I am thankful for the opportunity to speak tody on the Public Health (Tobacco Products and Nicotine Inhaling Products) Bill 2023. I support this legislation and the introduction of a licensing system for the sale of tobacco and nicotine-inhaling products such as e-cigarettes. I welcome the proposed restrictions on sales of these products, including banning sales from mobile premises and vending machines, and the prohibition on the sale of e-cigarettes to those under the age of 18. I also support a ban on sales of tobacco and e-cigarettes at events aimed at children, and a ban on e-cigarette advertising and promotion in certain places, including within 200 m of the perimeters of schools and at bus stops or train stations.
We know well the negative health impact of smoking cigarettes and of second-hand smoke. Every single week, more than 100 people die and over 1,000 people are hospitalised in Ireland from smoking-related illness. It is shocking that one in two of all smokers will die from a tobacco-related disease. According to the HSE, tobacco use is the leading cause of preventable death in Ireland, with almost 6,000 smokers dying each year from tobacco-related diseases. Smoking harms nearly every organ of the body, causing many different illnesses and diseases because cigarettes contain over 4000 toxic chemicals, many of which are proven to cause cancer. Smoking also has a very negative financial impact and is estimated to cost almost €10.6 billion per year. The Tobacco-Free Ireland policy document developed by the Department of Health in 2013 set a goal that fewer than 5% of people in Ireland would smoke by 2025. Although there was a significant drop from 23% in 2015 to 17% in 2019, the figure, unfortunately, increased to 18% in 2021, far from the less than 5% target set out, and demonstrates that we are going in the wrong direction. It is also important to note that at the time of publication, e-cigarettes were not for sale in Ireland and so were not accounted for in these targets. Those in the 25 to 34 age group are most likely to smoke, with men more likely to smoke than women across all age groups. We know that 35% of men aged 25 to 34 are smokers, while 14% of women in this age group are smokers. This disparity is worth researching further in order to fully understand smoking behaviour and smoking habits. I also feel that further research is needed into the methods used by the tobacco industry to influence public policy across the world.
In 2000, the Bulletin of the World Health Organization identified some of these methods, and stated:
The tactics used by the tobacco industry to resist government regulation of its products include conducting public relations campaigns, buying scientific and other expertise to create controversy about established facts, funding political parties, hiring lobbyists to influence policy, using front groups and allied industries to oppose tobacco control measures, pre-empting strong legislation by pressing for the adoption of voluntary codes or weaker laws, and corrupting public officials.
It is important that we protect public health policy from being influenced by industries that profit from harmful products, such as cigarettes and e-cigarettes. I would go even further by saying that public health policy also should be protected from all industries that profit from public health problems.
It is important to note that while e-cigarettes are not as harmful as traditional cigarettes, they are certainly not harmless. Risks of e-cigarettes and their impact may depend on frequency of use and other factors. Emerging research indicates that prolonged use of vapes may lead to an increased risk of heart and lung conditions. E-cigarette emissions typically contain nicotine and other toxic substances that are harmful to users and to non-users who are exposed to them. The WHO has stated that these products are harmful to health and has found that it is too early to provide a clear answer on their long-term health impact. There is no doubt that e-cigarettes are safer than traditional combustible cigarettes, but they are still in no way safe and are seemingly not even very effective as a quitting tool. It is claimed that the key benefit, if any, of these devices is that they assist in helping smokers to quit. However, a review carried out by the Health Research Board, HRB, in 2020 found that e-cigarettes are not regulated or approved as smoking cessation devices. Furthermore, there is insufficient data to show the effects that they have on the human body with prolonged and sustained use. Beyond 12 months, the safety of their usage is not known. The WHO has said the level of evidence is inconclusive in relation to the role of e-cigarettes as a quitting tool. Results show that e-cigarettes perform about the same, in terms of a quitting tool, as nicotine replacement therapies, and that for every 100 people using nicotine e-cigarettes to stop smoking, eight to 12 might successfully stop. The emphasis is on the word "might".
