Léim ar aghaidh chuig an bpríomhábhar

Joint Committee on Health díospóireacht -
Wednesday, 17 Nov 2021

General Scheme of the Public Health (Tobacco and Nicotine Inhaling Products) Bill 2019 (Resumed): Discussion

I welcome all our witnesses to our meeting this morning to discuss the public health (tobacco and nicotine inhaling products) Bill 2019, including Ms Averil Power, chief executive officer, and Mr. Paul Gordon, policy and public affairs manager, Irish Cancer Society; and Mr. Chris Macey, director of advocacy, and Mr. Mark Murphy, advocacy officer, Irish Heart Foundation.

Members now have the option of being physically present in the committee room or may join the meeting remotely from Leinster House. Members and all in attendance are asked to exercise personal responsibility in protecting themselves and others from the risk of contracting Covid-19. They are strongly advised to practice good hand hygiene and to leave at least one vacant seat between each other. They should also maintain an appropriate level of social distance during and after the meeting. Masks, preferably of a medical grade, should be worn at all times during the meeting except when speaking and I ask for the full co-operation of those in attendance in this regard.

All witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that may be regarded as damaging to the good name of the person or entity. Therefore, if witnesses statements are potentially defamatory to an identified person or entity, they will be directed to discontinue their remarks. It is imperative that witnesses comply with any such direction.

Members are reminded of the long-standing practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official either by name or in such a way as to make him, her or it identifiable. I call Ms Averil Power-----

My apologies, Chairman, but I must attend the finance committee meeting which is in session all day today. I will have to come and go as best I can.

That is not a problem. If the Deputy has a window, we will try to facilitate him in joining the meeting.

I thank the Chairman very much.

I call now on Ms Averil Power from the Irish Cancer Society to make her opening remarks.

Ms Averil Power

I thank the Chairman and members of the committee for inviting my colleague, Mr. Paul Gordon, and I to attend this meeting of the Joint Committee on Health on behalf of the Irish Cancer Society.

First, I would like to recognise all the work that has been done on this Bill to date, by the Minister, the committee members and the civil servants in the Department of Health and the Office of the Parliamentary Counsel. The Irish Cancer Society welcomes the Bill's provisions to ban the purchase of e-cigarettes by under-18s, to introduce a new licensing fees regime for tobacco and e-cigarettes and to end sales of tobacco products from vending machines and at child-centred events. These changes will help to reduce children’s opportunities to buy cigarettes and that is very welcome. However, unfortunately, it is not enough.

As we all know too well, if young people want something badly enough, they will find a way to get it. That is why the tobacco industry is spending billions making e-cigarettes attractive to children and why any legislation that does not address its aggressive advertising and child-friendly flavours and packaging is destined to fail.

Ireland has a proud history of being a world leader in tobacco control. The introduction of the workplace smoking ban and plain packaging by former Ministers for Health, the Taoiseach, Deputy Micheál Martin, and James Reilly were courageous and important victories for public health in a world that often values commercial interests more. Unfortunately, when it comes to e-cigarettes, Ireland is a laggard, not a leader. Estonia, Finland and Hungary have banned non-tobacco flavouring in e-cigarettes and the Netherlands announced its intention to do the same. Nine EU countries have total bans on e-cigarette advertising, promotion and sponsorship. Right now, while young people elsewhere in Europe are being protected against e-cigarette marketing, young Irish people are being bombarded with ads on billboards, on buses and at checkouts. Our young people deserve better. As the head of the Health Research Board, HRB, Dr. Jean Long, recently stated:

Children and adolescents require the same protection from e-cigarettes as conventional tobacco cigarettes through a well-enforced regulatory regime of measures including age restriction on purchase, control of availability through licensing outlets, limits to product visibility and attractiveness, and appropriate pricing through taxation.

From speaking to policymakers I understand the need for tougher e-cigarette regulation that their hesitance to do so is driven by genuine concerns. They want to help adult smokers to quit and believe e-cigarettes have a role to play. They know individuals, as I am sure we all do, who have moved from smoking tobacco to vaping and they are persuaded by industry arguments that the kind of measures required to protect young people from vaping will hinder the efforts of long-term smokers to quit tobacco.

Let us not forget that all the major e-cigarette companies are owned by big tobacco. When a representative of PJ Carroll wrote to members recently about this Bill, they described the company as an e-cigarette company. However, PJ Carroll is one of the biggest tobacco companies in Ireland and is owned by the global tobacco giant, British American Tobacco.

For years, the cigarette industry told us that cigarettes do not cause cancer, that low tar cigarettes were healthier than other products and that second-hand smoke was harmless. It produced its own so-called research, misrepresented the findings of genuine studies and hired persuasive lobbyists to hoodwink public representatives and block progressive public health measures. Now it is at it again. Companies whose primary business is selling cancer-causing tobacco are trying to convince our public representatives that their main concern is smokers' health and that they want to help smokers quit tobacco using e-cigarettes. It would be laughable if it were not so serious.

It is true that some smokers prefer vaping to the use of licensed nicotine replacement gums and other products. However, as the HRB pointed out, e-cigarettes are no more effective than approved and regulated nicotine replacement therapies to help people stop smoking. The World Health Organization stated that electronic nicotine delivery systems cannot be recommended to help cessation at the population level and warned they could impede cessation among some individuals by prolonging or even increasing addiction to nicotine.

The Irish Cancer Society is committed to doing everything we can to help people quit smoking. We constantly monitor emerging evidence both nationally and globally. We promote cessation methods that reputable independent bodies have found to be effective. We provide smokers with individual support and advice and we have helped developed peer support programmes that been proven to help people quit. We know how hard it is to quit smoking and stand in solidarity with those who are trying. We understand why many adult smokers choose to try vaping and we respect that decision. However, we cannot promote something that the WHO and others have found to be harmful.

The improvements we are advocating to this Bill will not hinder adult smokers who want to try vaping, but they will protect children and young people who have never smoked and would never take up the habit if it were not for e-cigarettes. They will protect children from flavours like bubblegum, tutti-frutti and cola that are clearly aimed at them and not at lifetime tobacco smokers. It is well established that e-cigarettes can develop into a gateway to nicotine addiction and ultimately traditional tobacco consumption, as they mimic and normalise the action of smoking. Indeed, the HRB found adolescents who have tried an e-cigarette are between three and five times more likely to start smoking compared to those who never used e-cigarettes. That is the real reason that the tobacco industry is so invested in electronic cigarettes.

The tobacco industry kills one in two of its customers. Its business model is dependent on recruiting young people to replace them. It will do and say anything to achieve that goal. Ireland’s delay in effectively regulating e-cigarette sales and marketing has played right into its hands. Attracted by cool advertising, childlike flavours and aggressive point of sale marketing, more and more young Irish people are taking up vaping. As research by Professor Luke Clancy has shown, as vaping has become more popular, the smoking rate among our 15- to 16-year-olds has also increased from 13.1% in 2015 to 14.4% in 2019.

To conclude, Ireland has a proud tradition of taking on big tobacco and putting public health first. Let us not undermine all of that by allowing tobacco companies an unlocked back door to entrapping a whole new generation into nicotine addiction. Let us stand in solidarity with our EU partners in protecting our young people from tobacco and the devastation, disease and death it causes. To do that, this legislation must include a ban on e-cigarette flavours other than tobacco, a ban on e-cigarette product advertising through all communication mediums and the introduction of plain packaging for e-cigarette products. Heads 16, 17 and 21 should also be amended to include nicotine inhaling products as well as tobacco products. Together, we can help adults quit smoking through safe and effective methods while also ensuring today’s young people never take up the habit.

I remind members and witnesses not to mention individuals or companies if they can avoid it. I call Mr. Chris Macey from the Irish Heart Foundation to make introductory remarks.

Mr. Chris Macey

I thank the Chair for the invitation to appear before the committee today. Our legislators, health authorities and health NGOs have forged a powerful alliance over many years that has made Ireland a leading global force in tobacco control. Through bold action, enabled by political consensus, many thousands of lives have been saved in Ireland, and countless more in other countries where policies pioneered here have been replicated. Today, the Irish Heart Foundation urges members to act boldly again to revitalise the faltering quest for a tobacco-free Ireland and to protect young people from the misery and destruction that nicotine and tobacco addiction causes.

We fully support this Bill, although we have made some suggestions to strengthen it in our submission. We greatly appreciate the Department of Health and everyone else who has been involved with moving this forward and all the efforts to get the legislation to this point. However, we do not believe it goes far enough. After falling from 41% to 13%, the smoking rate among 15- and 16-year-olds here is now increasing for the first time in a quarter of a century. Additionally, 39% of this age group have used e-cigarettes and 15.5% are regular users.

There is serious concern that this is the result of a gateway effect from soaring youth vaping rates,with Health Research Board, HRB, research concluding that adolescents who vape are up to five times more likely to take up smoking. Far from achieving a tobacco-free Ireland, we now risk losing the hard-won gains of the past 25 years, as the world's big tobacco firms that now control much of Ireland's vaping market seek to addict a new generation of young people to nicotine. To turn the tide of youth smoking back in the right direction and robustly address the dangers of vaping to young people, we believe four further measures are needed to be added to the Bill. These are: to increase the legal age of sale of cigarettes and e-cigarettes from 18 to 21; to outlaw all e-cigarette flavours bar tobacco; to ban all e-cigarette advertising and; to introduce plain packaging of e-cigarette products. We do not want to delay crucial provisions in the Bill that must be implemented urgently and therefore suggest complex age-of-sale legislation for tobacco could be enforced through subsequent amending legislation.

We believe a new age-of-sale law is justified on the basis of three key tests. First, is it proportionate? Yes, because of the unique harm smoking causes. Many young people move from casual use to addiction between the ages of 18 and 20. For every three young smokers, one will die of tobacco-related causes, while for every death, 30 more will suffer long-term chronic disease at some point. Will it be effective? Yes. Tobacco 21 laws effected in various US states before becoming federal law have reduced smoking among 18 to 20-year-olds by as much as a third. The US Institute of Medicine says 223,000 lives will be saved among those born between 2000 and 2019. In Ireland, that would equate to approximately 3,500 lives saved. We can also be confident it will work due to the hugely positive impact of increasing the age of sale here in 2002 from 16 to 18. Third, would it breach young people's rights? The answer to that is "No". The notion that young people automatically acquire all rights possessed by adults at 18 is incorrect. Those under 21 are already prohibited by law from activities such as adopting children, driving large passenger vehicles, supervising learner drivers and standing in national and European elections. This measure also has overwhelming public support. Our Ipsos MRBI poll found that 73% of Irish people aged over 15 support the move, including 69% in the 15 to 24 age group and 71% in the 18 to 24 age group. We regard this as a clear message to policymakers that the Irish public wants decisive action to end the blight of smoking for good.

