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0:00 - Intro
0:55 - The Irish Heart Foundation is supporting calls to ban flavoured vapes
11:34 - There have been mixed developments over the regulation of vapes in the US
14:55 - Chimwemwe Ngoma shares his thoughts on smoking and vaping in Africa today
24:51 - GFN News is now available on SoundCloud, Spotify & Apple Podcasts
25:27 - Brent Stafford of Regwatch interviews Marewa Glover
48:08 - Closing remarks


Hello and welcome, my name is Joanna Junak and this is GFN News on GFN.TV. In today’s news:

The Irish Heart Foundation is supporting calls to ban flavoured vapes. Doctor Garrett McGovern will tell us more.

In the United States, there have been mixed developments in court and at the FDA itself over the regulation of vapes, as Will Godfrey will discuss.

Chimwemwe Ngoma, a leading tobacco harm reduction advocate from Malawi will share his thoughts on smoking and vaping in Africa today

And after the news, Brent Stafford of RegWatch interviews Doctor Marewa Glover, who has worked on reducing smoking-related harm for over 25 years.

The Irish Heart Foundation has welcomed new measures aimed at preventing young people using e-cigarettes - which include plans to ban flavoured vapes. The charity said it had actively lobbied for four sweeping recommendations included in a pre-legislative scrutiny report for the Public Health Bill that was published nearly two weeks ago. We asked Doctor Garrett McGovern, Medical Director of the Priority Medical Clinic in Dublin and GP Specialising in Addiction Medicine, about the regulation of vaping products in Ireland.

Garrett: As it stands, electronic cigarettes are regulated as a consumer product, they're not regulated as a health product. So they're not under the same sort of things as kind of the same regulations as nicotine replacement therapy. In Ireland, there's generally a lukewarm sort of reaction towards electronic cigarettes in general by medical profession, possibly other professions as well. The medical profession, my own profession, they either stay quiet about electronic cigarettes, some people are vocally against electronic cigarettes so you give some just a little bit of background about how they're viewed over here. In other words, they're not the Health Service Executive which will be the equivalent of the NHS in the UK. The HSC Health Service Executive don't advise electronic cigarettes as a smoking cessation device. So in their HSE Quit website, if you look at it, they just have a little paragraph on electronic cigarettes and they said there isn't enough evidence or determine their safety, therefore they're not recommending them personally. That's appalling advice and it's completely at odds with what the international evidence is telling us. It's completely at odds with World College physicians, public Health England and many other experts abroad. It's a contentious issue, but in the NHS they're now funding giving electronic cigarettes to people free. So I just want to give that a good background the way it is. Who is putting forward these regulations? It's a joint health committee in our government that's a problem because they didn't really consult consumers in relation to this. I didn't get an opportunity to say anything about it and hopefully I will. It seems to have taken up the views of taking on the views of people who are anti vaping rather than the people who are pro vaping and I think it will be a big mistake and I hope that we can stop it happening. I just hope that they don't over regulate electronic cigarettes. Yes, age restriction all on for that, but not removal of flavours.

Joanna: He shared also with us his thoughts on youth vaping.

