UK: A Case Study

The UK Government was an early adopter in recognising the positive public health role of vaping products. Along with public health organisations, it has created an environment that has resulted in millions of smokers switching to vaping, contributing to increased reductions in smoking prevalence.

UK Government Approach

England’s public health agency, Public Health England (PHE)* first advocated for a potential role of electronic cigarettes in Tobacco Harm Reduction (THR) in 2015. That year, it published a landmark report stating that “best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes.”^[1]  Notably, one of the report’s authors, Professor Ann McNeill from King's College London, described e-cigarettes as a "game-changer" in public health.^[2] 

PHE, and its subsequent replacement in 2021, the Office for Health Improvement and Disparities (OHID), have since published eight independent reports on vaping.^[3] This collection aims to provide information and guidance on e-cigarettes and vaping to inform policies and regulations. The 2022 OHID-commissioned review,^[4] the most comprehensive to date, highlights that while vaping is not risk-free, it is estimated to pose only a “small fraction of the risks of smoking.”

The independent Khan Review,^[5] commissioned by the UK Government to outline recommendations for achieving a smoke-free England by 2030,^[6] also recommended offering vaping as a substitute for smoking, alongside accurate information on the benefits of switching, including to healthcare professionals.

Strong Advocacy from Public Health Organisations

Other UK Government agencies and health organisations, beyond OHID, have been strong advocates for vaping as a tool for THR. These include:

• The Medicines and Healthcare products Regulatory Agency (MHRA),
• The National Institute for Health and Care Excellence (NICE);^[7] and
• The Action on Smoking and Health (ASH).

For example, ASH states that: “Using a nicotine vape is much less harmful than smoking in the short and medium term. However, vapes are not risk-free and their long-term health impact is unknown – though they are likely to be far less harmful than smoking.”^[8]

In a 2024 evidence review, the Royal College of Physicians (RCP) reaffirmed its support for e-cigarettes as a THR tool, stating that the evidence in this area has become much stronger. RCP also emphasises the importance of preventing youth uptake while ensuring access for adult smokers who use vaping as an alternative to continued smoking.^[9]

NHS Approach to Vaping

While BAT’s vapour products are neither licensed nor marketed as smoking cessation aids, strong independent public health advocacy of vaping as a tool for THR has been instrumental in shaping the NHS’s approach to vaping, leading to the inclusion of e-cigarettes in its smoking cessation guidance^[10] and NHS Stop Smoking Services.^[11] Following Khan’s review recommendations, in April 2023 the Department of Health and Social Care (DHSC) also announced a “Swap to Stop” programme, offering a vaping starter kit alongside behavioural support to one million smokers across England.^[12] 

Positive Outcomes

The positive attitude towards the role of vaping to encourage smokers to switch to reduced risk profile products in the UK has likely contributed to the increasing decline in smoking rates. Long-term data shows that as vaping has increased, smoking prevalence has contemporaneously declined as well. Between 2014 and 2023, adult vaping rates rose from 4.2% to 9.1%,^[13] while smoking rates among adults decreased by 6.2%, from 18.1% to 11.9%.^[14] Crucially, more than half of current vapers (53%) are ex-smokers who have switched completely to vaping.^[13] 

The UK’s progressive approach to tobacco harm reduction to date contrasts with the more cautious stance in a number of EU countries. As a result, the UK is one of the countries leading the transition away from smoking to Smokeless Products. In 2023, nearly a quarter (24%) of EU responders to a Eurobarometer survey conducted for the European Commission, reported that they currently smoke, with only 3% of the population using e-cigarettes.^[15] Meanwhile, the smoking rate in the UK for a similar demographic was significantly lower, at 10.5%.