly it is having a huge impact in the retail setting. I will deal with those separately.
First, we recently conducted a pack analysis of a representative sample of vape packaging that was legally available for purchase in the UK. We found that 85% of those packs are really brightly coloured. A proportion of them have a childish cartoon font on the pack, and the language and terminology on a proportion of the packs utilised youth language and slang, so it is tapping into something that young people could be receptive to.
There is also an issue with how the nicotine content is displayed on the front of the pack. There is no consistency. Some of the packs say that the nicotine content is 2%. We know from our qualitative work that young people misinterpret that as a low percentage, but it is actually the maximum legally allowable amount in the UK. All of that together is communicating to young people that this product is for them; in our qualitative work, that is what they have told us that they believe. We have also spoken to adult smokers, and they also believe that a lot of this colourful packaging is targeting young people. At the moment, there is a mismatch between what we would ideally like vape packaging to do—we want it to speak to adult smokers—and what it is doing. It is not speaking to adult smokers; it is communicating to young people.
The second part is the impact of the packs in the retail setting. I am sure you have noticed that in the retail setting—within the store, but also in the shop front—the display made up of brightly coloured packs is vast. We did a youth tobacco policy survey in 2020 and followed that up with the youth e-cigarettes policy survey last year, in July 2023. We are finding an increased awareness of vape displays in shops among 11 to 16-year-olds across the UK, from 40% up to 68%. That is a substantial increase.
We asked those 11 to 16-year-olds last year what they think about these displays in the retail setting. Some 58% think they are colourful, 36% think they are attractive, 36% think they are eye-catching and nearly a quarter think they are attractive. That shows not only how the display feeds into the appeal but, perhaps even more importantly, how it feeds into the social norm around this product and this behaviour. To give you just a couple of other statistics, nearly a third of our sample reported that displays make them think it is okay to vape, and 64% reported that vape displays make them think that a lot of people vape, so they are really feeding into this social norm. Thankfully, the Bill covers those aspects of promotion.
There has also been an increase in young people reporting seeing vapes and vaping imagery on social media: 25% of 11 to 16-year-olds reported that in 2020, and 41% reported it last year. On your final point about sponsorships, we are seeing quite a lot of sports-associated imagery with nicotine pouches. I know that nicotine pouches should be included in the Bill, because that is another nicotine product. We are starting to see the terminology, awareness and imagery of nicotine pouches take off among young people. This is concerning, and it is one to watch. The imagery is of it being a hit or a boost that helps you to focus. There is a big association with professional footballers; we definitely saw a gender difference in terms of the males picking up on that. For nicotine pouches, there is also sponsorship on Formula 1.
Q Are they the ones that you put on your gums?
Professor Ford:
Yes, it is a little white pouch. You put it underneath your lip and leave it there for up to an hour. For some of these products on the market, their displays are becoming more elaborate. The packaging is very childlike and the number of those childish packs is increasing.
The products can be incredibly strong. We have seen some for sale that contain up to 150 mg of nicotine. In terms of future-proofing the Bill and having the powers to regulate a range of products, the market is so innovative and developing so quickly that it is important to stay on top of that kind of thing.
Q This is very interesting evidence. I want to ask you about flavours. I note that more recently we have started to see flavours among the nicotine pouches that you have just described. I introduced a ten-minute rule Bill last year to ban disposable vapes, because I am concerned about their attractiveness to children and their environmental impact. As part of that, I met representatives of the vaping industry, who told me that the reason they have flavours is essentially to maintain an addiction.
If a person uses a standard stop smoking device, such as a nicotine patch or nicotine gum, the natural history is that they smoke, they use the said gum or patch, they wean themselves off the gum or patch, and then they are no longer a customer providing the industry with revenue. If a person uses vapes, however, they have a choice of flavours that help to maintain the addiction. One thing we have seen with the Bill, which contains powers for the Government to potentially regulate the flavours, is that people are using the argument that it will prevent smokers from stopping smoking. They are trying to argue that flavours do not attract children, but the evidence says otherwise. Do any of you have any comments on that?
Professor Ford:
It is true that the flavours are part of the appeal of these products for young people. That appeal is made up of a whole marketing mix of things, and flavours are one element of that. We know that adults like flavours as well, and they might help some adult smokers to migrate away from tobacco, so that is also a factor.
The concern is the vast number of flavours that are available—there are thousands. The way they are described is also an issue. In our pack analysis, we looked at how all the flavours are described: you have a basic flavour such as strawberry, or a flavour blend, but you also have what we call flavour concepts, which do not denote a flavour at all. We had examples such as tiger blood and koala drool. I do not know what they taste like, but they are certainly not flavours that I am aware of.
We believe that those descriptors are tapping into this youth culture and youth slang—some other kind of imagery. They go beyond the factual content of a flavour. One easy way to help to restrict the appeal around flavours would be to restrict those flavour descriptors in the first instance. I think it is great that the Bill would contain the power to go on to restrict flavours if that is the right thing to do.
Dr Branston:
Can I add that these are profit-seeking companies? They will do what they can to continue to make the profits that they are making. The profits are as addictive as the products that they make, so it is not in any way surprising to me that they design their products to be as appealing as possible to consumers, as well as being as addictive as possible to consumers.
Q I want to come back to the point about advertising. Should the legislation bring tobacco advertising and vaping advertising into line so that the same standards are applied across all products?
Professor Ford:
That is something to consider. As I said in my previous answer, it is the whole marketing mix of the current vaping products that has led to the rapid rise in youth use. That includes not only the packaging, the retail displays, which we have spoken about, and the flavours, but the actual product design: the price, the promotion, the price promotion, the images on social media, the posters in the shop window—there are a lot of youth cues and messages in some of those—the accessibility, because of the wide variety of retailers that sell these products, and the user imagery. We find when we speak to young people that they associate vapes not with cessation, but with social vaping.