Garrett: So we have another situation there, which is there seems to be a concern around youth vaping. And we don't have a huge amount of studies on this. But what we do know about youth vaping is it seems to me that the vast majority of young people who vape do so regularly or experimentally. And that's probably as much as 96%, 95%, 96%. There is about 4% of young people who are dating more regularly, some of them possibly dependent on baby. That's the group that everyone's getting into a tizzy about. Although when this is reported in Ireland, it's called using highly charged language like epidemic. So we call it the vaping epidemic. I don't think there is an epidemic, but I'm not lying to the fact that even 4% of young people who vape is still too much. And also that works out at about 1% of all young people below the age of 18. I think the problem there is and we'll get back to this maybe later, I think we're taking our eye off the ball I think we still have a problem with youth smoking. And youth smoking, regardless of age, comes with, as you know, huge harms. It doesn't seem to be a huge amount of problems that I'm seeing with baiting. Other than the fact that people would say they're addicted to nicotine, I don't see that as particularly a problem because nicotine, that's all you're taking is nicotine. The concentrations in NRT or in vapes are so small, I don't think it's going to do anything to them. I know people will say it changes people's brains and stuff like that, but I think that's marginal stuff, really. I don't see vaping nicotine as normal. So we have now a situation where the answer to this is to ban flavours because I think they're taking the queue from the alcohol industry. If you remember, there was a big, huge way, I don't know in your own country whether you had this issue of alcohol or alcohol, which would be flavoured alcohol drinks. And they felt that that was the name that young people and that it increased the number of young people drinking. So it's kind of similar argument here about vaping. What people may not realize, and I don't think a lot of people in my own country realize this, is that I would have thought that one of the first regulations you would bring in to try and reduce access of young people to vaping is an age restriction. But there isn't any age restriction in Ireland, so no age restriction. So they're going to bring that in now, but whilst they bring that in, they're going to ban flavours. So they're going to ban flavours. And we know from research internationally that flavours are a very key component for people to use electronic cigarettes. Yes, some people like tobacco flavours, but very many people like other flavours, and it's flavours that gives them the opportunity to have a quit attempt. I have to say that smoking is a tremendously difficult habit to overcome, and anything that helps a smoker overcome smoking has to be really kind of supportive. But in Ireland, we've got this idea that with banned flavours and everything will be fine. It's unlikely to protect young people because what they don't realize is even the small number of people who are vaping, they're likely now, if they don't get access to what I plan to do, they probably will smoke. So they talk about the gateway. No real evidence of the gateway between vaping and smoking. I think the phrase more often uses common liability, which is just another way of saying that people, kids will try things. They'll try vaping, but they'll also try smoking. They will try cannabis, they will try and they will try alcohol. It's called common liability. It's not gateway. But there's a scare mongering in my country in relation to this, and my biggest concern is that with this scare mongering, it will discourage people away from vaping, but also it will reduce access for the people who need electronic cereals.

Joanna: Mark Murphy of the Irish Heart Foundation said: “Vape manufacturers are clearly using flavourings – and research has found thousands of them – that they know will attract minors”. Let’s hear Garrett’s thoughts on this.

Garrett: Don't accept that they attract minors. If minors are getting access, then we need to regulate so that minors don't have access on cigarettes. But we're not very good at protecting minors away from cigarette smoking either. So if you're asking me which would I prefer, would I prefer a minor to vape, or would I prefer minor to smoke vape? Every time? A lot of experiment. The evidence shows it's experimental anyway. But I accept that we shouldn't be giving vapes to people or underrating. I accept that although you could argue under ratings can get dependent on tobacco as well. And if they are, then maybe you need to look at that and see, can you make exceptions in certain circumstances under supervision? But if that's the case that's attracting them, then why don't we just regulate it so it looks less attractive? You know what I mean? So I know problems. That's what they really feel, but I would fall short. I think we need to tease out regulation. What they're trying to do here is they're saying it attracts young people. I'm assuming they mean the advertising and the presentation of it. Well, I'm sure that they I don't know. I can't speak for vape companies, but I'm sure they are quite willing to engage with the government about how they sell their products. But they've decided not to do that. This committee, they want a full ban on the flavours. Now, the one thing they haven't been challenged on is the fact that many people use electronic cigarettes because of the flavour that seems very unfair to me. You're going to protect a very small group of people, which is less than 1% of the overall people who use electronic cigarettes for a smoking session. There's a small group that will use them that's not the best or something. It's a recreational progress. And we're trying to protect a very small group who don't use 95% of them, don't use it regularly anyway. And we're going to completely forget about the vast, vast, vast majority of smokers who are using flavoured cigarettes to quit. It just seems like a policy that has had I'd like to see the minutes of meetings to see how they arrived at this conclusion. There wasn't any recognition at all of the vast number of smokers. There are 200,000 people estimations. I don't know how accurate the figure is, but possibly as many as 200,000 largely smokers in Ireland who use electronic cigarettes. There's going to be a number of bills, I don't know. Act fresh if we get rid of labels.

