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Britain has been among the world leaders in promoting e-cigarettes as an alternative to smoking, and Public Health England has gone so far as to say that vaping is 95-per-cent safer than cigarettes.NIKLAS HALLE'N/AFP/Getty Images

The growing backlash against vaping in Canada and the United States has raised concern among public-health officials in Britain, where vaping has long been seen as a critical tool in the fight against smoking.

Britain has been among the world leaders in promoting e-cigarettes as an alternative to smoking, and Public Health England has gone so far as to say that vaping is 95-per-cent safer than cigarettes. It is credited with helping as many as 70,000 smokers quit every year in the U.K., according to researchers at University College London.

So far Britain has avoided an outbreak of the vaping illness that has swept across the U.S. and parts of Canada. As many as 40 people have died in the U.S., where the cases appear to involve illicit e-cigarettes containing cannabis and vitamin E, which is used to thicken the vaping liquid. No cases have been reported in Britain, and research has shown that in the past 10 years there have been just six serious pulmonary illnesses and two deaths linked to vaping.

British officials worry that the outcry in the U.S. will ruin efforts to reduce smoking, which has steadily declined for decades and is now at historic lows. “What we’re seeing in the U.S. is an acute outbreak of what looks like some adulterated product. It’s not a result of mainstream vaping,” said Deborah Arnott, the chief executive of Action on Smoking and Health (ASH), Britain’s largest anti-smoking organization. She added that there are 3.6 million people in Britain who use e-cigarettes, and 80 per cent of them have been vaping for more than a year. “Vapers should not be scared back to smoking by the news of vaping illness in the U.S. Nor should smokers stick to smoking rather than switch to vaping.”

There are already indications that could be happening. Sales of vaping products have started falling across Britain, and the outlook for the market globally is gloomy. Analysts at ECigIntelligence, which tracks the vaping industry, had been forecasting global e-cigarette sales to grow 14 per cent next year and about 20 per cent in Britain. However, because of the U.S. outbreak, they now expect no growth in sales globally and half the expected growth in Britain. Meanwhile, sales in the U.S. are expected to fall 13 per cent after years of double-digit growth.

“What we risk right now is the potential for inadvertently sending some people back to smoking, or to smoking if they haven’t smoked before, because of the effort to stringently crack down on e-cigarettes,” Cliff Douglas, the director of the centre for tobacco at the American Cancer Society, told a conference on e-cigarettes in London this month. “Right now, we’re at risk of actually interfering with our efforts to reduce smoking and stalling what has been the most successful public-health campaign in modern time, which is to reduce the tobacco epidemic.”

Much of the recent concern about vaping has focused on the rising number of teenagers who use e-cigarettes. Some researchers fear that vaping could lead young people to get hooked on nicotine.

While the number of young people who vape has risen sharply in the U.S. and Canada, Britain has not seen a similar increase. A recent survey by ASH found that 15.4 per cent of children between the ages of 11 and 18 had tried e-cigarettes, down slightly from 2018 and less than three percentage points higher than 2015, when Britain introduced regulations governing e-cigarettes. Only 1.6 per cent of teens use e-cigarettes once a week, up from 0.5 per cent in 2015.

Even more crucial for British vaping proponents: There is little indication that teenagers who have never smoked are turning to vaping. Just 0.1 per cent of non-smoking teenagers use e-cigarettes more than once a week, according to the ASH survey, and none vape daily.

By contrast, a study by researchers at the University of Waterloo found that 0.6 per cent of 16 to 19 year olds in Canada who never smoked, vaped regularly in 2018. Another health survey of 75,000 Canadian students in Grades 9 to 12 asked about reasons for using e-cigarettes. Only 4 per cent of e-cigarette users said they used them to quit smoking, another 4 per cent said they used to smoke fewer cigarettes, and 73 per cent said they used out of “curiosity" or "to try something new.”

Ms. Arnott said one reason for the lower uptake of vaping among British teenagers has been the country’s public-health campaign, which concentrates on portraying vaping as a harm-reduction tool for adults. By contrast, she said, the U.S. Food and Drug Administration’s warnings about vaping include pictures of teenagers using e-cigarettes, which makes them look cool. “I think the public-health campaigns in the U.S. are disgraceful,” she said. “If you look at how vaping is promoted here by our public-health body, they are saying this is something adult smokers do and it’s for cessation. And the photographs they use are all of middle-aged men vaping, not young people.”

Cannabis e-cigarettes are also banned in Britain, and the country has restrictions on advertising as well as reporting rules for defective vaping products.

Britain also limits the level of nicotine in e-cigarettes, as do all other European Union countries, at 20 milligrams per millilitre. That’s lower than some products sold by Juul Labs Inc. in the U.S. and Canada, which contain as much as 50 milligrams per millilitre. Some experts in Britain have suggested raising the nicotine level to encourage more smokers to switch, but Ms. Arnott said most vapers prefer e-cigarettes with less than 20 milligrams.

Many health experts believe it’s too early to assess the long-term impact of vaping, and some studies have linked e-cigarettes to heart and lung problems. Last week, Ewan Fisher, an 18-year-old from Nottingham, described how he almost died from serious respiratory failure linked to an allergic reaction to vaping known as hypersensitivity pneumonitis.

Despite the concerns about vaping, researchers such as Ron Borland, a professor of health behaviour at the University of Melbourne in Australia, told the London conference that nothing compares with the dangers of tobacco. Smoking kills about 100,000 people every year in Britain, he said. Vaping products “are not going to kill anywhere near as many people as cigarettes. Smoking is like no other problem.”

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