A natural experiment in vaping policy

AND A vast natural experiment was taking place Down Under. This resembles a large-scale controlled study, but it can teach us a lot about the effects of dramatically different regulatory approaches to nicotine vaping.

The subjects of this experiment are the populations of Australia and New Zealand. The two countries have broadly comparable tobacco policies, demographics, quality of life, and population health – similarities that increase the likelihood of disparate tobacco outcomes and related harms primarily caused by vaping policies.

If this were a clinical trial, the negative effects on Australian residents would be so severe that it would be unethical for researchers to allow it.

June 24, Australian Government announced that it would ease strict restrictions on vaporizers. But this move, while welcome, is too little, too late.

Regulatory approaches

In 2020, New Zealand took a progressive and supportive approach legalization and regulation vaporizers. The Ministry of Health encourages vaping as: help you quit smoking through various government initiatives – including an educational website calledFacts about vaping“, “Vape to go strong”, media education and clear advice for healthcare professionals.

Vaporizers are sold in New Zealand as adult consumer products through licensed retail outlets, with strict age verification. A wide range of flavors are available, although nicotine-based horizontal are limited to 28.5 mg/ml. Both disposable and advertising vaporizers vaporization products are prohibited.

Australian public education campaigns they focus mainly on the harms of vaping, with minimal support for adults who smoke to get over.

In contrast, Australia has implemented highly restrictive, a purely medical approach to vaping. Nicotine liquid is classified as a medicine that requires a prescription from a doctor or nurse. Nicotine and vaping products can only be legally purchased in pharmacies, and flavors are limited to tobacco, menthol and mint. Recreational vaping and personal importation are prohibited. Vapes have become so difficult to obtain legally that these rules effectively amount to a ban.

Australian public education campaigns Meanwhile they focus mainly on the harms of vaping, especially among young people, with minimal encouragement for adults who smoke to switch to vaping as a harm reduction measure. The Minister of Health announced that his goal will be “push the vaping industry out of the country“

Yet this health minister has just been forced into a political agreement with the Australian Greens. Thanks to this, from October, people will be able to buy vaporizers in pharmacies without a prescription. However, only three versions will be available, with poor hardware selection and high costs. What’s more, powerful Pharmaceutical Guild has strongly opposed any involvement in this proposal and it remains to be seen whether this model will be implemented without his support.

However, this could be read as a belated, tacit admission that the status quo is not working.

Public health outcomes

New Zealand has historically had a higher smoking rate than Australia. However, recently this trend has been reversed.

Since vaping was regulated in 2020 New Zealand recorded an unprecedented decline in adult daily smoking rates: from 11.9% in 2020 to 6.8% in 2023, a total decline of 43%, or approximately 14% per year.

Significant reductions were seen across a range of demographic groups, including Māori and Māori Pasifika communities and those of lower socio-economic status. As smoking has declined, vaping has increased, with 9.7% of the adult population now vaping daily. The decline in smoking was most pronounced among young adults with the highest rates of vaping, those aged 18-34, supporting the idea that vaping contributed to the decline.

By 2023, daily smoking in Australia was significantly higher than in New Zealand.

Thanks to the rapid decline in smoking, New Zealand is now well on its way to achieving its goal of becoming smoke-free by 2025.

In contrast, Australia recorded a much slower decline in smoking rates, with an annual reduction of 6% from 2020 to 2023. By 2023, the rate of daily smoking was much higher than in New Zealand at 8.3%, with 3.5% of the adult population vaped every day.

In both countries, smoking among young people continues to decline – only 1.2%. New Zealand youth and 0.3 percent Australian young people smoke every day. However, youth vaping rates have raised concerns, particularly in New Zealand. In 2023, 10 percent of people aged 14–15 will New Zealand they vaped every day.

However, most of the increase in young people vaping in New Zealand occurred before regulation was introduced. Since the regulation went into effect, vaping rates among young people have started to level off. This rate is expected to decline as the novelty of vaping fades, as we have seen in the United States.

IN Australiadaily youth vaping was 3 percent in 2023, and anecdotal reports suggest that vaping among young people is constantly increasing. The unpopular prescription-only model means that the market is dominated by illegal vaporizers, which are easily accessible to young people.

Illicit markets and economic impacts

Majority Australia 1.7 million vapers rejected medical path. Less than one in 10 have a prescription for nicotine. Difficulties in finding doctors to write nicotine prescriptions and the limited range of products available in pharmacies have forced 90 per cent of Australian vapers into the illicit market.

estimated 120 million disposable vaporizers are illegally imported and sold every year in retail outlets, social media and online. These unregulated products pose potential health risks and are sold free of charge to young people. Nicotine vaporizers are here now second largest the country’s illegal drug market, second only to cannabis.

This illegal market is largely controlled by organized networks of traffickers and motorcycle gangs. As a result, violence broke out grass war control market share. There have been over 80 of them in the last 18 months incendiary bombs tobacco and vape shops, three public murders and regular extortion. Defenseless children they are used to start fires and commit other crimes on behalf of gangs.

In response, the government established a special criminal force, Operation Lunar, and intensified border control and police activities. However, past experience with drug wars suggest that these measures will have little long-term impact on supply and use.

In New Zealand’s consumer model, expensive doctor visits are unnecessary. and the country avoids the expense of trying to control a large illicit market.

By contrast, New Zealand’s legal and regulated vape market means the country has seen it very little evidence organized illegal market. The legal market offers measurable economic benefits, including tax ones revenues from vaping products, stimulation of the retail and manufacturing sectors, and government savings from reduced healthcare costs. In New Zealand’s consumer model, expensive visits to the doctor to obtain a prescription for nicotine are unnecessary, and the country avoids the expense of trying to control a large illicit market.

The collapse of Australia’s retail vape industry is another detrimental effect of its strict medical model, depriving smokers of valuable support and advice previously available in vape shops.

Even under Australia’s new plan, given the continued relative difficulty of obtaining a limited number of unpleasant vaping products exclusively from pharmacies, the illicit market will continue to expand.

A clear winner

This analysis validates New Zealand’s harm reduction and consumer-led approach to vaping. The most striking benefit was an accelerated decline in smoking rates, followed by predictable improvements in public health.

While New Zealand is currently on track to meet its 2025 smoking reduction target, modeling suggests that Australia will largely fail to meet its own smoke-free target.

While New Zealand’s approach is not perfect, it offers a much more effective strategy for reducing total damage.

In addition to hindering progress in smoking cessation, Australia’s restrictive model has handed control of the vaping industry to illegal operators, eliminating consumer protections and age restrictions, creating further dangers from the resulting turf wars.

While New Zealand’s approach is not perfect, particularly with higher rates of youth vaping, it offers a much more effective strategy for reducing overall harm. Improved compliance measures could further stabilize youth vaping, although net harm from youth vaping are debatable and certainly incomparable to smoking.

Australia has just recognized, to a limited extent, the urgent need to change course and abandon an approach that is high-cost, creates violent chaos and clearly undermines public health goals. The country still has a lot to do to ensure every smoker has low-barrier access to vaporizers.

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Top image by U.S. Geological Survey via Picryl/Public Domain. Graphic inset by Colin Mendelsohn based on public data.