Joanna: Now let’s turn to the United States. Will, what’s been happening since we last spoke?

Will: Hi, Joanna. Here, It's all still about the FDA's chaotic handling of vaping regulation. Since the uproar over the agency's dual decision, which we discussed last time, there have been several more developments, few of them encouraging. Firstly, on July 13, the FDA was granted the power to regulate and exercise enforcement discretion over synthetic nicotine vaping products. Per a law passed by congress some months ago, the agency wasted no time that very day in sending out over 100 warning letters to companies marketing these products without authorization and to retailers that have allegedly sold them to miners.

Joanna: What’s behind the synthetic nicotine phenomenon in the US?

Will: It's largely a creation of the FDA itself. Numerous companies, having seen their PMTA applications to the agency, denied, switched over to synthetic, which was a legal gray area. The FDA's remit technically encompassed only tobacco derived nicotine products, not nicotine made in a lab, even though it's essentially identical. The new law has now got rid of that apparent loophole. Synthetic nicotine companies had meanwhile been ordered to submit new PMTAs in what critics have called an impossible time frame.

Joanna: What else happened?

Will: Well, talking of PMTA denials, as we know, several smaller bait companies have fought back against them in courts. They've achieved some stays and limited successes. And Triton distribution, a company of the forefront of these efforts, was seen by some as a proxy for this wider campaign. On July 18, however, the company was dealt a significant blow in the fifth circuit court of appeals when its petition for a review was denied. Triton's lawyers argued that the FDA acted arbitrarily and capriciously, never making it clear that certain scientific studies would be required until too late. But in a split two to one decision, the judges backed the FDA. Judge Edith jones wrote an eye catching dissenting opinion. However, she called the agency's actions a mockery of reasoned administrative decision making. Adding Kafka would have understood the FDA all too well. Triton may have some legal options to fight on, but the decision was undoubtedly a major setback.

Joanna: Is there any kind of good news?

Will: That depends on who you listen to. But on July 20, Dr Robert Calif, head of the Crisis Freedom FDA, announced that he would commission external experts to conduct, quote, a comprehensive evaluation of the agency's centre for Tobacco Products, which handles PMTAs. Will this significantly change the agency's approach? Cliff Douglas, director of the University of Michigan Tobacco Research Network, told filters Alex Norse that he was optimistic for improvements. But after all this happened, there's great scepticism in the THR community for anything that comes out of FDA mouths. The agency had to look like it's doing something, an anonymous former employee told Alex. But I wouldn't expect huge changes from this.

Joanna: Thank you, Will, for your update. Over the summer, we decided to travel to a range of countries and speak to local experts to find out what’s happening with tobacco harm reduction around the world. In the last episode, we spoke with John Summers about vaping and smoking in the UK. This time, we crossed over to Malawi to hear from Chimwemwe Ngoma, a leading tobacco harm reduction advocate. Thank you, Chim, for joining us. Can you tell us what’s happening across Africa - in terms of the use of combustible cigarettes and the harm reduction situation, including the use of safer nicotine products across the continent?

