Thank you to you and the committee for the invitation here to give evidence. I do so as professor of epidemiology at the University of Nottingham. I'm director of the UK Centre for Tobacco and Alcohol Studies, a research network based in the U.K. for alcohol policy and practice, and I chair the Royal College of Physicians' tobacco advisory group. It was in that role that I led the production of a report called Harm Reduction in Nicotine Addiction, which was published in 2007 and called for exploitation of the opportunity to provide smokers with alternative sources of nicotine to reduce the death and disability caused by tobacco smoking. We used as our proof of concept that it can work the experience that the Swedes have had with oral tobacco, which has resulted in very low levels of smoking prevalence and very low cancer rates.
That approach was accepted by the U.K. governments. The outgoing Labour Government published a policy strategy document that included harm reduction, and then the incoming coalition government a year later did the same thing. We've had an environment of encouragement of alternative sources of nicotine for smokers for some years in this country.
Electronic cigarettes came along just at the time that the RCP report was published in 2007. So it wasn't covered in that report but essentially went a long way towards fitting the bill of what we felt was needed to encourage smokers to use less harmful sources of nicotine—something that's socially acceptable, affordable, available in the same points of sale as tobacco cigarettes, and something that works as a tobacco substitute. It's probably fair to say that the early generation electronic cigarettes were less effective than the later generation ones, but the fact remains that these have proved extremely popular in the U.K. and many other countries since.
Earlier this year with Dr. Bogdanovica, I published a report for Public Health England, which is available on their website and which I think has been accepted by Public Health England, the organization that supervises public health in our country, as the sort of background policy or principle of electronic cigarette use and public health. The report concluded that smoking kills. We have 10 million smokers in the U.K. I don't know what the figure is in Canada, but five million of those are going to die unless they stop smoking tobacco. Although we're doing our best with conventional tobacco control policies, the prevalence of smoking is coming down steadily but slowly. Most of those smokers are alive today. Therefore five million of those smokers are alive today. Most of those will die from their smoking before existing policies touch them.
That burden of morbidity and mortality falls particularly on disadvantaged people, the socially and economically disadvantaged, those with mental health problems, and various other isolated groups in society. Electronic cigarettes provide a substitute that many of those people find acceptable. We have found that by switching as a lifestyle choice rather than something that's medicalized involving a commitment to quit smoking, a couple of million of our smokers in the U.K. are now occasional or regular users of electronic cigarettes and about 700,000 are now exclusive users. Seven hundred thousand people quitting smoking by swapping to an alternative source over the course of about four years is more than our National Health Service smoking cessation services have achieved in over a decade.
We therefore feel that electronic cigarettes and the products that are in development that follow them into the market offer huge potential health benefits, which will be accrued particularly by the most disadvantaged in society. But they also pose risks to society. A number of them—too many to list here—include renormalization of smoking, concerns over long-term safety, use by the tobacco industry to re-engage in tobacco policy, use as a dark marketing tool by tobacco companies, promotion to children to establish new generation of nicotine addicts and many other risks. We feel that all of these deserve concern, but all of those can be managed and it would be a mistake to throw the baby out with the bath water by restricting electronic cigarettes so severely as to prevent the benefits to existing smokers.
Already in this country electronic cigarettes are being used by many more people than use conventional nicotine replacement therapies. The latest evidence from the Smoking in England website, which is a rolling survey of smokers, is that the prevalence of use has levelled off and is about one in five smokers.
On the pros and cons of how these products can be regulated, I can only comment on what's happening in the U.K., where we currently cover them under general sales regulations and which do not require demonstration that the products work. So a smoker can go out and spend a lot of money on one of these things and get no nicotine from it. Nor do we have guarantees of their safety. I think most people accept that this is an unsatisfactory situation. We do have legislation in progress and voluntary agreement recently accepted to stop advertising and selling to children.
The MHRA, our medicine regulatory agency, has recognized these nicotine products as a good thing for public health and stepped back from defining them as medicines a year or so ago, but have offered what they call right-touch regulation of medicines as a route to market for manufacturers. The idea was that the right-touch regulation would be a simplified version of medicines regulation or licensing. In my opinion it isn't working out that way and it remains extremely cumbersome.
From 2016 or 2017, depending on which products, all electronic cigarettes will come under the control of the European tobacco products directive, which will impose limits on emissions and amounts of nicotine delivered according to standards that have yet to be set. We have no idea what they will involve, but they will limit the maximum dose delivered by the products so as to render them ineffective. That's unsatisfactory regulation and we don't have a suitable way out.
Going back to the original RCP report, what we argued was that the only solution to this is to regulate nicotine differently from other products, and that tobacco and non-tobacco products should all come into a consistent system. This allowed market freedoms in direct proportion to the relative safety of the product, therefore making cigarettes extremely unaffordable and difficult to get hold of, but making it increasingly easy to get hold of nicotine substitutes. I would like to see us doing that, but I don't think it's going to happen.
A final thing that is very important to the monitoring of electronic cigarettes, and realizing the potential they offer, is that you must have very effective monitoring or prevalence monitoring in place. In the U.K. we have that on a relatively small-scale survey. If we do this then it's possible to see where the abuses are and to deal with them early. At the moment in the U.K., use among smokers, as I've said, is about 20% exclusive use to the exclusion of cigarettes and about 7% of smokers. Use among children and young people is almost entirely limited to those who smoke, with about 1% or 2% of young people who are non-smokers ever experimenting with the product. At the moment the impression is that electronic cigarettes are providing a very powerful force for the good in English public health, and we hope that can continue.
Thank you.