As in the US, such a law would have to be accompanied by similar restrictions on e-cigarettes or we would risk further fuelling of youth vaping rates. The need for further tough measures on e-cigarettes is a product of the duplicity of an international vaping industry whose lobbyists promote e-cigarettes as a quit tool for long-term smokers, while their marketers relentlessly target young people with tactics that are as aggressive as they can get away with. The truth is e-cigarettes are far from safe as they can damage the heart, blood vessels and lungs, while exposure to nicotine can have long-term damaging effects on young people's brain development.

The industry's business model betrays everything. Would Marlboro manufacturer, Altria, have paid €12.8 billion for a 35% stake in Juul Labs, just to help long-term smokers quit, ultimately putting itself out of business? Of course not. The reality is underlined by its recent €40 million settlement with the state of North Carolina, after being sued for using deceptive practices targeting young people. Long-term smokers represent only a small part of the target market of big e-cigarette brands. The main objective – and profits – lie in addicting young people who have never smoked. By banning child-friendly flavours and advertising, along with plain packaging of e-cigarette products, the State could remove the key methods used to target young people. Many e-cigarette liquids are sold in bright, attractive packaging with cartoon characters. I have a couple of them here that I can show members. They come in various sweet, fruity flavours such as bubblegum and strawberry milkshake designed to entice young people. Vaping industry claims that such flavours are not intended for young people but are necessary to assist long-term smokers are nonsense. US research shows that almost 80% of youth users gave the availability of flavours as the reason why they vape. US Food and Drug Administration research also found that 97% of youth vapers had used a flavoured e-cigarette in the last month and were more than three times more likely to use fruit flavours as older adults. This was backed up by research we conducted with the Irish Cancer Society showing unanimous agreement among focus groups of third and fourth-year students that sweet and fruity flavours, along with bright colourful packaging, were aimed solely at young people.

Meanwhile, e-cigarette advertising is banned in print, radio and on TV but is permitted on billboards, public transport and at point of sale. This means young people are exposed to advertising near their schools, on high streets, in shops and on buses, trains etc., as part of their everyday lives. Research shows this advertising is effective. The bigger and hidden danger, however, is online. While online e-cigarette marketing is illegal, accounts are permitted on social media platforms like Instagram and Facebook. This enables targeting of young people by social media influencers and celebrities promoting e-cigarette brands. Companies claim they only engage with adult audiences, but research shows they circumvent these rules by using hashtags like #gaelicfootball, for example, to communicate with teenagers. Despite the success of tobacco control policies in Ireland, smoking still claims almost 6,000 lives here every year, more than have, sadly, died throughout the pandemic. Without decisive action now we will condemn this generation of children and young people to a similar and completely avoidable health catastrophe. We cannot let that happen.

I thank Mr. Macey for his opening remarks. We will move straight into questions to the witnesses. Each group will have ten minutes. The answers must be given within the ten minutes as well. A few apologies have been received from members. Some members also outlined at the start of the meeting that they have other meetings to attend, but they will try to get in later on. We will see how the morning goes.

I thank the witnesses for their presentations. Both presentations were very strong in calling for a total ban on advertising on billboards and on public transport, among other places. Do we have any idea of the kind of expenditure at the moment by these companies on such advertising? I presume they are spending large amounts of money, so they must find it very effective. If we ban such advertising, will they divert the money into other ways of promoting their product? Reference was made to nine countries where there has been a ban along the lines the witnesses indicated. Does someone want to take that question?

Ms Averil Power

I thank Deputy Colm Burke for the question. It is not fully transparent exactly how much tobacco companies spend on billboards but we do know from going out and about the proliferation of advertisements for e-cigarettes on buses, billboards and in shops. Prominent product placement is evident in shops. Mr. Macey referred to marketing e-cigarette products so that they look like sweets. There is a proliferation of marketing going on to make such products attractive to children in particular.

The question on whether the industry will try to find another approach if we ban one type of advertising is a good one. Yes, they will. That is why we have to keep up with them. We have seen from other countries that such an approach works. Finland, for example, has managed to reduce the adult smoking rate while also maintaining vaping rates really low.

The reason is that Finland is very progressive in its legislation and has been a leader in this area. We have to be vigilant and protect our children. Industry will find a way. There have been news reports on the tactics it still uses in the developing world. The smoking prevalence in Lesotho is 50%, which is horrifying, because single cigarettes are still sold outside schools. Industry will also find loopholes that governments allow. It is important that we keep up with those loopholes and close them.

I will talk about one of those loopholes relating to the sale of cigarettes at present. We brought in a regulation that cigarettes have to be sold in packs of 20 or more. My understanding is that 30% of all cigarettes now sold are in packs greater than 20. Should we also look at this in the context of, for argument's sake, someone who is on 20 cigarettes a day now buying a pack of, for example, 27 cigarettes? The likelihood is that that person will smoke those 27 cigarettes in one day. While we have said cigarettes cannot be sold in packs of less than 20, should we also be bringing in a regulation that only packs of 20 can be sold?

Mr. Paul Gordon

As the Deputy pointed out, in recent years we have certainly seen a proliferation in the sale of packs of 27, 28 and, in certain cases, 35, which makes up approximately 30% of sales so far. The worry is that when they are sold in those pack sizes, the cost per single cigarette is in fact lower than might be found for a pack of 20. That is a concern. We know that higher prices discourage people from taking up the habit and also encourage people to quit smoking. It is known, and the WHO has shown, that if the price of cigarettes in high-income countries is raised by 10%, there will be a subsequent drop in the smoking rate of 4%. That is certainly something we should look at. The Department has stated that there has not been a whole lot of evidence on it to date, but it suggests that the Department should take a look at that, examine what further evidence is available and do research into smoking habits around those larger packs.

The other issue that arose during the lockdown in 2020 was that the sale of cigarettes, and cigarette and tobacco products, went up by €150 million. I presume this indicates the amount of product that comes in from abroad when people go on holidays and bring cigarettes back with them. Should we do more to control that whole area? For instance, Finland was referred to earlier. My understanding is that tobacco products can only be brought into Finland if the health warning on the packets is in Finnish and Swedish. For argument's sake, what if a regulation was introduced here whereby a tobacco product could only be brought in if the warning on it was in Irish and English?

Mr. Chris Macey

I will come in briefly on the previous question. I remember a time when young children would be seen going into shops to buy three Major cigarettes and a pennyworth of chewing gum for 10p. That was stopped, then the sale of a packet of ten cigarettes was stopped and we went to packs of 20. In Australia, cigarettes are sold in packets of 30. I have seen some evidence that what Deputy Burke is talking about may be a problem and may be something we have to deal with. It needs to be looked at. We might be able to look at that through the tax system. The excise on cigarettes could be amended or adjusted to take account of those larger sales that are cheaper per unit and are, therefore, making it cheaper to smoke. As Mr. Gordon said, generally speaking, the more young people have to pay for cigarettes, the more out of their reach they tend to be.

The issue of bringing amounts of tobacco in that are not smuggled but are not duty paid is one that should be looked at. There is no point having a high-tax policy if people can circumvent it in any way. We have to constantly be vigilant in rooting out loopholes to prevent that. Smuggling is the other area. Over many years, we have called for Revenue to have more resources, both manpower and physical resources, to ensure that smuggling is minimised. Up to two or three years ago, it was doing very well in getting the rate down to below the EU average but it is creeping up again. We have to make sure that there is a proper action plan to tackle, specifically, cigarette and tobacco smuggling. In addition, Revenue should be empowered with the resources it needs to tackle the problem effectively.

Is there more we can do to help people who are currently smoking? A lot of work is being done by the health service and the Department of Health. Is there some further action we can take to help people move away from smoking? We have had major campaigns over the years but do we now need to refresh those campaigns?

Mr. Chris Macey

The figures show the problem. We spend between €11 million and €12 million a year on helping smokers to quit. The tax cost to smokers, on top of all the other tax they pay, is €1 billion. Between 70% and 80% of smokers want to quit. We have to do more to help them through advertising campaigns, availability of medications and quit services, which is support that can really help people. Cigarettes are more addictive than they were 50 years ago. The industry is always looking at ways to pack more addictive nicotine into them and to make it more difficult than ever to quit. It is more difficult now than it has ever been before. We have to help people more. The State is taking in approximately €1 billion each year from smokers and spending around 1% of that on helping people to quit. It is not right or fair.

I have no problem with Deputy Shortall speaking first. I will wait.

I thank the two groups for attending and for their presentation and the work they do all year round. There is a lot of similarity between them in terms of their asks. To what extent have the two organisations discussed these asks with the Department? What has been its reaction in respect of additional measures in the legislation?

Ms Averil Power

We have been lobbying for this legislation for a good few years now. The Irish Cancer Society and the Irish Heart Foundation work together very closely on this and we have had joint meetings with different Ministers about it. As I mentioned in my opening contribution, there has been resistance on matters such as flavouring and marketing. We understand that resistance is driven by a view in some quarters that vaping can be helpful in quitting smoking. That is not our view. We have done an extensive review of the research. It is not the view of the WHO, the US Surgeon General, The Lancet Respiratory Medicine or other international experts on this.

We understand that people, from their experience, know smokers who swear by vaping and believe, on an individual level, that it is effective. As I said, we support smokers who want to try to quit through any means they can. We know exactly how hard it is but we can only advocate for measures that are evidence based. We have heard from officials that they believe that regulating e-cigarette marketing and flavours will make these products less attractive to adult smokers. We do not believe that is true. Do members really think that the packet Mr. Macy showed them, with "juicy" printed on the front and which looks like a packet of sweets, is really aimed at the 60-year-old adult who smokes four packs a day? That is absolutely not the case. Somebody moving from the taste of tobacco to vaping does not need something that tastes like pineapple or cola.