Chim: In most African countries, combustible cigarettes and other high risk products are the ones that dominate the market, and you find less of safer nicotine products being available on the market. But I think the products are getting popular each passing day and people are adopting them. I'm talking of regulation. In most African countries, there are no specific laws regarding the use or sale of nicotine products. But I know of some countries, like Kenya and South Africa, which have been trying to come up with a regulation of the electronic cigarettes and other safer nicotine products. On availability, I would mention Kenya as one of the only African countries I mean, I would mention Kenya's, one of the only African country where there is a bit of diversity when it comes to safe nicotine products. In Kenya you find vaping products and before the sales were suspended, they also had nicotine pouches known as lift. But the problem in Kenya is that when they take a step forward in the right direction, they later on take a step or more backwards. For example, the diversity of safer nicotine products, the availability of vaping products and lift in Kenya would be considered as the right step in the right direction. But the prohibited tax measures on the products is just with progressive. So yeah, we can talk about the diversity and availability of electronic cigarettes and nicotine pouches in Kenya, something that is good and they're doing better. But when we talk about access and affordability. They have a tax measures on the products that are prohibited. This means that some consumers might resolve into the black market, or they might go for high risk products that sound to be cheaper.

Joanna: And what about vaping in Malawi, where you live?

Chim: in Malawi, people are slowly taking up electronic cigarettes as a means of consuming nicotine. But the problem is that these products are considered as products for the elite, because a lot of people in Malawi cannot afford vaping products because they are just expensive, not because of tax measures like in Kenya, but it is because of what made or cause the role of demand and supply. The supply is still very low, but the product is getting the demand each person day. So that means that their prices are higher than we want them to be. So for an average income in smoke and living in Malawi, I would say that they are not able to access these products. And unfortunately for us, we don't have nicotine pouches in Malawi, which is a low tech product, which I think would be ideal for countries like Malawi, where there are a lot of low income aiming smokers. So I think that's where we stand at the moment in Malawi. And talking of regulation in Malawi, we don't have any regulation on the sale and use of electronic cigarettes and any other safer nicotine products.

Joanna: Is the government of Malawi supporting people to have better access to safer nicotine products?

Chim: I think it is true that a lot of smokers living in Malawi and other low and middle income countries do not have access to safer nicotine products. And some studies review that. Underfunding is one of the factors that clip on the health care system in many African countries which are low income, to the extent that some governments are unable to meet the basic requirements for a good health care system. And this means that small guys have difficulty in accessing reduced risk nicotine products, including the nicotine replacement therapies that are supposed to be widely available, but you barely find them in our healthcare institutions. And what we expect is that government in Africa embrace the tobacco harm reduction, which would be easier for them to implement at minimal cost to the government itself and the taxpayers, because mainly what happens is that the science and research on tobacco harm reduction is mainly done by the industry and not the government. And the consumers find their own nicotine news. If they want cigarettes, they buy by themselves, and if they would want safer nicotine products, they would get them by themselves. So this is something that the government in Africa and Malawi should consider doing, and it's something that I haven't really seen the government's doing, and I would like to encourage them to maybe explore this route.

Joanna: Bloomberg-funded organisations operate in many African countries, and these organisations tend to act against the interests of tobacco harm reduction. Can you tell us more about what they do and how they are affecting the situation in the countries where they are active?

Chim: The philanthropy is to some extent trying to impose the western tobacco control measures on Africa, which are not only expensive, but complex to implement for any stretched government in Africa. Like I mentioned earlier, that there is a bit of underfunding and in a resource-rich economist, it is very rare for countries to prioritize top of control or top of harm reduction. So the Bloomberg funded organizations available in Africa to some extent are simply trying to propel their ideologies. And what bothers me the most is that the philosophy funded organizations propel misinformation that nicotine causes lung cancer and that safer nicotine products are as harmful as combustible cigarettes, deliberately ignoring the science and evidence. And we all know the effects of misinformation. For example, that time we had the Evali outbreak, there was misinformation that the Evali was being caused by vaping nicotine products. It was later on disproved. But what we see and what is happening here in Africa is that some people are still arguing, basing on that misinformation about the Evali being caused by electronic cigarettes, which is causing more harm than good. So I think these Bloomberg funded organizations are on the forefront in propelling misinformation, which I think is something dangerous to public health and it might cause a lot of harm to the healthcare system here in Africa. And there is another group I believe to be funded by the philanthropy, which is just there to attack and discredit anyone who say anything good about tobacco harm reduction. Have been attacked and mentioned names and all sorts of things based on misinformation, disinformation and propaganda, and not based on what the science and evidence says. So there is this happening, there is this thing happening in Africa which I think is something terrible and should not happen. And everyone should follow science and evidence. And that is what should inform our arguments and the policies that African countries disable.

