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Heated Tobacco

Volume 662: debated on Wednesday 26 June 2019

I beg to move,

That this House has considered Government policy on heated tobacco.

May I say how pleased I am to serve under your chairmanship, Mr Gray? I immediately declare my interest as an honorary life fellow of Cancer Research UK.

Smoking remains a terrible public health problem in the United Kingdom. The Government recently referred to it as the “continuing tobacco epidemic”. It is the country’s principal cause of cancer and single greatest cause of preventable illnesses and avoidable deaths. Some 7.4 million people in this country smoke, and smoking is the cause of around 100,000 deaths every year. There is a mistaken perception that the problem of smoking has largely been addressed, which might be because smoking, like many other societal ills, does not affect everyone equally. The smoking rate remains around 25% in many of the poorest areas of the country, whereas it is around 5% in more prosperous areas. In my constituency of Clwyd West, the rate is above the national average, at 17% to 18%.

The Government are to be commended for their achievements on smoking, and indeed for their ambitions for the future. Since 2010, Conservative-led Governments have brought the smoking rate down from 20.2% to 15.5%, which is a significant accomplishment. The Government are to be applauded for their ambition to lower smoking rates to 12% by 2020. Although they have not set yet a target date, the Government aim eventually to create a smoke-free generation, which they define as less than 5% of adults smoking. However, the challenge today is far greater than it was a decade ago, because smokers with a higher level of motivation to quit will have done so already. Those who remain have withstood years of public health campaigns and societal pressures, as well as the rise of e-cigarettes as an alternative to smoking.

I congratulate the right hon. Gentleman on bringing this important matter to the House for consideration. Does he agree that advice must be provided first about smoking cessation, rather than about vaping or any other alternative method? Does he also agree that although there are no long-term indications of the effects of vaping, whether burned or heated, the chemicals that are used will not be neutral, and there will therefore always be an element of concern and a need for greater research?

Clearly, the ideal is for people to give up smoking altogether, but there are ways of reducing it. I will go into that in my speech. The hon. Gentleman makes a point to which I shall also refer: there is a need for research on the effects of alternatives to combustible tobacco.

E-cigarettes have had a revolutionary effect on efforts to reduce smoking rates in this country, and credit must go to the Government for facilitating that. E-cigarettes have had a highly positive impact on helping smokers to quit. In 2010, a particularly enlightened member of the behavioural insights team, David Halpern, influenced the Government’s decision not only to resist banning e-cigarettes—other countries were poised to do so—but to seek deliberately to make them more widely available. David Halpern advanced the principle of harm reduction: it is more effective to give somebody a reduced risk product than to insist unrealistically on immediate total abstinence. An expert in harm reduction, Professor Gerry Stimson of Imperial College, has supported that argument, pointing out that it is easier to persuade people to do something if that thing is enjoyable rather than a painful chore. He said:

“For those trying to stop smoking, e-cigarettes have profoundly changed the experience. For the first time quitting cigarettes is no longer associated with being a ‘patient’ and personal struggle.”

I am grateful to my right hon. Friend for securing this important debate. As a non-smoker, I think there is nothing worse than sitting outside a café in London or Shropshire and having my lungs full of somebody else’s smoke, or indeed trying to walk to Parliament and taking in a street full of smokers’ smoke. Having said that, I am a libertarian—if people want to smoke, they should be free to do so. His substantive point on public health education is absolutely right: the campaign against smoking is not over. In my constituency of The Wrekin, 19,000 people still smoke. Does he agree that public health is important?

I do indeed. I will also comment on my hon. Friend’s point about other people having to endure smokers’ smoke. One point that the Government make in their response to the Science and Technology Committee’s report is that heated cigarettes are far less offensive to other people than combustible cigarettes.

Consumers’ principal reason for using e-cigarettes is to give up smoking. According to Action on Smoking and Health, 62% of ex-smokers use e-cigarettes for that purpose, and the majority of users have successfully quit smoking. However, it might well be that we have now passed the apogee of the e-cigarette effect. According to the Office for National Statistics, the number of new e-cigarette users peaked at 800,000 in 2013-14. Since then, the number has approximately halved every year, down to 100,000 in 2016-17. It is not the case that the remaining smokers do not want to quit; the ONS reports that nearly 60% do. For some, however, the experience of using e-cigarettes does not come sufficiently close to that of smoking to be an adequate substitute. In this context, I urge the Government to consider the alternatives.

In Japan, heated tobacco is proving very successful in helping smokers to quit. Evidence there shows that 70% of heated tobacco users give up smoking altogether. That is a better conversion rate than for any other alternative nicotine-containing product on the market.