We do not believe that is true. However, while other people have genuinely held views, we must bring forward our evidence- based view that they are not appropriate. When the Department was before the committee on the Bill, one of the officials said that people are voting with their feet for for vaping because vaping has become very popular.

I will return to the question Deputy Burke has highlighted which is we are not giving them realistic options. We were really disappointed to see a reply to a parliamentary question tabled by Deputy Louise O'Reilly last year that State expenditure on smoking cessation medications actually failed by 12% between 2010 and 2019. We are not giving people the help they need to use the tried and tested methods of NRT. People need peer support. We have developed the We Can Quit programme that we piloted and worked with the Department to have it mainstreamed as a quit support. People need a mixture of affordable alternatives and practical hands-on peer and behavioural support. It is only when those are available that it is possible for people to quit. The advertising and marketing is part of that, to make people aware of the importance of quitting. Most smokers want to quit. They know what smoking is doing to their health, the risk of cancer, the impact on their household budget, particularly those on low incomes, but they need the practical supports to make it possible-----

I accept that Ms Power has presented the evidence to us but where is the opposition coming from? If, as she said these flavoured vaping materials help people, who is expressing that view?

Mr. Chris Macey

Deputy, when the Department appeared before the committee on this issue of flavours, it indicated that no conclusion had been arrived at. We found, working with the Irish Cancer Society, there has been great political support but it is clear that officials do not share that. How long does it have to make a decision on this? We are talking about an addiction, and an industry that is trying to take hold of a generation of children. We do not have time to make a leisurely decision on it. Even from a precautionary principle perspective we need to do something about that. It is not acceptable just to see how the situation develops because it will be too late. Imagine if tobacco smoking was invented today, and we said we will wait for 30 or 40 years to see what happens before we decide what we do about it. Knowing what we know, it would be stopped outright and there would be no issue about it. It will be terrible if we are in a position in five or ten years' time where we are saying "God, I wish we did something about that when we had the chance".

I thank Mr. Macey for that. We will pursue that with the Department. In regard to the issue of illegal sales of cigarettes, this was very prevalent up until a couple of years ago. I am not aware of it to the same extent now. Is that an accurate assessment of the situation, or is it just that I have not come across it? What is Mr. Macey's information on the extent of illegal sales? It does not seem to be as open as it had been previously.

Mr. Chris Macey

Much of the publicity on that in the past was driven by the tobacco industry and its lobbying. It was deliberately over-estimating both the scale and the impact of smuggling in an effort to stop Governments putting up the price of cigarettes each year, in other words, to get that money going into its coffers rather than into the State's coffers. What has happened over the past six or seven years is that research showed smuggling reduced from around 16% down to around 10% or 11%. Now it is creeping back up again to around 14% or 15%. It is still there, it is still an issue and it needs to be dealt with so the impact of those tax increases is registered in terms of reduced consumption particularly among young people. The Deputy is right in that there is not as much said about it now because the industry is not using it as one of its lobbying tools at the moment.

I appreciate that. In terms of the practice of illegal sales of cigarettes, I would not be aware of people going door to door or selling on the street in town. I would not be as aware of it now as I had been previously. Has it reduced or is it just that we are used to it and do not notice it as much?

Mr. Chris Macey

That is what I am saying, it has gone down but is now starting to go back up again. The actual level of smuggling is at around the same level as it was when all that publicity was happening.

Regarding the practice whereby people go to Spain on holidays and come back with case loads of cigarettes, what is Mr. Macey's information on that? Is that as prevalent as it had been previously? Mr. Macey made comments about the Revenue Commissioners and the need for additional personnel, so what is the evidence on the extent of illegal importation?

Mr. Mark Murphy

On the matter of people travelling to Spain on holidays, the EU is looking into reducing the amount of tobacco and alcohol that can be brought back from other jurisdictions. The EU recognises that many countries, like Ireland, have a strong tobacco control policy and that it is a problem when many people come back from holidays or from their home countries bringing large quantities of tobacco. The EU is looking into that. With the EU it takes a while, perhaps a few years, but there was a consultation on it a few months ago which we responded to obviously agreeing that it should be clamped down on, and restricted. The EU is looking into the problem whereby people can go to another EU country where tobacco and cigarettes are sold for miniscule prices compared to here. We recognise that is a problem and the EU is looking into it. It definitely needs to be addressed in that sense.

Does Mr. Murphy know if our Government has made a submission on that or adopted a position?

Mr. Mark Murphy

I cannot comment. The Government probably would make a submission and be supportive of it because if people can bring back large quantities of tobacco from their holidays it effectively takes away from our tobacco control policy and keeps the prevalence of smoking here higher than it should be.

I thank Mr. Murphy. I am happy to support his cause.

Ms Power's opening statement was very hard-hitting and rightly so. She said that the tobacco industry kills one in two of its customers. That is very hard-hitting but obviously true. That is why we are here in regard to this Bill and the pre-legislative scrutiny to look at how we can make this Bill better. I accept what both organisations are saying. They welcome the legislation in as far as it goes, but it should, and can, go further. I agree with them. There is one point of difference between the two organisations. They are on the same page in most areas but, and this is a question for Ms Power first, the Irish Heart Foundation supports increasing the legal age of sale of cigarettes and e-cigarettes from 18 to 21. I do not see that in her opening statement. Is there a point of difference or is that something she would also support?

Ms Averil Power

I agree with our colleagues in the Irish Heart Foundation that we need to do everything we can to make cigarettes less attractive to young people, and harder to access. In the US, Tobacco 21 law was introduced in various states there and in 2019 reduced smoking in the 18-21 age group by up to a third. There is a small but growing body of evidence particularly from the US but also from elsewhere that suggests that a ban on tobacco sales to those under 21 may prove effective in reducing smoking rates among younger people. We agree on that. We also agree that supply is only half the equation.

The Government can increase the age limit as much as it likes, even up to the age of 30, but children will still get their hands on cigarettes if we do not deal with the demand issue, the marketing and the advertising. We think the Government must do both. That is something both our organisations have closely advocated on and that is a view we share.

Very good. I thank Ms Power for that response.

On that issue, Mr. Macey accepts, and it is a sensible approach, that this issue might be best dealt with in separate amending legislation. He referred to it as a complex age of sale item of legislation that might need to be done separately. Is that the proposal he would make? While he is flagging this legislation, he does not necessarily think this is a measure that should be primarily dealt with in this legislation but that it is something that should be done later. He might talk us through the logic of that from his perspective.

Mr. Chris Macey

The conclusion of an Economic and Social Research Institute report from 2017 entitled, Do youth access control policies stop young people smoking?, was that there continues to be a considerable debate about the effectiveness of that, but the evidence is strongly in support of continued use of minimum legal age regulations as a measure to reduce smoking prevalence among young people.

On the evidence point, the evidence is very strong. We think the Department of Health will support this measure. We hope it will. We had an international transatlantic conference on it yesterday. The level of evidence is very strong.

In terms of the various elements we both agree on and call for regarding e-cigarettes, that will stop nicotine addiction and it will have a gateway effect but we have to do more to tackle youth smoking. With respect to the policy that Ireland would be tobacco free by 2025, there was a time when we thought that by 2025 we would get the youth smoking rate down to 5%. It is not 14% now and that will not happen. Therefore, we must do more. This is a very sensible and evidence-based method of doing it.

There are very important measures in the Bill, with which we are dealing, that need to be enacted quickly. There has been quite a long delay, understandably in light of Covid, and we cannot wait any longer. That must be done separately. A separate Bill or amending legislation could be introduced quite quickly. There needs to be consultations with sellers. Education and enforcement must be thought through to make sure it is as effective as it needs to be. We would separate those out but we think the other three points around e-cigarettes should be included in the current legislation.

That is sensible as I would have some questions about increasing the legal age. It is more about teasing some of this out and looking at the international best practice and research. It would be sensible for the committee in making its recommendations on foot of the prelegislative scrutiny process to recommend that this measure would be examined separately and perhaps we, as a committee, could examine it also, but certainly it is an issue that needs to be examined and progressed.

On the flavouring issue, and this is a question for Ms Power first, there is no doubt and it cannot be argued that e-cigarette flavouring ranging from strawberry milkshake to bubble gum is anything other than targeting young people. How could that be targeting people in their 40s or 50s or 30s? It is obviously targeted at young people. I missed the first contribution as I was doing a media bit and I apologise if this question has been answered already, but why is a provision in this respect not in the Bill as presented? Where is the resistance coming from? Is there resistance within the Department to a ban on such flavouring? I would certainly support such a provision and also elements around advertising. What the organisations are proposing makes sense but it does not make sense that it is not in the legislation as presented. Ms Power might respond first to that point followed by Mr. Macey and I will leave my contribution at that.

Ms Averil Power

It is self-evident to us also that those flavours and the packets Mr. Macey highlighted earlier are clearly directed at children. The Irish Cancer Society and the Irish Heart Foundation also undertook research. We consulted young people on this, showed them the packets and marketing and asked them if they believed the advertising and product design were aimed at them. They very strongly believed they were. They believed it mimicked sweets that are popular among their age groups. They are also seeing influencers on social media promoting vaping. They believe the marketing is very much aimed at them and not at their parents or grandparents.

I cannot talk for the officials but we know from the contributions they made to the committee previously there is a view that vaping can be helpful as a cessation aid. We would say that is not the mainstream view internationally. There is a minority view from Public Health England, to which the officials referred, but its view on this is very much an outlier internationally and it is not the view of the World Health Organization, The Lancet, the European Respiratory Society or the US surgeon general. The body of evidence on this internationally is that vaping is not effective as a cessation tool, that it is no more effective than the existing nicotine replacement therapy, NRT, tools we have and that there are risks with vaping that are not associated with the other forms of NRT, as Mr. Macey mentioned with respect to the health effects of vaping. Another problem is that people move from smoking to vaping but then they never quit vaping. There is an ongoing nicotine addiction with vaping that people do not have if they move from smoking to other forms of NRT. For that reason, having reviewed the evidence, we do not recommend vaping.