Joanna: Before we go over to Brent for our RegWatch / GFN TV interview, we’ve got some news about GFN News to share with you. Do you want to enjoy the latest developments in tobacco harm reduction while you are on the go? Because now you can. From now on, each episode of GFN News will also be available as a podcast. Find us by searching for GFN News on SoundCloud, Spotify and Apple. Stay informed on tobacco harm reduction around the world while you are cooking dinner, at the gym, or on your commute. And now, we go over to Brent Stafford and his guest, Doctor Marewa Glover. Marewa has worked as a policy analyst, a co-ordinator of a national tobacco control programme, a smoking cessation trainer and, for over 17 years, as a researcher. She has also chaired numerous committees and organisations including End Smoking New Zealand. In today’s interview, Marewa will share her thoughts on nicotine vapes in New Zealand. Over to you, Brent.

Brent: Hi, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV. We're here in Warsaw, Poland for the Global Forum on Nicotine, GFN22 and in a minute we'll be speaking a fascinating conversation, actually, with Dr. Marewa Glover. Now, New Zealand is a country that's had an up and down relationship when it comes to nicotine vapes. For a while it looked not so good, but about a year ago, they passed legislation, new regulations that made nicotine vapes legal and things look pretty good. Or does it?

Brent: Glover And we had you back on the show about a year or so ago, and it wasn't for a great story. I think we titled that Shunned. Let's jump right into it. You know what's been going on with your battle in New Zealand?

Marewa: In New Zealand? Well, I just continue on with my work and my studies. And of course, with lockdown, I couldn't go anywhere anymore. So any studies involving face to face had to be shelved and put on hold. And so most of us have been desk work and but there's been some big changes. We had the vaping regulation go through, so that was a huge relief. The government has been running a Vape to quit campaign, so encouraging people who smoke to switch to vaping.

Brent: So it was a real 180, wasn't it.

Marewa: It was. Well they had the campaign made some time before but really needed the regulation to go through before they could launch it. So once that went through, they launched the campaign and we have the smoking rates are going down. And then you see on the graph, as the smoking rates come down, the vaping rates are going up almost, you know. Yeah, it's a perfect kind of picture showing that vaping is displacing smoking.

Brent: Which is excellent news. So what happened to you professionally?

Marewa: Oh, I've just keep doing my work and pumping papers out. It's been difficult to get published, but I know that that's across a lot of sectors. Once with the pandemic, researchers just all turn to writing about the pandemic, writing about COVID and a lot of research, money and focus and effort just all switched away from whatever people were working on. And there's been concerns about that in the scientific community. So we ran a survey of in the US, India, New Zealand and Russia online survey of people who smoke vape, drink alcohol and or use other drugs. And we got that up and running fairly quickly. And the first wave to try and gauge the effects of lockdown. How were people coping and lockdown? I was my theory was that with the stress of everything, that people would actually smoke more.

Brent: And that didn't happen.

Marewa: The research around the world tends to say some people smoke more, some people smoke less. Some people stayed the same. So it's kind of mixed. For example, in New Zealand, many people didn't mind lockdown at all. It was like didn't have to go to work or they worked from home. It was summer, it was warm. People got time off with family. So there were a lot of positives that it didn't it wasn't stressful. It was the opposite. It was like a almost a holiday for a lot of people.

Brent: Is this your first in person since?

Marewa: Yeah, in three years.

Brent: In three years. Right. So you've been here before?

Marewa: Since 2015. I've been coming to GFN

Brent: So why?

