The hopes and fears for the public health impact of e-cigarettes

This talk will look at what were the hopes and fears for the public health impact of e-cigarettes to 10 years ago, how far these have come to pass, and what we might expect in 10 years’ time, depending on policies adopted and technological change. It will take an international perspective, examining the landscape in countries where good population-level data are available. Neither the hopes nor the fears have yet been fully borne out. E-cigarettes appear to have contributed to reductions in smoking prevalence in countries with more permissive regulatory regimes but as yet the contribution has not been as great as some had hoped. Credible evidence has emerged that e-cigarettes are not harmless but the degree of harm appears likely to be an order of magnitude less than from cigarette smoking. At a population level, evidence has not supported the hypothesis that e-cigarettes would be a gateway to tobacco use among young people. There is evidence that some young people who would never have smoked have used e-cigarettes, but to date this use appears to be primarily occasional. E-cigarette technology continues to advance in terms of creating devices that deliver nicotine efficiently in a palatable form but there are challenges regarding their impact on the environment. The topic of e-cigarettes has become, if anything, more divisive among public health experts, with evidence often being distorted or misrepresented and personal attacks being launched both ways across the divide. It remains possible that with the right kind of regulation, e-cigarettes could contribute further to a reduction in tobacco-related harm as part of a comprehensive tobacco control policy. This will be more likely if protagonists sign up to a set of ethical standards regarding the conduct and interpretation of science and work collaboratively to the development of evidence-based policies.