No sooner had I written last week’s column about how the government is undermining its goal of a “smokefree” England by going to war on vaping than the Department of Health and Social Care (DHSC) announced plans to ban vaping in every publicly accessible building in the land.
What are they thinking? To find out, I read DHSC’s Impact Assessment (IA). Impact Assessments were introduced in the 1990s in an attempt to make policy-making “evidence-based” but they soon became a burden on the civil servants who were compelled to turn the vibes-based policies of impulsive politicians into sensible pieces of legislation that balance costs against benefits. I have read a few of them in my time — it is one of the downsides of working for a think tank — but the IA on “smoke-free, heated tobacco-free and vape-free places” is one of the oddest I’ve ever seen. The authors do not appear to know what purpose a vaping ban would serve, let alone whether it will work. Impact Assessments usually try to monetise the costs and benefits of a policy, even if the benefits are intangible (as health benefits often are), but this one doesn’t even try.
DHSC offers two possible objectives for a vaping ban: firstly, reducing people’s exposure to the “potential risks” of “second hand vaping” and, secondly, reducing the number of people who vape “whilst being mindful of the role vapes can play as an effective quit aid for adult smokers.” The problem with the first objective is that the health risks of active vaping seem to be fairly negligible and it stands to reason that the risks from passive “exposure” will be orders of magnitude lower. When Public Health England looked at the issue in 2016, it concluded that “there is no evidence of harm to bystanders from exposure to e-cigarette vapour” and advised that vaping “should not routinely be included in the requirements of an organisation’s smokefree policy”.
The IA references a more recent study which found that children living with vapers absorb more cotinine (a biomarker for nicotine) than children who don’t. But, as the data in that study show, the quantities were homeopathically small. Cotinine in the blood of secondhand vapers averaged 0.08 μg/L (micrograms per litre) whereas secondhand smokers averaged 0.49 μg/L and children exposed to neither vape nor smoke averaged 0.02 μg/L. To put that in context, the average vaper has a blood cotinine reading of around 250 μg/L, more than 3,000 times higher than that seen among those who are “exposed” to secondhand vapour. It is a credit to modern technology that such trace amounts can even be measured.
DHSC admit that the evidence of harm from passive vaping is “limited” and consequently do not try to monetise the “benefits” of banning it in six million workplaces. So what about the “benefits” of the more overtly paternalistic objective of getting people to quit vaping by making their social lives less enjoyable? DHSC cannot say for sure whether there will be fewer vapers as a result of the ban and since it cannot prove that vaping harms health, it can’t say whether it would be a good thing if there was. The best they can say is that “there is a possibility that the health of those no longer using heated tobacco products, or vaping improves” (my italics), but when looking at the impact on business, they give a strong hint that they don’t hold out much hope that either the proposed ban on heated tobacco and e-cigarette use indoors or new restrictions on smoking outdoors will do any good:
Tobacco manufacturers are not expected to be directly affected by this legislation as they will likely only be impacted if consumption of products fall.
So much for the benefits. What about the costs? Banning vaping indoors comes with three potential costs to business and the public. The first is the direct cost to hospitality venues if vapers spend less time in them. The authors of the IA can’t be sure that this will happen and so they don’t attempt to put a price on it.
The second is the cost to vapers’ wellbeing if they prefer sitting down indoors to standing outside in the cold, which seems very likely. It might surprise you to hear that even DHSC recognise that making people’s lives miserable is a cost that deserves to be taken into consideration, but it is one they swerve in this Impact Assessment by claiming that the choice to vape “may not be based on rational decisions but influenced by addiction”. Taking a somewhat Orwellian view of freedom, they explain why they have not attempted to monetise forgone pleasure by nicotine users:
We acknowledge that under ‘rational choice’ assumptions, the restriction of locations where individuals can vape may result in a loss of consumer surplus. However, it can also be argued that becoming free of addiction improves consumer surplus.
It is not at all clear how banning vaping indoors is going to free anybody of addiction, nor why being “addicted” to something stops it being pleasurable. If anything, preventing an “addict” from pursuing their vice is crueller and imposes a bigger personal cost than stopping a non-addict from doing it. This would be easier to justify if the addiction led to horrendous consequences for the individual and those around him, but that isn’t the case with vaping.
On the flip-side, DHSC considers the extra consumer surplus that some people might enjoy from not being around vapers, which they seem to consider perfectly rational. This, they say, could be “considered a gain to non-users’ utility”. And so it could. Leaving aside the possibility that most “non-users” may not be particularly bothered either way, the question is how to deal with such a clash of preferences on private property in a free society. So many pubs and restaurants have banned vaping that some people mistakenly think that it is already the law. This is not a country where vapers hold the whip hand over “non-users”. Does the desire of some non-vapers to avoid vaping everywhere trump the right of all vapers to vape anywhere? Without evidence of tangible harm to health — which is the only thing DHSC should be looking at — the answer must be “No”. In any case, the IA doesn’t quantify the putative benefits to non-vapers.
The third cost is the most important from a health perspective. If people are forced to go outside to vape, they may decide that they are better off smoking. This is not a theoretical proposition. Cigarettes deliver a much higher dose of nicotine into the bloodstream and it stays at a high level for longer. If you want to avoid cravings for nicotine and don’t want to go outside too often, you may find the combustible cigarette to be a perfect plant-based substitute for your vape. It is vastly more dangerous, of course, but most people no longer believe that and, as the IA acknowledges, one potential unintended consequence of regulating vaping like smoking is that people will assume that the health risks are comparable.
Vapers going back to smoking is by far the most likely consequence of the vaping ban
DHSC admit that banning vaping in so-called public places “could increase barriers to vaping by making it more inconvenient and less socially acceptable to use these products”. They accept that this could lead to “a slowing of smoking cessation at a societal level”. No kidding! But they say that they have “tried to mitigate against this” by making the vaping ban less draconian than the smoking ban. By this, they mean that they are going to allow people to vape outside hospitals. I am not making this up. They say it three times.
It is risible. Vapers going back to smoking is by far the most likely consequence of the vaping ban, especially since it will be accompanied by a tax on e-cigarettes that will double the cost of vaping, and the possibility of a ban on various flavours. And for what? DHSC admit in the Impact Assessment that “we cannot conclusively say whether these policy options will impact smoking, heated tobacco product, or vaping prevalence or consumption, and therefore whether there will be an improvement on health.” It puts the cost of the various new restrictions at £531.8 million, mostly from businesses having to put up new signs and train employees, while the benefits are priced at £0 because DHSC have no idea what the consequences will be. I never thought I’d say this about a government department, but you have to admire their honesty.