The Department previously put much stock into getting the Health Research Board to research this issue. We note the Health Research Board, having done a systematic review of international evidence came out strongly stating it could not recommend vaping. I quoted Dr. Jean Long from the Health Research Board in my opening statement as having called for the same regulation for e-cigarettes as for tobacco products. While I cannot speak for the officials, I believe it is their genuine view with respect to regulating e-cigarettes in the way we have called for young people. They have told us some adults like strawberry flavour. That is fine but by not tackling those kinds of flavours, e-cigarette products are being made more attractive to children. While some people might like the different flavours, if somebody is used to tobacco flavour, does he or she really need the enticement of fruit flavours to move to vaping? We just do not accept that. We can only bring an evidence-based view to the committee and ask the members to listen to us. Our only agenda in the Irish Cancer Society is to stop people getting cancer and to do everything we can to help smokers to quit. The same is true of the Irish Heart Foundation and international bodies which are urging action on this. We are not asking Ireland to be at the vanguard of this. As I said in my opening statement, we are well behind our European partners and we need to play catch-up and protect our young people before it is too late.

To answer the Deputy's question, what is known about e-cigarettes is that there is a known harm reduction benefit to them for long-term smokers who have failed to quit using other safer methods. However, at the same time because of the business model and the marketing practices of certainly the vast majority of the people who sell them, there is a danger to young people. The issue is where to strike the balance. I do not know how anyone could even think a balance can be struck by having the availability of 16,000 different flavours that are in various markets.

These are marketing tools and they are almost exclusively directed at young people because if young people are not addicted, there is no business model. As Ms Power said, someone working in an industry whose products kill one in two of the people who use them is not really concerned about what effect those products will have. It beggars belief that anyone would think it is preferable to ensure that a long-term smoker has access to strawberry milkshake and chocolate fudge flavours of e-cigarettes, even though that creates a danger and risk for a whole generation of young people. We do not know the full extent of the problem. We can legitimately say that the impact of e-cigarettes on people's health will be less than smoking but a lit cigarette contains 4,000 different poisons and it has elements of rocket fuel and rat poison in it. There is little that could be sold that would be as toxic or more toxic than that. Just being less harmful than cigarettes is not a great recommendation for anybody to use e-cigarettes.

The balance has to be struck with children in mind because we cannot afford to have a situation in ten years' time where we see the effect of wider scale addiction than we have already. The addiction level is serious. It can still be tackled effectively but we are running out of time. We have to move on this quickly. We cannot afford to wait and see how this develops.

I welcome the witnesses. This is a very interesting debate. My opinions have changed on this issue a number of times. I have moved from having an agnostic point of view to favouring more regulation and harm reduction, which is what we are here to discuss today. There is no doubt the tobacco industry is trying to reinvent itself by selling another product by another means. We have seen in the last 50 or 60 years that big tobacco plays an insidious role in how it markets its products and so forth. I have no doubt it is trying to get new consumers to use its products. I am all for regulation and if that means people have less access to products that are harmful, then that is a good thing.

I have about six questions so I ask for short answers. They relate to the Bill and also a matter that falls outside its outside. First, where are these vape products mainly made?

Mr. Paul Gordon

It varies depending on the market and manufacturer. Many are made outside the EU and some are made within the EU. It is hard to say definitively what proportion of the products come from where.

Mr. Mark Murphy

I imagine many of the products come from China and Vietnam where manufacturing is cheaper. I doubt many come from within the EU. The majority probably come from further afield.

The majority of them come from outside of the European Union.

Mr. Paul Gordon

Yes, but they would still have to meet standards set out under the tobacco products directive, which has been transposed into Irish law for the last five years.

How much is the market for e-cigarettes and vaping in Ireland worth?

The witnesses may wish to revert to us on that question as I do not think they have the figure to hand.

What is the average spend per week for those who are vaping?

Mr. Paul Gordon

A cheap vape pen might cost around €10, while a starter vaping kit could cost close to €30. After that, the costs are relatively low. A bottle of e-liquid, about 10 ml, would cost between €2.50 and €6, depending on the bottle. It might take a smoker who was on ten or 15 cigarettes per day one week to get through that.

Ms Power referred to the Department talking about people voting with their feet. Part of the reason for that is the cost because traditional nicotine replacement therapy, NRT, costs are more expensive and some of it is subsidised on the medical card. However, a prescription from a GP is required for this, which is another barrier. The cost for people who are not on a medical card is about €36 per week for patches or about €26 per week for gum. People are not necessarily moving to e-cigarettes because they find them more effective. Rather, they do so because they are cheaper than nicotine products, even though they want to quit. As Ms Power said, we have seen that while the funding towards tobacco cessation as a whole increased by about 1% between 2010 and 2019, the investment in medical cessation products and NRT, including gums, patches and other prescription products like Champix, has fallen by 12%. We need to see a drive towards supporting people to quit and that is something that the Irish Cancer Society and the Irish Heart Foundation have called for in numerous joint pre-budget submissions in the past. It is disappointing that it has not come to pass in recent years.

The following is one of the most important questions. Is there evidence that young people, who have traditionally started with tobacco products, are now starting with vaping products? We all have friends and family who have gone from smoking 15 cigarettes per day to vaping. That is a better evolution but the science says that these products could be just as harmful as tobacco, although that is another discussion. Is there evidence that young people aged between 13 and 17 are going straight to vaping products?

Mr. Paul Gordon

There is. In the 12 to 17 years category we have seen a rise from one in ten people using vaping products to one in five people using them. There were studies in the past year on 15 and 16-year-olds showing that the proportion of people in that age range who have ever used e-cigarettes is around four in ten. That has risen significantly in the past five years. We are concerned with the emerging evidence, particularly from the Health Research Board, indicating that people who have used e-cigarettes are three to four times more likely to progress to tobacco smoking. That is why we are talking about flavours and advertising. It is because we need to restrict children's access to products that are harmful and can lead to lifelong addiction. The industry wants to replace smokers who are dying. Some 6,000 people die in Ireland per year from smoking-related illnesses and about 45% of those deaths are due to cancers. My colleagues can talk about the proportion of those who die from cardiovascular disease and stroke, which cause around four in ten smoker deaths. That is why the industry is targeting these kids with packaging and flavours like tutti-frutti and bubble gum.

Ms Averil Power

A young person trying a cigarette will often cough and think it is disgusting but vaping has a pleasant flavour, feels like a pleasant experience and is seen as cool. That makes it much easier to get young people hooked on nicotine through vaping than through taking up cigarettes.

That is a big part of the problem.

Mr. Mark Murphy

I agree with colleagues that for young people the cost is cheaper, many parents do not recognise or know what e-cigarettes are and they are a lot easier to hide. In regard to flavours, studies from the US show that most children start off with flavours. The EU Scientific Committee on Health and Environmental Risks found that flavours decrease the perception of harm, attract young users and increase willingness to try e-cigarettes. We are concerned about that and cancer. As stateD by Mr. Gordon, they start off with e-cigarettes. There is a strong gateway effect to smoking. Our major concern today is young people. We do not want to lose a new generation to tobacco and nicotine addiction.

I am not sure if the witnesses will be able to answer this question. How many people in Ireland are vaping or using e-cigarettes on a daily basis? Do we have a percentage or number for that?

Mr. Paul Gordon

We do not have a figure for use on a daily basis but overall for the general population it would be 5%. That includes daily users of e-cigarettes and occasional users. Again, more generally, we see a higher preponderance of it in younger people. It was mentioned that four in ten 15 to 16 year olds have used e-cigarettes. Some 16% of that group used an e-cigarette in the past 30 days, which is really worrying, particularly when taken in tandem with a rise in smoking rates among that group in the past few years, as pointed out earlier by Mr. Macey.

The evidence shows that fewer people are smoking tobacco products, in particular cigarettes. There are number of factors at play there, but it is a good thing. Looking at this over a 25 year block, I am guessing that the percentage of people that have stopped smoking is, probably, 25% to 35%. Some people have gone the route of stopping completely and a reasonable percentage have moved to vaping. That has a wider societal effect in regard to public health. There are a number of factors at play here too but, again, let us be honest, that is a good thing. What we do not want to see - I was slightly fooled by this - is people giving up cigarette smoking and replacing it with something else. The narrative out there is that vaping is less harmful than cigarettes. It was stated in the witnesses' opening statements that vaping is not less harmful. Some people will argue that vaping is less harmful. For the person who previously smoked, say, 30 cigarettes per day and for health reasons decided to give them up, is vaping less harmful? Some people have said to me that vaping is less harmful than smoking 30 cigarettes per day.

Mr. Chris Macey

The evidence to date shows quite strongly that it is less harmful than smoking. As stated previously, when you light a cigarette 4,000 poisons come from that, including elements of rocket fuel and rat poison. There would be very little chance it could be as toxic or more toxic. What we do not know is how damaging vaping will be over time. We have only the evidence from the general sale of these products for the past 15 years or less to work on and so the harm has not been fully worked out. We know they are harmful; it is the extent to which they are harmful that is the question. It is not likely that they are going to be found to be as harmful as cigarettes. That is it.

What we would say to people is that they should only try e-cigarettes if they have tried every other quit means out there. If they cannot quit in any other way, then they should try e-cigarettes because the chances are that that will reduce the harm that they suffer from smoking. We know plenty of doctors who take that view. As I said, cigarettes are becoming more addictive. It is really difficult to give up. Those of us who have gone through it know just how difficult it is. Doctors are encouraging people to try the other quit methods that are safer and, if they do not work, as a last resort, to try e-cigarettes because they will not be as damaging in all probability.