I have been a smoke-free person for 15 years, but it took me 12 years to get there. I had various failed attempts to give up smoking because it was a choice between smoking and chewing gum, which really was not a successful pathway—it took me 12 years before I could finally give up. Any method that helps the process has to be a good idea.

I am very pleased to hear that. Of course, it is debatable whether chewing gum is more or less antisocial than smoking—particularly in its effect on pavements.

The heated cigarette process uses an electronic device that heats tobacco, producing an aerosol that tastes like tobacco, and it delivers nicotine in a similar way to a cigarette. Importantly, however, it is not a product of combustion. Tests on heated tobacco carried out by the tobacco industry and scrutinised by the Committees on Toxicity, Mutagenicity and Carcinogenicity of Chemicals in Food, Consumer Products and the Environment found a reduction of up to 90% in the number of toxic chemicals emitted by heated tobacco compared with combustible cigarettes. That is not greatly dissimilar to Public Health England’s finding that e-cigarettes are up to 95% safer than combustible cigarettes.

Heated tobacco is currently sold in the UK, but there is no independent research to validate its use. Members of Parliament have said that research is needed, and the Government have agreed. As I mentioned a few moments ago, the Science and Technology Committee’s July 2018 report highlighted the need for independent research. It identified the opportunity for the Government to

“help fill remaining gaps in the evidence on the relative risks of e-cigarettes and heat-not-burn products”

and support a long-term research campaign that would be overseen by Public Health England and the Committee on Toxicity to ensure that health-related evidence is not dependent solely on the tobacco industry.

The Government’s December 2018 response to the report was favourable. They accepted the recommendation and undertook to

“review and consider where there are gaps in evidence for further independent research”.

They went on to say that they are

“committed to providing the outputs of research to the public on the risks of e-cigarettes and novel tobacco products.”

They also committed to including heated tobacco in their annual review of e-cigarettes. However, this year’s e-cigarette review contained no mention of heated tobacco.

We are falling behind our international peers on this front. The United States Food and Drug Administration recently produced research that concluded that heated tobacco is

“appropriate for the protection of the public health because, among several key considerations, the products contain fewer or lower levels of some toxins than combustible cigarettes.”

It reported up to 95% lower quantities of certain toxins.

My question to the Minister is this: will the Government commit to producing or supervising independent research into heated tobacco this year? We are talking about a matter of personal choice for smokers, but the Government have a duty to inform them about the available alternatives. We have seen the value of e-cigarettes in helping people to quit smoking, and if there is a prospect that heated tobacco could help to bring down smoking rates further, are we serving the interests of public health by not carrying out the promised research? Might not an approach akin to the innovation principle, as opposed to the precautionary principle, ultimately lead to fewer smokers? If it might, should we not, like David Halpern, seize the opportunity?

The research will not happen by itself. The responsibility to produce it lies with the Government, as they have acknowledged. From 1 July, we will be acknowledging heated tobacco in the tax system. Is not now an appropriate time for the Department of Health and Social Care to ensure that the new tax category goes hand in hand with independent research on the efficacy of heated tobacco in bringing down smoking rates and its impact on public health? It may be suggested that the lack of funding is an issue, but I urge the Government to consider requiring tobacco companies to pay for the research to be carried out, thereby circumventing the need to apportion departmental budgets to it.

The reduction of harm from smoking must remain a top priority for this and any other Government. I therefore hope that the Minister will respond positively to my suggestion.

It is a pleasure to serve under your chairmanship, Mr Gray. I thank my right hon. Friend the Member for Clwyd West (Mr Jones) for raising the important issue of heated tobacco products and their contribution to reducing harm from smoking, and for his lifelong service as a fellow of Cancer Research UK. He put it very well: smoking is still prevalent in certain communities in our country, and still causes over 78,000 deaths a year in England. It is one of the leading causes of preventable illness and premature death. We have made great progress, particularly over the past 10 years. Adult smoking prevalence is now 14.9%—the lowest ever recorded level—but, as he pointed out, we have much further to go, particularly among certain groups and in certain parts of the country.

In the 2017 tobacco control plan, we set out our ambition to reduce smoking and ensure a smoke-free generation. Part of that strategy is about helping people to stop smoking by adopting the use of less harmful nicotine products. They may, for example, take up chewing gum. I have never seen my hon. Friend the Member for Broxbourne (Mr Walker) spit out his gum on the pavement.

I quit 15 years ago, but it took me 12 years because the only choice besides smoking was nicotine gum, and it was simply revolting. I would have quit a lot earlier if we had some of these modern products around 15 years ago.

