It’s often forgotten where Australia started to go wrong in its response to cigarettes and vaping: Australia ignored the fact that its official national policy since 1985 has been ‘harm minimisation’. This term was defined in the 1990s as supply reduction plus demand reduction plus harm reduction.
Australia’s commitment to harm reduction is explicitly endorsed in Article 1 (d) of the Framework Convention on Tobacco Control; signed and ratified by Australia; Australia’s National Drug Strategy & Australia’s National Tobacco Strategy. But since 2011, harm reduction has missing from Australia’s response to cigarettes, tobacco and vaping.
Smoking causes 24,000 deaths of Australians/year – that is, more than the combined deaths from all other psychoactive drugs, plus HIV, plus road crashes, plus suicide.
But now, smoking has also become a problem in Australia because of the severe unintended consequences of sky high and ever increasing cigarette excise and the quasi prohibition of nicotine vaping.
Raising the price of cigarettes helped reduce smoking rates but the substantial and multiple recent increase in cigarette excise resulted in retail prices that Australian smokers have been increasingly unable or unwilling to pay. Remember, not only are smoking rates higher among low income populations, people with mental illness and First Nations Australians, but these groups also smoke more cigarettes per day.
The illegal trade in cigarettes, tobacco and vapes has become increasingly violent with rampant extortion, widespread firebombing, several alleged homicides, possibly increasing smoking rates and a shortfall of $77 billion of government revenue over the last five years. The alleged kingpin of Australia’s illegal trade in cigarettes is also linked to the attack on the Adass Israel synagogue in Melbourne, outsourced to young criminals. Recently illegal alcohol in Australia laced with methanol has also been linked to the illegal sales of cigarettes.
The severely restricted availability of much lower risk nicotine vaping despite strong demand has resulted, according to official estimates, of 95.7% of vape supply and 50-60% of cigarette supply in Australia being provided by illegal sources.
Meanwhile, most global traded tobacco companies are rapidly transforming from deadly combustible cigarettes to much safer, smoke-free, nicotine products. For example, these products now account for 42% of the earnings of the world’s largest traded tobacco company, Philip Morris International and 18% of the earnings of British American Tobacco, the worlds second largest traded tobacco company.
Not only is this transformation rapid, it is probably also accelerating. The Compound Annual Growth Rate for heated tobacco products in the US is now 48.3%, nicotine pouches 21.0%, vaping 9.5%, and cigarettes -7.9%. PMI’s global cigarette shipment volume declined from 927 billion units in 2012 to 617 billion units in 2024. It is clear that smoke-free nicotine products are now rapidly replacing combustible cigarettes. This replacement is now inevitable and unstoppable.
The development of a range of safer, smoke-free nicotine products represents tobacco harm reduction. But it is also an example of ‘disruptive innovation’. Harm reduction is overwhelmingly effective, safe and cost effective although when applied to psychoactive drugs, it is often vigorously resisted initially. Harm reduction contributed greatly to Australia achieving and maintaining a low rate of HIV. People or governments who bet against harm reduction generally lose.
Disruptive innovations are new ways for the commercial world to better meet the needs of consumers. Examples include electric vehicles replacing cars powered by internal combustion engines; smartphones replacing Nokia or Blackberry which earlier replaced landline phones; Netflix replacing Blockbusters; and vaping, heated tobacco products and nicotine pouches replacing cigarettes. People or governments who bet against disruptive innovations generally lose.
To reduce the huge illegal cigarette trade, Australia will have to (1) start reducing cigarette excise; & (2) ensure that smoke-free nicotine products are easier to obtain than combustible cigarettes. What’s missing from Australia’s policy on smoking, harm reduction, has to be reinstated as the driving force of our response to smoking.
Dr. Alex Wodak AM,
Emeritus Consultant, Alcohol and Drug Service, St Vincent’s Hospital, Sydney, Darlinghurst, NSW, 2010, Australia
Tobacco Harm Reduction Adviser to the Harm Reduction Australia Board