Ms Averil Power

I agree that for long-term smokers who are desperate to give up smoking vaping is an aid to help them to quit. The last thing a long-term smoker wants to see is a child or young person taking up the habit. It is possible to maintain access to vaping for adults who feel in desperation that it is their only option while also protecting children from the flavouring and marketing so that children who never would have taken up e-cigarettes, or who might have tried them once and found them disgusting and so did not go on to develop a nicotine addiction, do not end up using e-cigarettes as a gateway to cigarette and tobacco smoking and, thus, nicotine addiction. As stated by Deputy Kenny, we are making progress. We have been winning this fight. A small proportion of people still need our help to get off cigarettes. There are people who are really struggling and they need more Government support. They need nicotine replacement therapy, NRT, to be cheaper and they need more direct support in terms of helping them to quit. Over time, smoking rates have decreased dramatically in this country both among young people and adults because we have been brave enough to take on industry, ban smoking indoors, introduce plain packaging and increase prices, as well as other positive public health measures. It would be madness to risk all of that. We know that the rates of smoking among young people are increasing for the first time in years because of vaping. It is possible, from a harm reduction point of view, to maintain that choice for the long-term adult smoker for whom vaping is the only option in terms of helping him or her to quit tobacco smoking without having vaping products pushed in the face of children every time they go into a newsagents and on billboards and the sides of buses. We can do both.

I thank the witnesses.

The next speaker is Senator Conway.

I thank the witnesses for being here. This is an incredibly important engagement. This legislation is long overdue. Like Deputy Cullinane, I am concerned that all of these issues are not part of the Bill. It is not good enough. The delay with regard to the Bill is also not good enough. As has been stated by Ms Power and others we have an excellent record in this country in terms of dealing with smoking. We have not been afraid to take on big business and powerful vested interests and so on. Sadly, in terms of vaping, that is not the case.

I have a number of questions. Is vaping in buildings legal or, like smoking, is it banned?

Mr. Paul Gordon

It is legal. It is not covered under the workplace smoking ban.

Does this legislation ban vaping in those areas?

Mr. Paul Gordon

I do not think, from my reading of the legislation, that it does. It is stated in the legislation that this would be a matter individual employers and businesses. That is a problem.

What we saw with the introduction of the workplace smoking ban was that it significantly reduced the rates at which people smoked.

Internationally, is vaping banned in public buildings, restaurants and so on, like smoking?

Mr. Paul Gordon

A number of EU countries have put in place bans in restaurants, pubs, workplaces and so on.

Why did the Irish Cancer Society not include that as part of its submission on this Bill? Why is it not pushing for that to happen?

Mr. Paul Gordon

It is something we have raised a number of times in the past, particularly as it relates to e-cigarettes. We would certainly like to see such a ban and we would ask committee members, the Department and the Minister to take it into consideration.

Ms Averil Power

We also know there would be support from many businesses for that. Businesses have raised with us the fact that it makes them very uncomfortable. Restaurant representatives have told me previously that it puts them in a really uncomfortable position when, for example, they have a vaper at one table who insists that he or she has the right to vape while customers sitting beside the vaper feel really uncomfortable about the impact on them. Restaurant owners would prefer to be able to say that the law states that people cannot vape indoors rather than being in that invidious position. If the committee could consider adding that to the Bill, we would be very supportive.

Mr. Mark Murphy

The health effects of the second-hand aerosols emitted must also be considered. Also, quite like smoking, if e-cigarettes are allowed indoors, it normalises these products. If someone inside is using e-cigarettes, it makes them attractive, especially to young children. They see this and think it looks cool. We would very much encourage the Government to follow the workplace smoking ban and stamp it out.

The witnesses are calling for plain packaging as part of this legislation but I believe e-cigarettes should be completely banned or at least kept under the counter, the same as cigarettes. I also believe that vaping shops should be closed down because they are made to look trendy. They are usually beside mobile phone shops and we know that young people love their mobile phones. A type of zone is created that appeals to young people. As Ms Power has said, the number of young people smoking has increased and one would have to say that is a direct result of vaping.

I commend Ms Power on the work she did in this House previously and the work she is doing in her current role. Is it time to consider further anti-smoking measures such as introducing no-smoking zones outside school gates and the front doors of hospitals? Does Ms Power agree that smoking should be banned outdoors where people are eating? Is there work to be done in that regard?

Ms Averil Power

I certainly do agree. We have called for this previously and other countries have taken a lead on it. It is problematic if one walks out a door and the first thing that hits one is a waft of smoke. We know that hospital campuses and universities have done that themselves, while local authorities have introduced regulations around playgrounds and so on but we believe it should be the law. As CEO of the Irish Cancer Society and a former CEO of the Asthma Society of Ireland, I know that this causes huge problems for people with respiratory illnesses like asthma, including me. I cannot eat outside where people are smoking in my face, which was a particular problem during Covid, because it has an immediate impact on my asthma. The indoor ban has been amazing and it is great that we led on that but it is time to make all of our public spaces, including parks, beaches and hospital campuses, smoke-free, safe places for everybody by law.

We could start in Leinster House by making it a complete no-smoking campus.

Mr. Chris Macey

We have asked for that and apparently it is being considered at the moment.

I would be the first to support it because the smoking areas in Leinster House are disgusting to pass. I know I will not be popular with certain people for saying this but I believe that needs to happen. There seems to be a lot of agreement on what needs to happen vis-à-vis this legislation but as a committee, we should prepare a report on increasing no-smoking areas in the public realm.

Mr. Chris Macey

We have written to the current and previous Ministers for Health, since Covid happened, about smoking in outdoor areas of pubs and restaurants. About four years after the workplace smoking ban was introduced, research was done which showed that as a result of that legislation there was a reduction of three deaths per day from acute coronary syndrome and stroke in the country. It is believed that the main impact was from the reduction in passive or second-hand smoking. It is a major issue. We wrote to local authorities around the country and we understand that Dublin City Council is going to provide that there will be no smoking in the public areas outside pubs. Several county councils that we wrote to have told us they would prefer national legislation on this rather than trying to deal with it individually. Some of the councils we have written to are doing it but others are not. We need a proper response on this.

Well done on that. I would certainly support such a measure. We have come a long way and the silent majority are on the side of further restrictions. I suspect that if there was a proposal to reintroduce smoking in pubs, there would be an outcry, similar to the outcry in 2003 when the current Taoiseach and then Minister for Health and Children, Deputy Micheál Martin, introduced the ban. At that time, the vintners tried to say that they run the country and that it would not happen but the conversation now would be completely different. The people who want to ban smoking everywhere for health reasons have huge support from the silent majority.

Mr. Chris Macey

I agree.

Ms Averil Power

This is something that a lot of parents feel strongly about too because they do not want their children exposed to smoking in public places. Unfortunately, there can be a level of misunderstanding among smokers who do not realise it can be damaging to the people beside them even when they are outside. Of course, it is less damaging than in an unventilated indoor space but depending on where a person is sitting and what way the wind is blowing, cigarette smoke can blow straight into a child's or adult's face and can be extremely harmful. That is compounded, obviously, in busier spaces. This is an issue we would love to see this committee taking on and I thank Senator Conway for raising it.

Mr. Chris Macey

We have done so much to protect people during Covid but then we have these outdoor spaces where people are blowing cigarette smoke into the faces of others. There is a danger in that, particularly in the context of approximately 6,000 smoking-related deaths in this country every year.

I thank all of our witnesses for their informative presentations this morning. I have learned so much today. I want to return to the issue of flavours and the banning of flavoured e-cigarettes which I agree is vitally important, particularly as HRB research indicates that adolescents who vape are more likely to take up smoking. Flavoured e-cigarettes are definitely targeted at children. What do the witnesses think about the fact that such a ban is not in the Bill? What is the thinking behind that because such a ban seems like common sense to me? Why is it not in the Bill? Why is banning flavours not in this legislation?

Mr. Chris Macey

The Department has said that it has not made up its mind on this issue. We do not agree and cannot understand that thinking.

As I said earlier, we have to act on this one way or the other and having a watching brief on it is not really acceptable.

It is good to hear the Department has not made up its mind on this. It will be our job to persuade it. I worked very closely on the Public Health (Alcohol) Bill 2015. This is not unlike it. We have a big battle fighting against the industry. I want to touch a little on the matter of advertising. We can draw on the alcohol experience here and think about how visible it is. I would like to hear a little more from the witnesses on why they think it is important that we ban e-cigarette advertising. I ask them to say a little more about that and the importance of banning advertising in that regard.

Ms Averil Power

It is great to see Senator Black. It is the same argument as with alcohol. The reason the industry invests so much in advertising is to create this view that its product is a lifestyle choice and that it is cool, sexy and attractive. There are restrictions on direct online advertising for e-cigarettes under the tobacco products directive but the types of things we see on social media are influencers promoting vaping in the same way as cigarettes were traditionally promoted by attractive-looking people promoting the idea that smoking was cool. That is obviously very attractive to teenagers in particular and they are the market audience.

As we said earlier, we can deal with supply all we like, and it is very important that the Bill is bringing in restrictions on supply, but unless we deal with advertising and the relentless promotion of both alcohol and tobacco, we will never really fix the problem because if people - young people in particular - want something badly enough, they will get their hands on it. We have to do both. The problem with e-cigarettes in particular is that they are promoted as something that is cool. They mimic the physical actions of smoking and get young people addicted to nicotine in a way that we know leads them on to smoking. The industry would not be spending so much on that kind of marketing if it did not work. That is why it is so important that we deal not just with the supply but with everything that pushes that demand and makes people think that something which, as Mr. Macey said, is inherently dangerous and bad for us is actually cool. We have to deal with that insidious, disgusting use of advertising that gets children hooked on a product that is hugely harmful to their health and is likely to lead to them taking up smoking, with all the disease and death that smoking causes. We have to cut that off and make sure companies are not able to promote e-cigarettes in the same way they are no longer able to promote tobacco.

I thank Ms Power for that. I totally agree with her. It comes back to the legislation around alcohol and the importance of advertising in that legislation. What role do tobacco companies have in e-cigarette companies? We have heard that some tobacco companies have shares in these groups. Are there alliances made by tobacco companies to prevent these regulations? Is this not a conflict of interest if we have tobacco companies inadvertently lobbying on public health? Again, it is a little like the alcohol issue because that was almost like public health versus big industry. I just wanted to get a little understanding around that from the witnesses' perspective. Do they think tobacco companies have an interest or shares in e-cigarette companies? What is their thinking on all of that?