I hear what my hon. Friend is saying. For a lot of people, nicotine substitutes are a good transition to giving up smoking or other things completely. We have seen a dramatic rise in the use of e-cigarettes from 1.6 million users in 2014 to about 2.5 million in 2017. Encouragingly, about half of them in England have quit smoking completely. E-cigarettes are not risk-free, however. The evidence is increasingly clear that they are significantly less harmful to health than smoking tobacco. They can help smokers to quit, particularly when combined with stop smoking services. Recent studies have shown they can be twice as effective as nicotine replacement therapy in helping people quit smoking. As my right hon. Friend the Member for Clwyd West pointed out, the sales of e-cigarettes are plateauing, and we are coming to the stubborn 5% of people who are still smoking.

The Minister will know that expenditure on smoking cessation programmes has fallen rapidly in the past few years. I promoted a ten-minute rule Bill to put a levy on tobacco companies to fund smoking cessation programmes and research into less harmful products. The greatest problem we have had for many years—this is anecdotal at the moment—is that products such as patches and gums cannot get heavy smokers to quit. There is some evidence, although it is not firm, that heated products are a way of getting to people who have a real problem with addiction.

The right hon. Gentleman makes an important point. Those of us who represent seats in the north and the devolved nations know that in some communities a very high proportion of people—particularly older men—are still smoking. Smoking cessation services are obviously part of the conversation about public health that the Department will be taking forward to the spending review.

My right hon. Friend the Member for Clwyd West has argued that it would be timely for the Government to commission independent research into heated tobacco products’ potential for harm reduction. Obviously, if the tobacco companies were paying for it, it would not be independent. The right hon. Member for Rother Valley (Sir Kevin Barron) has set me an interesting challenge on tobacco levies. The new levy is being introduced in a few days, and I will definitely keep that under review.

The primary focus of our research at the moment is e-cigarettes, because heated tobacco is still very new on the market in this country. We will keep it under review and we will monitor the evidence through Public Heath England’s reviews. I agree entirely that it is important to look carefully at the evidence of harm reduction. I assure the House that we are, and will continue to be, led by that evidence.

Heated tobacco products are regulated under the Tobacco and Related Products Regulations 2016 as novel tobacco, in accordance with the EU’s tobacco products directive. We know far more about e-cigarettes than we do about heated tobacco products. The research and evidence base is still in its infancy, and is mainly conducted by the tobacco industry. We asked the Committee on Toxicity to research the toxicological risks of heated tobacco products and compare them with those attributed to conventional cigarettes. It reported in December 2017, and the evidence suggests that heated tobacco products still pose a risk to users. There is likely to be a reduction in risk for cigarette smokers who switch to heated tobacco products, but quitting tobacco entirely is the most beneficial thing that anybody can do.

We have asked Public Health England to update the evidence base on e-cigarettes and other novel nicotine delivery systems annually. The PHE 2018 evidence review also had a comprehensive chapter on heated tobacco. It concluded the same as the Committee on Toxicity. As my right hon. Friend the Member for Clwyd West said, it stated that e-cigarettes are less harmful than heated tobacco. The latest PHE evidence review in February 2019 did not cover heated tobacco products, essentially because there was insufficient new evidence since the previous review in 2018.

My right hon. Friend pointed to the experience of other countries. I agree that we must look beyond our shores and learn lessons, but we must also acknowledge that there are different contexts in which heated tobacco products are used. For example, Japan has banned e-cigarettes, but it has introduced heated tobacco products, which have made an impact there. The Food and Drug Administration in the United States has permitted the sale of heated tobacco products, but is yet to pronounce on whether Philip Morris International may make claims of reduced risk for its IQOS product. I believe, therefore, that we need to be cautious about assuming that heated tobacco products are likely to find a large market in the UK.

I recognise that more independent research on heated tobacco products would be helpful for understanding their relative risks. The Department and its arms’ length bodies will consider research proposals in this field, but at present none has been forthcoming. I need to be clear that such proposals would need to demonstrate good use of public money. We will continue to monitor the international evidence and develop our policy as such evidence develops.

I have listened carefully to what the Minister has to say. It seems that the Government’s position now is identical to their position six months ago, when they published their response to the report of the Science and Technology Committee. Is that right? Has nothing moved?

There is a definite need for more research to be done on heated tobacco products. Only through proper, independent research can we draw different conclusions. However, my right hon. Friend has raised a very important issue about these products, which are helping certain people in this country and other jurisdictions to quit smoking. He has set me a challenge and I will certainly ask my officials to look closely at the issue.

It is important to remember that heated tobacco products are tobacco products, and we must apply suitable caution. Although switching from traditional cigarettes is likely to reduce risk, the best approach is to quit entirely. The Government remain committed to helping people quit smoking and promoting reduced-risk products where it makes sense for smokers. We will continue to be driven by the evidence.

Question put and agreed to.

Sitting suspended.