I understand that e-cigarettes may be helpful to smokers and do not want to create an additional barrier to them quitting cigarettes. However, it is worth addressing the fact that as a nation, if we truly want to become tobacco free and meaningfully lower our current smoker population of 18% of the overall population, we need to do more to assist in quitting while also moving to heavily regulate ancillary products that are highly addictive. I applaud anyone who is in the process of trying to quit cigarettes or has done so already. I attest to the fact that it is not easy, having come off cigarettes myself. It is very difficult for people to break that habit. We should be trying to make it as easy as we can. Addiction has a strong grip, and the willpower to overcome it is commendable. I am also aware that vapes are a useful tool for those trying to give up smoking. However, there is some evidence that e-cigarette usage may actually encourage smoking, particularly among young people.
The HRB has concluded that teenagers who use e-cigarettes are three to five times more likely to start smoking tobacco cigarettes compared with their peers who have never used them. That in itself, is enough to ban vapes. They are a path to people getting addicted to cigarettes. It is too dangerous to even consider it. Nicotine is highly addictive. Some evidence suggests that minors who have never smoked before and who use e-cigarettes can double their chances of starting to smoke cigarettes later in life. In addition, the exposure of children and adolescents to nicotine can have long-lasting and damaging effects on brain development. As it currently stands, 14.9% of the population aged 15 years and older have used e-cigarettes at least once in their lifetime, with that number continuing to increase. Again, boys are more likely to use them than girls, with 26% of boys having used electronic cigarettes at least once, in comparison to 18% of girls. I reiterate the importance of further research into this to establish why this may be.
It is clear that e-cigarettes are very harmful for young people, which is why I support this legislation, and why I also have serious concerns that with the design, flavours and promotion of e-cigarettes to children, they are targeting young people and teenagers. This Bill needs to go a step further and increase restrictions on flavours, packaging and advertising. The Irish Cancer Society has raised concerns that flavours such as bubblegum, strawberry milkshake, tutti-frutti and cola are aimed at adolescents and young people, and has said that it is important to regulate flavours which could be seen as targeting younger people. One of the health committee's recommendations states: "The Bill should regulate the flavouring of e-cigarettes and all flavours, except for tobacco, should be strictly prohibited so as not to entice minors." I agree with that. It is disappointing that it has not been included in the legislation.
Further, in relation to marketing, it is noteworthy that in the USA a massive settlement has been made to resolve a two-year investigation into an e-cigarette manufacturer’s marketing and sales practices, including claims that it marketed addictive nicotine products to children. Some US jurisdictions are implementing an outright ban on sales, including online, or on certain flavours that are believed to attract young people to vaping. In Australia, the Government brought in a near total ban, making e-cigarettes available by prescription only. The benefit of this is that you have to be a smoker already in order to access one. It also means that children and teenagers have no access, which stops them from becoming addicted. The New Zealand Government is banning younger generations from being able to legally purchase tobacco products, with the age limit for legal purchases rising every year. Brazil, Mexico and Singapore have banned e-cigarettes altogether.
I welcome this Bill, but I urge the Government to pay close attention to nicotine products and their impact on people's health in the longer term. There are about 300,000 different types of products currently registered within the EU. We need to keep pace with new tobacco and other nicotine products, given the evolving market. The fact that the tobacco companies are buying over vape-producing companies shows how dangerous it is. It shows that it is something that we should be acting on to make sure that we are protecting people. We have recently seen products, such as chewable nicotine pouches, being introduced and marketed in Ireland. These are not regulated under tobacco legislation either.
I also urge the Government to consider the committee’s recommendation that the legislation be reviewed following the first year of enactment, given the introduction of new products and the importance of this legislation in relation to public health. It is vitally important to have a review process. I know, from the way the Government operates, that a review following the first year of enactment may be too soon, because many of the aspects of the legislation may not even be implemented by the time a review takes place. However, I am of the view that a review mechanism must be built into the legislation in order to ensure that reviews actually take place. One thing that we are very slack on in Ireland is reviewing legislation. The view appears to be that once legislation passes through the House, the job is done and dusted. Over the past while I have submitted a number of questions to every Department, asking about the amount of legislation and parts of legislation that have not been enacted yet. The list of sections and whole pieces of legislation that have not been brought into force is shocking. When legislation is put through the House, there seems to be a mad rush. When legislation then goes to a Department, nothing happens with it. I am hoping that will not happen with this legislation and that it will be implemented, but it must be reviewed as well. That is something the Minister of State should take on board. She and the Minister should be prepared to accept amendments to provide for a review process.