Mr. Paul Gordon

Most of the large e-cigarette companies are either owned or part-owned by tobacco companies. In the US, for example, Juul, which at one point had a 70% market share, is part-owned by Altria, which is Marlboro's parent company. Here, a couple of the main brands like VIP are owned by P.J. Carroll & Company, which is a subsidiary of British American Tobacco. Logic is owned by Japan Tobacco International. These companies all have significant shares in those vaping companies. We certainly feel that tobacco companies are using vaping as a back door or a Trojan horse to try to get a seat at the table in making laws around tobacco control. That is clearly what they have been doing through vaping. They have no interest in people quitting their tobacco products and they have no interest in people quitting their vaping products. An internal R.J. Reynolds memo that was leaked by a whistleblower stated, "Doubt is our product since it is the best means of competing with the 'body of fact' that exists in the mind of the general public." Tobacco companies' products are death and doubt and that is what they have been selling for decades.

Parliamentarians have been standing four-square against the tobacco industry for a very long time but it is becoming increasingly difficult for Deputies and Senators to actually know who is lobbying them. That is a real challenge. It is the same issue with the general public. We did research with Ipsos and it showed that only three in ten people had any awareness that the tobacco industry owned or part-owned many of the major vaping brands. It is a real challenge and one that we have to face head-on. We have to apply a lot of scrutiny to what is happening, particularly when we see vaping companies talking about reducing harm, referring to studies from Public Health England and latching on to figures that have been, if not debunked, then heavily criticised by the likes of The Lancet.

Mr. Chris Macey

To add to that, e-cigarettes are the gift that keeps giving for the tobacco industry. It gives them access to a whole new generation of children to addict to nicotine. It assists them in increasing the smoking rates among children and gives them access back into the political system that they lost, at least in Ireland although maybe not in other countries. We adhere to the WHO framework convention on tobacco control, FCTC, regulations that are designed to prevent lobbying by tobacco companies. Their interest in vaping companies has given them a route back in to lobby for whatever they want. The last thing they care about is long-term smokers trying to quit. They are looking at a whole different area of making vast new sums of money and regaining the influence they have lost.

Mr. Mark Murphy

I will come in on the question of advertising. A lot of e-cigarette companies, similarly to tobacco company tactics, try to make their product look cool and attractive. One of the ways they do that is by selling these e-cigarettes at festivals and at other kinds of temporary premises. Juul was a big culprit there. This legislation will ban tobacco products at temporary or moveable premises but that does not include nicotine-inhaling products like e-cigarettes. That is a major amendment we would have to make to the Bill, that e-cigarettes and tobacco products be banned at these temporary facilities. E-cigarette companies have their stands at festivals or other events in Ireland that young people attend. They are not even trying to market them as any kind of cessation device; they just want to market them as something cool that people can have with friends while listening to music. This Bill needs to be amended to ban e-cigarettes at moveable premises, and also at events for children. This Bill bans tobacco at events with children. There is no reason nicotine-inhaling products need to be sold at events for children either. Those are two major amendments that we think need to be included.

I thank the organisations for their presentations and for all of the work that they do. I am hopeful that we will take on the recommendations. Again, we should always prioritise public health before profit just like in the Public Health (Alcohol) Act.

The witnesses have spoken a lot about long-established tobacco companies presenting themselves as vape companies that allegedly want to get people to quit smoking and about their slight smoke and daggers approach. Can they outline the rules and regulations for lobbying by the tobacco industry in Ireland and internationally and how lobbying works here? I ask because it is important for the people listening in to understand the regulations here, particularly when we talk so much about tobacco companies presenting themselves as vape companies and other such things.

Mr. Paul Gordon

The Framework Convention on Tobacco Control was the first international binding public health treaty that was negotiated by the World Health Organization to which 168 countries have signed up. Within that there is an article that states that public health policies on tobacco control should be protected from the vested interests of the tobacco industry. That includes all Government sectors, that is, the executive, legislative and judicial sectors. In part we have seen the industry use front groups to get around that because compliance with the convention is really good. In practice, it has meant that Government and public officials can only engage with the tobacco industry if it has a means to progress legislation on technical issues. For example, a few years ago the Department had to meet representatives of the tobacco industry to say there was a need to figure out the type of font that will go on the plain packaging. Discussing things like that is where they can meet industry. Obviously the Regulation of Lobbying Act applies to any lobbyists. From our perspective, the FCTC is the strongest global binding factor. The convention looks at declarations of interest by any public officials. It ensures that Government bodes cannot accept partnership with industry and that Government officials divest themselves of any interest in the tobacco industry.

The tobacco industry sees opportunities, through e-cigarettes, to recruit, aggressively market and keep existing customers hooked. Mainly, it is an opportunity to influence public policy and allow unfettered access to their products. That is the main concern but, thankfully, in the main, implementation of the Framework Convention on Tobacco Control has been really good. However, the industry is muddying the waters and it is becoming increasingly harder to tell so it is a matter of vigilance by everyone as to who they are talking to, be it civil society, governments or legislators.

I have some outstanding thoughts to express about the presentation made by the Department a couple of weeks ago. Obviously the Irish Cancer Society, in its submission, has expressed concern about the threat posed by e-cigarettes. A lot of submissions from the industry mention the Public Health England, PHE, report stating e-cigarettes are 95% less harmful than tobacco. I have heard the 95% figure bandied around all over the place and there is a huge amount of marketing that says e-cigarettes are considerably less harmful than tobacco. A couple of years ago I heard the society say that further research was somewhat limited. Has there been further research? Are e-cigarettes 95% less harmful than tobacco? Do we still await research on the matter or is the 95% figure merely a good marketing ploy to encourage people to choose e-cigarettes and keep them within the smoking curriculum?

Ms Averil Power

The Public Health England position is very much a minority one and is not shared by the World Health Organization or other leading global health bodies. In fact The Lancet criticised the research on which Public Health England based its position and said: "The reliance by PHE on work that the authors themselves accept as methodologically weak", and along with the declared conflict of interests surrounding its funding "raises serious questions not only about the conclusions of the PHE report, but also about the quality of the agency's peer review process". That is quite a strong view from The Lancet, which is a respected international medical journal.

The Irish Cancer Society, as am I sure does the Irish Heart Foundation, constantly monitor emerging evidence in this area. We always check our positions against new and emerging research. Our view, having looked at the body of international research, is that vaping cannot be recommended as a smoking cessation tool. Recently the HRB carried out an extensive systematic review for the Irish Government and the board also reached the same view as us. As I mentioned in my opening statement, Dr. Jean Long from the HRB, having reviewed the international evidence stated that "Children and adolescents require the same protection from e-cigarettes as conventional tobacco". There may be a harm reduction argument for long-term adult smokers, who have tried everything else but cannot stop smoking, to vape. However, we need to make sure that we protect children and young people from ever taking up vaping and then moving on to smoking.

The percentage produced by PHE is constantly rolled out by industry as a means to claim that research has found vaping to be safer and an effective cessation tool. Mr. Gordon can quote all the different surveys that we have reviewed in our own work but so many international studies have found otherwise.

Mr. Chris Macey

The figure is out of date. A huge amount of additional research has been done since that figure was first used. The figure has been long debunked by the likes of The Lancet.

All we knew five or six years ago was that e-cigarettes raised blood pressure but as evidence emerges, the situation continues to worsen for these devices.

I wish to put it on the record that the 95% figure is tosh. Ms Power has said that e-cigarettes are not recommended as a cessation method except for long-term adult smokers so why do people use e-cigarettes to quit smoking? Is it because there has been a powerful marketing campaign and we have let the ball slip? I have the 95% figure in my head and I remember that she said a couple of years that research still needed to be done. What drives people to use e-cigarettes? Every second person I know seems to vape all the time. Maybe it is just my age group but a lot of people are vaping.

The Irish Heart Foundation, in its opening statement, proposed an increase in the legal age of sale of cigarettes and e-cigarettes to 21. Is that a realistic option in Ireland? What engagement has there been in terms of whether that legislation will ever happen? Do the witnesses think that they will get political support for the increase? Is the proposal aspirational and even though it is based on evidence, the reality of whether it might happen is another thing?

Ms Averil Power

The Senator asked why is vaping so popular. Part of it must be the relentless marketing. We are bombarded with images of vaping left, right and centre.

Point-of-sale marketing is particularly effective. It is also worth pointing out that vaping products are much more accessible than NRT products, as was mentioned earlier. For people to get NRT products on a medical card, they must get a prescription from their GP and collect the products from a pharmacy, whereas they can go into a petrol station forecourt shop, a newsagents and up to a kiosk in a shopping centre or at a festival and get vaping products that are openly available. We welcome that the proposed Bill will bring in a licensing regime to deal with at least some of that.

Marketing and accessibility have an impact. Price is another element. As stated earlier, vaping products are much cheaper than the tried and tested, safer and more effective NRT alternatives. All of that has helped, as has the lack of Government investment in proper cessation methods. As was mentioned earlier, Government investment in cessation medications, which is primarily aimed at those on medical cards, fell by 12% between 2010 and 2019. Smokers are not being given realistic alternatives and practical supports. That is also part of the problem. I will let the representatives from the Irish Heart Foundation answer the question about the age at which cigarettes can be sold to people.

Mr. Chris Macey

The intention to raise the age at which nicotine products can be bought by a young person is definitely not aspirational. We had a transatlantic conference yesterday on this issue. The HSE spoke in support of this measure. We believe there is support in the Department for it. I do not know how substantial it is at this point but there is definitely support. The Economic and Social Research Institute stated in 2017 that this is the way to go, or one of the significant ways to go to further reduce tobacco use. This measure became federal law in the United States in 2019, having been introduced in a number of states, starting with Hawaii and California in 2016. The evidence is suggesting that among people aged 18 to 20, it is reducing smoking by between 21.7% and 33.9%. It is also having a major impact on people aged between 15 and 17. Older groups often procure cigarettes for those younger groups when they are underage. This is a serious and important measure that will come through because it makes sense. As I said in my opening statement, it is proportional because of the damage that smoking does to people, particularly young people. We heard evidence yesterday about how one is more prone to addiction to cigarettes when one is young and the damage, not just from the length of time one is smoking but the actual damage being done while one is young, is much more considerable than among people who started in older age. It will be effective. We have done it before. In 2002, we increased the age of sale from 16 to 18 and it was incredibly successful. It is one of the main reasons our teenage smoking rate fell from 41% to 13%.