Marewa: Oh it was, I was tweeting and I. Yeah. I was tweeting a lot about harm reduction snus because I'd already been lobbying for snus to be legalized in New Zealand. The organisation I was chairing and smoking NZ had been lobbying for snus for about ten years and then along came vaping and we looked at vaping. We were one of the first organisations to maybe, maybe this, maybe this. And so we started looking into vaping and I was tweeting about harm reduction and snus and vaping and I got invited to come and speak at the JDRF in 2015 and I've been coming every year since. It was really a big turnaround, a big learning curve for me. I went back from that. I went to visit the people at the Ministry of Health. I was like, We've got to do this, we've got to do this. We've got to encourage people to switch to vaping because we didn't have snus. The Ministry of Health was saying that this was illegal.

Brent: So what is it then about the conference, the speakers, the mingling? What is it that is important about GFN?

Marewa: It was the likeminded other people learning so much from the consumers. That's a really huge difference between this conference and any of the other tobacco control or public health conferences that I'd been going to for a couple of decades or more. And huge presence of consumers. They're part of the panels. They that there are sessions on the consumers perspective and they're the ones I really learnt a lot from and with my expertise in smoking cessation. I've been doing that for nearly 30 years now and I could I learnt, yeah, I can see how this is working and how, why it's working so quickly for people, why it's so easy for people to switch from smoking completely even and transition there's a whole transition pathway so that harm reduction and not just harm reduction, but the more in-depth understanding of harm reduction, I got that here. This is a lot of people who come from drug harm reduction that are part of running the conference and they always have that perspective there as well. And we never really had that in tobacco control.

Brent: And it's interesting because I guess in harm reduction, you have users in vaping, you have consumers, but it's both the it's the end person. It's strange because even for us in our coverage, it's hard to just go out and get interviews with the consumer. It's they're hard animal to find.

Marewa: Really.

Brent: Yeah. Yeah. Because I think that you'd have to hang out at a vape store and most of them that come in are not really amenable to having a camera stuck in their face. And in Canada we used to have vaping expos, which went away when vaping became legalized. That was one of the deals the industry made with Health Canada. So there would were no they didn't have any consumer expos anymore. And even then the people that were coming didn't really recognize themselves as a vaping consumer. And so and if they weren't advocates, they were just somebody who vaped what are you it was it was not very easy to be able to ask them. Too many of the questions like we talk about.

Marewa: Oh, we also have lost vape expose in New Zealand with the vaping regulation. So the vape meets that were smaller local meetings and small regional kind of vape exposed vape meets. I began going to those, I don't know that might have been around 2015 as well or the first one was after that. And yet the vaping regulation banned all of those. So that's a real loss.

Brent: Why is it that the regulators, at least in Canada and New Zealand, you know, got rid of the Expos? And why is it that the industry rolled over on that? Because it seems to me that those are extremely important events because they not only drive business, but they drive lifestyle.

Marewa: They saw it as a marketing and promotion opportunity. And even though our vape expo was routine, you know, they made a lot of kids will get in or so they really clamped down and our regulation. No promotion of vaping and have restricted it to specialist vape stores. it also dampened the online forums that people who vape had set up to help others so they would educate other people. Anyone in New Zealand that wanted to try vaping and they would go on to one of the vape forums. I've been smoking this or I'm thinking about vaping or I'm trying vaping and I'm coughing a lot and all of the people who were part of those forums would help them. So you had access to 24 seven support and advice from other people who had already vaped and switched. So those were really excellent. The vaping regulation kind of left it very grey about whether or not those were allowed to continue I think the vaping regulation one, it's kind of legitimized vaping as an alternative to smoking. It's got the government stamp of approval now. And one of our studies called Voices of the 5%, we're interviewing people who smoke who never were going to quit or they didn't believe they would be able to. And actually, we are, because we're following them through. And many have tried vaping now and many have transitioned or some have to transition to vaping altogether.

Brent: This is fascinating. So, I mean, there was a time when it looked like New Zealand wasn't so much in favour of vaping and then that was what I meant by the 180 is they kind of all of a sudden they really got behind it and now it's a couple of years now isn't it. I guess that that when did the regulation pass.

