Build Back Better Flaw Highlights Broader E-cigarette Fallacy

After months of negotiations, the Biden administration’s Build Back Better plan was finally passed by the House, and some analysts are predicting that the sweeping bill could get the Senate’s signoff before Christmas. Public health experts, however, have drawn attention to one particular provision of the act.

The landmark social policy bill aims to help make Americans happier and healthier, but the latest version contains a troubling provision: forced to water down several income-raising measures targeting the ultra-wealthy, the White House is set on introducing a tax on alternative nicotine products, such as electronic cigarettes, raising their cost by roughly 25 percent for an average user. Taxes on conventional cigarettes, meanwhile, will remain unchanged.

Health experts have warned that this is a serious strategic blunder with major risks for public health. According to numerous economic studies, cigarettes and e-cigarettes are typically substitutes for each other. If the cost of vaping increases relative to smoking, individuals will elect to smoke more conventional cigarettes— with devastating consequences.

Research has repeatedly shown that nicotine products exist on a continuum of risk: at one end are cigarettes, posing the greatest risk to public health via a toxic cocktail of tar, ammonia, and carbon monoxide. Electronic cigarettes, with their controlled delivery of vaporized liquid, sit at the other end of the continuum, posing a drastically lower risk to public health.

Any measures which give an edge to conventional cigarettes over less harmful products, such as the uneven taxation in the Build Back Better plan, clearly fly in the face of scientific evidence. Smoking already kills some 480,000 Americans each year, and a breadth of research now exists in defence of e-cigarettes as a crucial public health tool. Policy oversight at this stage is inexcusable.

Worse still, the framers of the Build Back Better plan are hardly the only ones failing to assess and regulate nicotine products in proportion to their risk. Despite the scale of Europe’s tobacco epidemic—some 23% of Europeans still smoke conventional tobacco products such as cigarettes or cigars, and smoking-induced illnesses cause some 700,000 deaths per year—Brussels has yet to adopt a reduced-risk approach to nicotine products.

Instead, rather than recognise findings that making the switch from smoking to e-cigarettes can significantly help adult smokers reduce their risk of health complications, many European policymakers remain guided by “scientifically unsubstantiated” opinions and are at risk of “sabotaging” anti-smoking public health efforts.

In some cases, European policymakers are even adopting highly restrictive measures against e-cigarettes, including flavour bans which threaten to push many people back to smoking. Even the typically liberal Dutch government would see flavoured e-liquids banned in 2022; a similar move in California correlated with a 30 percent increase in underage use of cigarettes for the first time in more than ten years.

Understanding the link between curbs on e-cigarette flavours and an increase in cigarette consumption means looking at individuals who have managed to switch to e-cigarettes. One recent study, which examined vape users from Canada, England, and the U.S., investigated attitudes to proposed policies to ban non-tobacco flavoured e-liquids; researchers found that more than 80 percent of vape users oppose such a ban, with at least one in five considering a switch back to smoking if the ban were enacted.

Meanwhile, a 2017 study found that despite an increase in the number of vape users in the U.S. and UK since 2011, there had been no corresponding increase in the rate of youth smoking. Instead, smoking among middle school students declined from six to four percent in the U.S., while smoking among high school students dropped precipitously from 21 to 13 percent. For all the political hand wringing about vaping as a “gateway” to cigarettes, the data tells a different story entirely.

Indeed, the dangerous misconceptions about e-cigarettes represent a problem that goes right to the top of the public health community, with the World Health Organisation (WHO) taking such a narrow view of alternative nicotine products that more than a hundred specialists signed an open letter last month urging the international health body to reassess its position.

“[We must] consider the substantial body of evidence we do have,” the experts in nicotine science and policy emphasized, “and not allow excessive caution or residual uncertainties to deny smokers promising options to switch away from the combustible products that we know with certainty are lethal…[the] WHO is rejecting a public health strategy that could avoid millions of smoking-related deaths.”

The issue could well be one of inertia: the WHO has been opposed to e-cigarettes for years and has consistently approached vaping products with extreme caution. By 2010, the WHO was already calling on governments to ban vaping in public places and restrict the marketing of e-cigarettes. Unfortunately, this intransigent sentiment clearly persists today—at the WHO as well as among policymakers on both sides of the Atlantic—despite a wealth of scientific evidence pointing to the clear benefits of a harm-reduction approach.