It is enforced in other countries, such as India. This is not an out-there, extreme proposal. The other thing is that it does not go against young people's rights. People have said to me that if you are old enough to go to war for your country, you should be old enough to buy a packet if cigarettes. That is fair enough. The first question is who would want to send an 18-year-old to war. We did send 40,000 young men to war in the First World War, many of whom were aged between 18 and 20. Many of them did not come home. This is about protecting young people's health. Based on the American figures, if we introduced this measure today, we would save the lives of roughly 3,500 people born between 2000 and 2019. It is a measure that can have a big and long-term impact on smoking rates. It would reduce much of the misery and destruction caused by smoking for future generations.

We must deal with it. We need an endgame for smoking. Tobacco had a beginning and it must have an end. We cannot just wait and hope, and go along as we are doing, with 6,000 deaths a year in Ireland. We must deal with this and the legislation is a very sensible measures that will help.

Those are all my questions. I thank our presenters. It has been very interesting.

I have two quick points to make. The first relates to lobbying. I was looking at the register. The industry has been in a fair bit. Our guests' organisations have also been in, which is great. Have either of our guests' organisations met directly with the Minister on this proposed legislation?

Ms Averil Power

We met with the Minister of State, Deputy Feighan.

Mr. Paul Gordon

We met the Minister of State, Deputy Feighan. We met with then Minister for Health, Deputy Harris, in 2019.

Ms Averil Power

We have not met with the current Minister, Deputy Donnelly, specifically on this matter.

Mr. Paul Gordon

We have not met him since he became Minister but we met him when he was Opposition spokesperson on health.

Our guests have set out all of the ways that e-cigarettes are being promoted, particularly with regard to attracting young people. Is there any way of dealing with that? I presume it is difficult to introduce a ban within a single country. I wonder is there any kind of move to outlaw online advertising, say at an EU level, or have our guests considered approaching some of the big companies directly on the basis of health and safety for young people? I wonder is there any potential for limiting that at all.

Mr. Mark Murphy

The EU's tobacco directive is being updated. It is being reviewed. The EU has recognised a problem online because although e-cigarette advertising is not allowed online, the likes of the big e-cigarette companies are allowed to have social media accounts. They pay their marketers millions to circumvent the rules through hash tags and social media influencers. British American Tobacco was caught in Italy hiring social media influencers through its e-cigarette company. Those influencers have large numbers of followers online, most of whom are young people. It is something that needs to be addressed urgently because that is the way they are getting in. It is hard to monitor because much of the analytics, including how many views an advertisement gets, is controlled by the likes of Instagram and Facebook. It is the major way those tobacco companies are getting into young people's viewing points. Young people see this activity online. The EU is looking at the matter. It will take a few years but it is something that needs to be addressed.

Ireland can definitely take the lead and start banning all forms of advertising, including billboards and point-of-sale marketing. It can be a leader at EU level and say this needs to stop. There is no reason why e-cigarette companies need to have a Facebook or Instagram account. There is no reason why they need to be promoted. Many of them promote themselves as a tech company. They promote the image of their product as belonging beside an iPhone, as if it is a cool tech product that plugs into a USB. There is no reason why they should be allowed any kind of advertisement. If an e-cigarette company tries to portray itself as a cessation company, it should be controlled in that way and not allowed all this glamorous online marketing, point-of-sale marketing or billboard advertising.

While we wait on Deputy Crowe, I will ask a few questions. The elephant in the room is the difficulty in giving up cigarettes. I was struck by something that a group that appeared before us last week said about advertisements and how films used to portray smokers as sophisticated, cool and so on. Perhaps I am missing it, but I am not seeing the same happening with vaping. I do not see many people vaping in films or the like. They are still probably smoking. There was some suggestion that films that predated the bans have the smoking parts censored.

After the meeting, I remembered when I was in a hospital bed in a cancer ward. The majority of the people there had throat cancer. One guy was called Johnny. Johnny's whole day was spent on how he would get out to have a cigarette. I woke up one night and Johnny's head was sticking out the window. It was -4°C or -5°C, there was white frost on the window and Johnny was smoking in his pyjamas. Every day from the time he got up, he talked about how he was going to get out. Would the nurse bring him? Would someone else bring him? As I mentioned last week, I am aware of people who have lost limbs from smoking. Giving up is not that easy. If we are going to get the Johnnys of the world off cigarettes, we must consider everything. That is probably the point that is being made in respect of vaping.

The witnesses touched on an idea on which I would like them to expand. We understand passive smoking. Going back to the hospital scene, the smoke was blowing back in. How much evidence is there that the "passive smoking" effect of e-cigarettes impacts negatively on people's health? If there is much evidence, the logic is that we need to move and legislate. Will the witnesses expand on this point?

Mr. Mark Murphy

At the moment, the evidence is somewhat limited. What evidence we have seen is that second-hand aerosols are not harm free. Second-hand aerosols have a health impact, as does direct aerosol usage on the person vaping. There is a minor health effect, but the evidence in this regard is not as widespread as evidence on the direct effect of e-cigarette use. It is the nature of the e-cigarette evidence that it is constantly evolving, given that it is relatively short term compared with tobacco research. From what we have seen, though, there is a minor health harm from the second-hand aerosol effect. If someone is sitting in an outdoor smoking area or indoors where e-cigarettes are constantly being blown into his or her face, there is a minor health harm, but the evidence is constantly evolving and we are always examining it to determine our position on it. We believe that vaping should be denormalised and people should be protected from second-hand aerosols. We would support the smoking ban being extended to e-cigarettes so that they are not allowed in workplaces. I imagine that many restaurants would encourage the same, as it would make it easier for them if there was national legislation telling people who want to have an e-cigarette to go outside and not blow it in the faces of other patrons on whom it might have a health effect. This would also denormalise vaping for children.

There does not seem to be any vaping etiquette either. No one would consider blowing smoke into another person's face - it would just not be acceptable - but it seems to be viewed as acceptable for people to walk along the street and suddenly find a cloud around them.

The issue of alcohol was mentioned. Where e-cigarettes are on sale, do the witnesses favour them being sectioned off? In quite a number of multiples, there are whole aisles full of them. People are walking down them because there might be garden products on one end, for example. The witnesses probably know one of the multiples I am talking about. It sells a lot of cheaper products and food, which brings in families, and there is a whole wall of vaping products. The different flavours, colours and the like that people have mentioned do not have an impact on me, but there are people who are looking to quit. Some say that a particular flavour helps them. A young lad who works in my office says that he used to smoke a brand that he brought in from the US but that he cannot bring in anymore. My message with this point is that he will now try to give up vaping. I have listened to what the witnesses have said about cessation and the fact of dropping-----

Mr. Paul Gordon

In-store advertising is probably one of the main problems in terms of advertising because it is not covered by current legislation. This is something on which we would like to see progress. Both of our organisations have recommended that. Both organisations recently undertook research on people's attitudes to advertising and advertising's impact. Brand recall was highest at point-of-sale, that is, in-store. In 2009, Ireland banned the in-store advertising of cigarettes, which had a major impact on teen uptake. Studies showed that, before the ban, approximately four in five teenagers remembered brands based on what they had seen in the store and, after the ban, that figure dropped to one in five. In-store advertising has a real impact. Children are bombarded with it if they go into any petrol station or local shop. It is brightly advertised with bright colouring, attractive flavours like tutti frutti and cartoon-type packaging, which has been shown to make products more attractive to children and make them more likely to use those products.

Senator Black touched on the structural separation of alcohol. We view it as a major priority in terms of advertising.

Ms Averil Power

E-cigarette companies say that smokers are their target audience. If that is the case, why do they need mass marketing? People have to ask for cigarettes, so let them ask for a vaping product. It will still be accessible to them, so why does it need to be beside the sweets at the checkout? Why is that level of marketing to everyone needed? Their adverts do not tell people to use their products to quit tobacco. Rather, the adverts stress what a pleasurable experience vaping is, how nice the flavours are, how cool the technology is, etc. E-cigarette companies are not marketing e-cigarettes just to move people from smoking. Point-of-sale advertising is a key way in which they reach non-smokers and promote vaping as something that is cool, with a perception of it being risk free. The Chairman talked about people vaping in front of others. They genuinely believe that is okay. They have been persuaded by industry that it is safe and not bad for them, let alone others. The Chairman mentioned Johnny in the hospital. Johnny is just another victim of a disgusting and relentless industry that will say and do anything. It tries to promote as cool something that will lead people to cancer wards and spending their final days with an awful disease. It will say and do anything to make that possible.

Our responsibility as civil society organisations, public representatives or the Government is to make sure nobody else needs to have that experience and to protect young people from it. That is why we have been so encouraged by all the contributions made by members today. I am very optimistic the committee will show leadership on this and work with the Department to improve the legislation and make sure we protect children and young people from that relentless marketing and disinformation.

My apologies. I ran down the stairs to get to the meeting room. I had been following the whole debate. These days, members have to juggle a few things. I have been following the debate from my office. I thank the witnesses for their contributions so far this morning. I have read their written submissions. It is great to see Ms Power back in Leinster House.

The Bill has several aspects, including a ban on the sale of e-cigarettes to those under 18, a new licensing fees regime for tobacco and e-cigarettes and the ending of tobacco sales from vending machines. I am a child of 1982. I do not want to hazard a guess as to the ages of those present, but when I was growing up, if you watched Formula 1 racing on Sundays, the cars that whizzed past had tobacco advertising on them. There were chocolate cigarettes on display beside the Smarties when one went into the local shop to spend one's pocket money. It was kind of saturation. When I got to 12 or 13 years of age there was always a huddle of ten or 12 guys smoking down a laneway behind school at lunchtime, with a cloud of smoke rising from them. I think that has more or less ended. It is rare to see a huddle of young people smoking and passing a cigarette between them, either on the streets of Dublin when I am up here for the Dáil or down at home in Ennis. It has become unfashionable. In fact, younger people are, in general, living far cleaner lives than our generation did. They are into the gym and healthy eating and living, yet there is still a problem and this legislation seeks to deal with it.

