A recently published Eurobarometer survey reveals widespread ignorance about e-cigarettes. Most people do not smoke or vape and therefore have little reason to educate themselves about these products, but it is nevertheless troubling that public understanding has gone backwards in recent years.
The survey shows that among those who have little or no experience with vaping, only 20 per cent think e-cigarettes and heated tobacco products help smokers quit. Seventy per cent think they do not. The proportion of all respondents who believe that e-cigarettes are ‘harmful to the health of their users’ increased from 27 per cent in 2012 to 65 per cent in 2020. The survey does not ask what they mean by ‘harmful’ and no one claims that e-cigarettes are completely risk-free, but there are indications elsewhere that the average member of the public thinks the risks are much greater than they are. A study published last year found that 59 per cent of Europeans wrongly believe that vaping is as dangerous or more dangerous than smoking.
Even in England, where health agencies have largely embraced vaping, the number of smokers who think vaping is as dangerous or more dangerous than smoking rose from 36 per cent in 2014 to 53 per cent in 2020. Less than a third of them believe – correctly – that vaping is less harmful than smoking and 40 per cent of them wrongly believe that nicotine causes cancer. A recent report from Public Health England concluded that ‘perceptions of the harm caused by vaping compared with smoking are increasingly out of line with the evidence’.
The evidence shows that vaping helps people quit smoking. This has been shown in a series of randomised controlled trials, the gold standard of scientific evidence. Evidence from the economics literature demonstrates that e-cigarettes are substitutes for conventional cigarettes. If you reduce the demand for one, you increase demand for the other. No serious academic believes that vaping is anywhere near as harmful to health as smoking. Experts in the field have repeatedly stated that it is unlikely to carry more than five per cent of the risks associated with smoking.
Why, then, does a growing majority of EU citizens believe the opposite? Partly it is because the Americans’ moral panic about e-cigarettes has drifted across the Atlantic. Junk science from California regularly makes its way into European newspapers. Chemical experiments on mice, zebrafish and other small animals have been inappropriately extrapolated to humans to produce scary headlines and undermine the public’s confidence in e-cigarettes.
The 2019 outbreak of so-called EVALI (e-cigarette or vaping product use associated lung injury) was confined to North America but soon became a global news story. Dozens of mostly young people died as a result of inhaling black market THC oil that had been adulterated with Vitamin E acetate. It had nothing to do with ordinary vaping, but activists cynically exploited the incident to portray e-cigarettes in the worst possible light.
The result is that people have become more ignorant about vaping and smokers have decided to take a ‘better the devil you know’ approach. In Britain, six per cent of adults are regular vapers, but the figure is just two per cent in the EU and has been since 2014. Most smokers in the EU have never even tried an e-cigarette and only 14 per cent of them say they find e-cigarettes appealing.
Fear and suspicion has led to intolerance. Hungary has banned e-cigarette flavours and the Netherlands has proposed doing likewise. According to Eurobarometer, 47 per cent of EU citizens would be in favour of such a ban, up from 40 per cent in 2017. An incredible 71 per cent of those who have little or no experience with vaping think e-cigarettes should be regulated as strictly as tobacco.
The flip side to the EU’s low rate of vaping is a stubbornly high rate of smoking. Smoking prevalence barely moved between 2014 and 2020, dropping from 26 per cent to 25 per cent. The EU itself didn’t help matters with its Tobacco Products Directive which made e-cigarettes less appealing through petty regulation and prevented vape companies from putting out a positive message by heavily restricting their advertising.
Consumers cannot make rational choices if they are ignorant of the facts. What is revealed in the Eurobarometer is worse than ignorance. People are systematically biased against the facts and this bias seems to get worse every year. While health campaigners have been busy demanding graphic warnings on alcohol and more labelling on food, the public’s knowledge about e-cigarettes has been going backwards.
Vaping has developed an image problem. Governments, charities and companies need to do more to get the facts out there. One of the primary duties of public health agencies is to educate the public about risk. In this instance, the public has a dangerously inflated sense of risk. Whatever you think of nicotine use, it cannot be right that so many people have perceptions of vaping that are at odds with the scientific evidence.
Vaping has the potential to make the combustible cigarette obsolete within a generation and yet a decade after e-cigarettes came on the market, the EU has twelve times as many smokers as it does vapers. Something has gone badly wrong.