Marewa: I think that only passed last year.

Brent: So last year. So is it has it been. I bring this up only because in Canada, right. We passed legislation, it became law. And then it didn't last more than six months before it suffered under the moral panic of teen vaping and then Evali. And we're looking at in Canada here now complete destruction of the industry by the very government that legalized it.

Marewa: Yes. So when I went back from Kiev in 2015, I went to see the Ministry of Health. The head of the tobacco section was dead against it. Then he moved on to another role within the Ministry of Health and the next person was open to it. So she was much more focused on this. You know, this could actually bring down especially Maori smoking rates, which Maori woman smoking rates are still the highest in the country. And so things began. It really did come down to, well, that person was against it and this person was very open to it. This could be a solution to more rapidly reduce smoking rates, which it has it has done that.

Brent: [Is it getting the recognition for doing that in the regular mainstream media?

Marewa: Oh, totally. Totally. I mean, there are a lot of people in media who were smoking. So many people if I was interviewed by reporters, they were either vaping or they'd given up smoking, gone on to vaping and now didn't vape either. So media have a lot of people who don't know about that. The high smoking rates among people who work in media.

Brent: Oh well yeah. That and drinking and a few other things. Yeah. Well, that's amazing. I mean, it's like I can't believe that story. It's such a good news story. I can't even possibly imagine it save for an American or Canadian because the media hates vaping.

Marewa: Right? Well, no. A lot of people in the media in New Zealand have been smokers and have switched. So no, they totally got it. And many people in public also got it. It was like, well, why would you ban it? But it's safer, isn't it? So it's going to reduce harm, isn't it? So it's really only the staunch prohibitionists and anti-tobacco, anti-nicotine, tobacco control people who continue to put out misinformation about nicotine continue to ramp up, try and ramp up this panic about youth vaping, and they just keep pumping that out there. There's only really there are real minority and some of them have switched when they saw that the horse has bolted. They're not going to get this ban. And now suddenly they're the experts in vaping and then they're winning all the research funding to study vaping.

Brent: That must be maddening.

Marewa: Yeah, it's you've got to watch them because we know that really they hate it. And so then you've got to worry about, well, what sort of research are they doing, how it's biased, how are they going to be treating these people who smoke and or vape? So they are very persistent and using stigmatizing terms, calling people dual users, calling them users and which we don't like to do and Harm Reduction stigmatize people and label them.

Brent: Would you say the last year is kind of changed your outlook a little bit? Do you feel redeemed in any way?

Marewa: Oh, I guess. I guess so. I mean, the evidence is just getting stronger and stronger and stronger. You know, you do take a bit of a leap when you decide early when there's a new innovation or technology and you go, oh, no, this is going to work. And of course, there's always a what if it doesn't? But when you have decades of experience, you understand about the chemistry, you understand about behaviour. And I looked into all of that. I was pretty sure, yes, this was going to work. And of course, I met many people who vape at in 2015, 16, 17, and they were talking about improvements in their health. So when you listen to the consumer, it becomes clear we are actually seeing reversal of some disease as Riccardo Polosa found in the COPD studies and the asthma studies. So I feel that the evidence was even indicating strong enough for me to say, no, this is this is the way to go. Yeah.

Brent: Do you think this will stick in New Zealand or are the forces allied against vaping still a challenge?