It is important for the Bill to be mindful of all of the marketing mix, and I would put sponsorship in there as well. We know that there has recently been investment from tobacco companies in outdoor advertising for their vapes, and we are seeing a lot of sponsorship of nicotine products at music festivals and music events and in the sports sponsorship that I mentioned earlier. It is really important to be mindful of all those marketing avenues.
Q You have talked about alternative products. We know that the industry is very adept at switching products to avoid regulation. Should we be creating a nicotine-free generation alongside a smoke-free generation, so that people who have never smoked will also not have access to nicotine products?
Q But these people have never smoked, because, having been born from
Professor Gilmore:
I would support that. These measures have been put in place in some cities in the US in Massachusetts and California, where they have implemented both smoke-free and nicotine-free generations. They have not been evaluated yet, but I know that other cities are now implementing the same policies, so I think they must have been going reasonably well. I am in touch with colleagues in the US to try to get any evidence from those measures as they emerge.
You are right: nicotine, as I mentioned, is harmful to the developing brain, so ideally we should be aiming for smoke-free and nicotine-free generations in future, in line with the smoke-free generation legislation, while making sure that current smokers are able to quit using nicotine. But that is recreational nicotine, not pharmaceutical nicotine.
Q I think a lot of people will be quite shocked at the statistics that you have just outlined to us on the profits big tobacco is making and the shocking tactics it uses to keep users addicted, ultimately killing half the people who buy its products. I know that this is not in the Bill, but would you support a “polluter pays” levy, so that at least the tobacco industry could give something back to society for the harm it is causing at an individual level, by killing people, and at the societal level, at the expense of our NHS? Do you think that that could be added to the Bill? I do not want to put you on the spot with that question, but in principle would you support a levy on the tobacco industry?
Dr Branston:
Absolutely. I would very much welcome that. It is obscene that the industry can make so much profit by killing up to two thirds of its long-term users. Addressing that profit incentive will go a long way to stopping the interest that the industry has in selling these deadly products. As you know, those products cause massive costs to society, so I think it is entirely reasonable that the companies make a bigger contribution.
In that regard, I know that the excise tax that is currently levied on tobacco products is not directly paid by the tobacco firms—it is passed on to smokers who are addicted to those products—so the “polluter pays” levy is an idea that I would strongly support. I encourage others to do so as well. Not only does it have the economic advantage of raising money that could be used to address the harms caused by smoking, but it would restrict the industry’s ability to price its products as it is currently able to. We know that it uses clever pricing tactics to make tobacco both affordable and profitable for the industry. On every level, a “polluter pays” levy would be a win-win for society, so I absolutely support it.
Professor Gilmore:
I would support that 100%. If I go back to my response to the earlier question about how we have a system problem, that is the sort of measure that can help us to address that system problem. Dr Branston and I have published on the idea of “polluter pays” or using a price cap system, so there is some evidence out there, and some evaluations or modelling of the impacts it might have and the revenue it would bring in. I would really support that.
Q Has anybody on the panel made any assessment of any kind of business association between the tobacco companies and the vaping companies, and also the ultra-processed food companies? The common denominator seems to be addiction. Is there any connection between those three industries, and perhaps even the pharmaceutical companies, which may be part of the solution for people who have become addicted to those three products?
Professor Gilmore:
I can talk a little bit about this. We run a website called tobaccotactics.org, which you can use to look up the organisations that might be lobbying on behalf of the tobacco industry. It identifies the front groups and third parties that are lobbying for it. We know that at least some of those third parties also lobby for the ultra-processed food and alcohol industries and take money from all those industries. That certainly goes on. We also know that they use the same practices, and that sometimes all those unhealthy commodity industries have worked collectively to change whole systems of policymaking. They pushed for the better regulation agenda, for example, because they thought it would make it harder to pass public health policies and environmental policies. We have gone on to show that systems such as better regulation make it harder to pass public health policies, because they provide those powerful industries with a route to feed in their misleading evidence and data.
There is also a revolving door. You see a lot of movement of staff—executives—from one of those unhealthy commodity industries to another. The investors also link them, so there are links at all sorts of levels. To be honest, I do not know the extent to which they learn from each other about addiction and the manipulation of products to make them addictive, but it would make sense.
Q I would like to ask one further question, if time will allow, about the locations where people can vape. Smoking has now been banned in indoor places, cars travelling and cars with children present. Would the same impact around deterring people from vaping occur if the same statutory requirements were put in place?
Professor Gilmore:
Smoke-free legislation had a number of impacts. It was primarily there to protect non-smokers from the effects of second-hand smoke, which we know is harmful, and it was successful in that: we evaluated it and showed reductions in admissions to hospital for heart attacks, asthma and so on. We know far less about second-hand vape, if you like, but smoke-free legislation also de-normalised smoking. I think that having vape-free public places would go towards de-normalising vaping, which is also really important, particularly among younger people.
The other thing, of course, is that the more you vape, the more nicotine you are taking in and the more you are addicted. If you can do it in public places and in workplaces, you can get more and more addicted; some ex-smokers have said to me that they find that a problem, because they can just keep vaping in some places, so they are now using more nicotine than ever before. I suppose it is theoretically possible that if they were not able to vape, they might shift back to smoking, but I do not think they would: we do not have any evidence for that and I do not think that that even really makes sense. Certainly, in terms of de-normalising vaping and reducing addiction, there would be benefits.
There are no further questions. I thank the witnesses on behalf of Committee members.