In her opening statement, Ms Power referenced the Health Research Board and the World Health Organization, WHO, both of which cite in their research that e-cigarettes are no more effective than approved and regulated nicotine replacement therapies. That needs to be repeated. I remember seeing an e-cigarette for the first time five or six years ago when they first came on stream. An individual took a battery-powered and fruit-favoured e-cigarette out of his or her jacket pocket. There was a little cloud of vapour and I was told it was going to wean the person off cigarettes. That claim has been put out time and again but now, several years later, the WHO has published research to state is not factual. That needs to be repeated.

On the issue of vending machines, I do not know if my head is in the clouds, but I have not seen many of them. Where are they located, in general? What is it being sought to limit?

Mr. Paul Gordon

They are usually located in pubs or hotels. We are a little bit behind the rest of Europe on this issue. Approximately 14 EU countries have a ban in place, as does the UK. I know the Department has been keen to push this ban for several years. The thinking behind it is that it will help to denormalise smoking as it will ensure that children see fewer tobacco products around them. In addition, there is evidence from the environmental health service that, despite most places with a vending machine having a token system in place, children tend to be more successful in their attempts to get cigarettes from vending machines than through other means.

The positioning of vending machines is probably more important than the fact they exist. In some cases they are located behind a bar counter. A token is given and down you go. It is kept as a financial transaction separate from the food or drinks that are sold at the till.

We definitely want to curb smoking. I have never smoked a cigarette in my life. I am very anti-smoking. However, there are cohorts, such as older people in particular, for whom it is very difficult to break the habit. I have grandparents who smoked. It is very difficult for smokers in their late 80s to give up cigarettes. It might make more sense for vending machines to be positioned away from children and the main thoroughfares of hotels rather than having an outright ban on such machines. They should be situated under a bar counter or somewhere like that. Having a point of sale should not be the main problem; it is more about the location of that point of sale.

Another issue I wish to home in on is the importing of cigarettes. We have won the battle on many fronts but there is an issue in respect of cigarettes being brought into the country. Many people come off a flight or a ferry laden down with bags filled with large boxes of 100 or 200 cigarettes. Is the regulation in that regard a bit soft?

Ms Averil Power

As was mentioned, there are moves at EU level to restrict this. As with alcohol, there are restrictions on sales at airports and in duty-free shopping areas but if one buys a product in another country and pays the tax on it, one is entitled to bring it in one's luggage. That creates problems for us, as a country that has led on tobacco. We increased prices to make cigarettes more expensive here but people are getting around that by going to Spain and other countries, buying them more cheaply on the high street there and then bringing them home in their luggage. That is definitely an issue that we would welcome the Government considering.

The Deputy is not much younger than me; we are members of the same generation. He is certainly better than me in terms of being able to withstand all the marketing and never smoke. I did smoke. As the Deputy stated, it was very popular back then. Cigarettes were pushed at you so much when we were younger. I took up smoking in school and it took me a long time to quit, and it was very difficult to do so. I know exactly how difficult it is. Thankfully, I managed to quit while I was in college. I know exactly how difficult it is for people such as the older people to whom the Deputy referred who have never been able to break that habit. These products are designed to be addictive. They have become more addictive through the years. They are designed to make sure that the older gentleman who was mentioned will still be smoking and a loyal customer of a particular cigarette brand until he goes to his grave. The more we can do to ensure young people do not take it up in the first place and do not have to go through the trauma and difficulty of trying to quit, the better.

I appreciate Ms Power's honesty. I refer to the old black and white photographs of nine-year-old or ten-year-old children with peaked caps smoking cigarettes. One could see the pathway of those children's lives. They probably aged far more quickly and faced more health problems than would have been the case if they did not smoke. We want to avoid situations such as that. Significant inroads have been made in the past 15 years or so in terms of not allowing it to happen again. We need to double down on that effort.

I always feel sorry for the people in their late 80s or 90s who go to the GP and are told to pack in the cigarettes, a product they have been smoking for many years. The person probably has only a few months or years left in his or her life. They are dying out, unfortunately, I want the law to be hard and clamp down on smoking. I certainly want us to do everything we can in terms of advertising. I believe that more taxation should be landed on top of cigarettes in each budget. However, I always feel sorry for those people. My grandparents were in their late 80s and they were told to pack in the cigarettes. We do not want other people to take that path but we need to keep those older smokers in the back of our minds.

I do not wish to name the company, but every supermarket and convenience store sells roll-up papers made by a particular firm. Many of the young people I see smoking - and there are far fewer of them than in previous years - make their own cigarettes because they are cheaper. On the train I took to travel to the Dáil yesterday, there were two girls sitting across from me who were rolling up seven or eight cigarettes to have later in the day. They were very young. No measures have been implemented in respect of that kind of paper. If it were to be taken out of the market, I am not sure what could replace it. Does that need to be considered?

Mr. Mark Murphy

Both of the organisations present have called for an increased level of taxation in this regard. Studies have shown that young people are moving towards roll-your-own tobacco as traditional packets of 20 cigarettes are being taxed at a higher rate. Overall, by quantity, roll-your-own tobacco is slightly cheaper. We have been calling for those products to be taxed at a higher rate. Studies have also shown that young people consider roll-your-own tobacco to be healthier and somehow more organic than traditional cigarettes that come in packets of 20. That needs to be addressed through taxation but it should also be highlighted that roll-your-own cigarettes are more harmful, not less harmful, than traditional cigarettes.

On the issue of vending machines and the locations where cigarettes can be bought, in order to make it easier for people to quit, we have to cut down on the number of locations in which cigarettes are sold, including vending machines.

We welcome the fact the proposed Bill will put new registration measures in place in the context of where tobacco products are being sold and will introduce an annual fee per outlet. We have called for a €500 annual fee per retail outlet that sells tobacco. In the Department of Health's regulatory analysis of the proposed Bill, it was mentioned that, in the context of alcohol, a €500 per retail outlet licence has to be paid annually. We need to put a high price on retail locations that sell tobacco. That could limit locations where tobacco could be sold. Studies have shown the higher density of places that sell tobacco, the more people smoking in that area and the higher initiation rate for children. That is a major step. We need to put a high annual fee on locations selling tobacco products and ban vending machines.

Mr. Mark Murphy

It will make it easier for people to quit. If people who are trying to quit walk down the street and both e-cigarettes and tobacco are being sold easily in every shop they go into, it makes it harder to quit and kids will initiate easier. This Bill has a lot of welcome elements to cut across the whole area of tobacco.

I agree with regard to advertising. There are not many instances around the country but I can think of one in my county where there is antique tobacco advertising. In many places, it is replicated signage that people put up for a nostalgic look in a shop. I know one shop in Clare where the signage is authentic and dates back to the 1920s or 1930s. It would be no harm in some scenarios to have old tobacco signage. It is in many pubs as well and harks back to a different era. It is about nostalgia and creating a historical context. There needs to be a hands-off approach to that. There is a building across from Limerick train station I come near to every day I get the train that has old tobacco signage. That needs to be exempt from this if it is historic. As for all forms of modern advertising - no way. That is aimed at selling a product. This is aimed at historical preservation of the old enamelled signage.

I did not choose to be scruffy this morning; I am doing Movember. I wanted to mention that while Ms Power and the Irish Cancer Society were here. I am a reluctant participant in Movember because I do not have a face that goes well with stubble and the rough look, but a good childhood friend of mine passed away at the start of this month from cancer. Far too many males are still passing from cancer. There are far too many people passing away from cancer, but one in eight men get prostate cancer. We are talking about lung cancer this morning. There are so many forms of cancer. It is a small gesture to not take the razor and it saves me a few minutes every morning. I want to highlight the fact that Movember is happening. A few Deputies have the permanent beard and mustache but a few of us are doing it temporarily for this month to raise funds and awareness of male cancer and male health overall. I thank the witnesses.

I do not think anyone noticed the Deputy was looking scruffy. Many of us would say that there are a number of Deputies who are scruffy all year round. Senator Kyne does not seem to be able to get in.

What struck me from the evidence this morning is that many of us see smoking as a cash cow for Revenue. The witnesses say it is worrying that supports for cessation have dropped by 15%. That is something we, as a committee, could follow up. Part of what we are trying to do is bring in all sections that have a view on and a relation to the issue. The discussion was really useful this morning. I suppose the witnesses are saying if the increase on the price of cigarettes works, maybe it will work for e-cigarettes. That is the message they are sending. Do the witnesses want to sum up?

Mr. Chris Macey

We have, in our two most recent pre-budget submissions, called for taxation of e-cigarettes at a level that will discourage young people but not prevent long-term smokers who might benefit. We would support that.

I thank the Chair for the opportunity to speak. Ms Power mentioned that the level of knowledge members have on the issues and the views we have heard this morning are encouraging. It is important that we do this. If we do not deal with the addiction issue in terms of e-cigarettes and children and young people now, we probably will not get the chance again. This is the proposed legislation, and this is the time to do it. Defensive measures will stop the smoking rate from increasing again, which is what e-cigarettes could, apart from people becoming addicted to them, lead to.

We need to get into the endgame for tobacco. We are still at 14% of teenagers smoking. The rate among adults has been falling steadily but increased in the last HSE tracker from 15.4% to 16.1%. There are more than 600,000 smokers in the country. To reach our tobacco-free Ireland target by 2025, that has to be brought down to approximately 200,000. We are way off that and we worried that the tide is turning negatively. We have to deal with that and to continue the downward trend. We have to look at ambitious and new ways of achieving that. That is why the Irish Heart Foundation will campaign hard in the time to come to get the age of sale increased, because the evidence is compelling on it. I thank the Chair and members.

Ms Averil Power

We have had a really good discussion. I am encouraged by the contributions from each of the members and optimistic. I hope we can work together to improve the proposed legislation. We will do anything we can to help with that. If members have further queries after the meeting, they should please come back to us and we will help them as the Bill, when drafted, goes through both Houses.

On behalf of the Irish Cancer Society, I thank the Chair and members for the work they do to raise awareness of cancer by sharing their experiences and making people aware of signs and symptoms and their general support for our work. We appreciate it.

On behalf of the committee, I thank both organisations for the positive work they carry out. If there is a public message this morning, it is that there are products and supports available to those who want to give up smoking.

The joint committee adjourned at 11.58 a.m. until 9.30 a.m. on Wednesday, 24 November 2021.