Marewa: I know that in other countries that are still fighting, like in Canada, the New Zealand regulation is being held up as a model. Know how fantastic that we got that through? Look at New Zealand, do what New Zealand has done, but people need to read the wording and the regulation. It is a prohibitionist piece of legislation. It says we want to encourage people who smoke, who are aged over 18 inches our we have rating for access to tobacco and vaping products. Encourage people over 18 who smoke to switch to vaping. Nobody who doesn't smoke should ever vape. Anybody who has stopped smoking and vaping should never go back to vaping. And it's in the legislation it says we must prevent the normalisation of vaping. So the normalisation and normalisation, this is a key strategy of tobacco control. The normalisation of smoking is all of the shaming. It's all of the punishing policies, it's the taxing, it's the banning where you can smoke. And so that is written into our vaping regulation that we will we must prevent the normalisation of vaping. So once everybody has switched from smoking, so we have about we had about 550,000 people who smoke in a country of 5 million. And now we're down to 450,000 who smoke, and that's going to continue to decline. Well, once you get them down there and then the legislation also says and then encourage people to stop vaping. So it's a plan to get them from this level down to this level and then down and then off or completely. And no one is ever allowed to go back. So all of the policies, the smoking cessation services, so they're quite willing to help you and support you to switch from smoking to vaping. And then they may even say and just keep vaping just to make sure you don't relapse to smoking and then we'll work on getting you off vaping.

Brent: So it's, it's not, it's a process that won't end until you stop your nicotine use.

Marewa: That's right. Yeah. Except that we have nicotine patches [00:24:30] and gum and it's okay to be on those for the rest of your life. But it's not going to be okay to be on vaping for the rest of your life. The legislation is written in that way. You switch from here to there and then you then you try to get off vaping.

Brent: So there's nothing to prevent the government if they decide three or four years down the road that there's not enough people have made that move or maybe enough people have made the move and now it's time to cut the floor out underneath it.

Marewa: Exactly. Yeah. So what it has done is lay the groundwork for the next legislative change, which has already been proposed and is supposed to be introduced later this year. So they can see that, yes, people are switching now. We just need to push harder. We need to encourage people to switch from smoking to vaping and make smoking even less attractive. So now we're looking at new legislation coming in. They want to bring in the cap on nicotine and combustible tobacco so you will not be able to buy tobacco that has more than 0.5 milligrams per gram. So that's the very low nicotine cigarettes. So basically an ineffective product. They looked at banning filters and cigarettes, but that isn't didn't make it through to what's going to be put forward. The sinking lid on the age of purchase. So from I think 2017, every year the age of purchase will go up by one year until nobody will be able to legally buy combustible products. Are they going to do that to vaping? Well, maybe not at first. Let's get everyone off smoking onto vaping. But that's the precedent is there for when they decide, okay, a very small number of people smoke, now's the time to do exactly what we did there to now crunch down on vaping and see that eliminated.

Brent: So it seems like to me that this whole endeavour for public health and tobacco control is an opportunity to exercise a muscle of social engineering.

Marewa: Yes. And there's a lot of excitement among tobacco control researchers in New Zealand that we may be the first not just to do very low nicotine cigarettes across the board, but to do the sinking lid on the age of purchase. And the other policy that they're putting in is to reduce the number of retailers that will be able to sell the combustible tobacco products. So we have about 8000 convenience stores that sell tobacco now throughout the New Zealand, a country the size of Japan with 5 million people spread, spread across. They're going to reduce that from 8000 to 500 throughout the whole country. Well, yeah. So, for example, people in a rural area who already might have to, when they go to the supermarket a couple of hours away, do their big shop, they have to buy in bulk already. Well, will there still be a shop there that will be selling tobacco? So these are novel policies, and many people don't actually know because it hasn't been done anywhere else what the ramifications will be or the consequences.

Brent: Boy, this interview sure changed for me. There was a moment there early on. I'm going, wow, things really have made a difference in New Zealand and this is amazing, but we're really not talking about that at all. This is a quick march to a boot on nicotine users.

Marewa: Complete elimination of nicotine use in any form. Yes.

That’s all for today. Tune in next time, here on GFN TV or on our new podcast, for more tobacco harm reduction updates and Brent’s interview with Riccardo Polosa, the Founder of the Center of Excellence for the acceleration of Harm Reduction at the University of Catania in Italy. Thanks for watching - or listening! See you next time.