Evidence and policy is certainly more complex than it seems

We thank the commentators for providing a sense of how the conclusions we drew [1] from research in Australia, the United Kingdom and the United States do or do not apply to the development of tobacco and e-cigarette policies in Japan [2], New Zealand [3] and the Nordic countries [4].

The commentaries support our conclusion that pre-history is important. Sweden has a long history of the use of snus to replace cigarette smoking, but oral tobacco products have been banned in England and Australia, and they are not widely used in the United States. Despite the Swedish history with snus, policymakers in neighbouring Nordic countries are hostile to its use for harm reduction. The European Union (EU) seems to have played a positive role, with special exemption for Sweden, but a negative role in Denmark and Finland. This is an interesting contrast with the EU’s later role in relation to e-cigarettes with its impact on England. Therefore, timing and history emerge as significant, together with the role of regional government.

Japan is an interesting case, because the major concern there is with the high uptake of heated tobacco products (HTPs) by young people. One suspects that Japan Tobacco has played a key role in this outcome by ensuring that HTPs have been legally promoted and widely adopted by those who smoke cigarettes, while the sale of e-cigarettes has been banned.

Waa’s commentary highlights another central issue: who policy is intended to benefit. We pointed to the stark contrast between English e-cigarette policy that focused upon reducing harms among people who smoke and the long-standing Australian and US concerns with protecting youth. Waa highlights the importance of policy attending to the high rates of e-cigarette and tobacco use by Māori youth and adults in New Zealand. The colonial legacy, much discussed in current work by historians, is clearly important here.

Deguchi & Tabuchi note that policy towards tobacco harm reduction products is dynamic and evolving. This has been clearly seen with the recent move in Australia away from a prescription-only model for e-cigarettes towards allowing their sale in pharmacies without a medical prescription. As these authors point out, the recent concern in the United Kingdom regarding unregulated youth vaping has been reflected in the UK Tobacco and Vapes Bill. That Bill has been revived by the incoming Labour government. However, it does not mark a major change in the use of e-cigarettes as a harm reduction strategy for people who smoke, as demonstrated by the provision of e-cigarettes in the ‘Swap to Stop’ scheme through the National Health Service (NHS). Some aspects of policy in the three countries may be converging around youth use, but some still remain distinct.

We are pleased that our paper has served its intended purpose in encouraging analyses of other countries’ e-cigarette policies, deepening our understanding how policy in this disputed area has evolved. The relationship with evidence is more complex than it might appear: these commentaries show that the issues of pre-history, change over time, governing structures and who policy is for, which we highlighted, have relevance.

Virginia Berridge: Conceptualization; formal analysis; methodology; project administration. Wayne Hall: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; writing—review and editing. Kylie Morphett: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; writing—original draft; writing—review and editing. Amy Fairchild: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; writing—original draft; writing—review and editing. Ron Bayer: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; writing—original draft; writing—review and editing. Coral Gartner: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; writing—original draft; writing—review and editing.

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