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I think it’s really important for people to understand that increasingly the vaping industry and the tobacco industry are tangled into one company, they’re not sort of distinct.In Melbourne, at least, it is so easy to buy a vape and they’re super cheap as well. With vaping, it is extremely easy to hide. It’s not like there is any big, nasty smell that you have to hide from a cigarette. It’s definitely something that is targeted towards younger people. Like, the packaging, like all that sort of stuff. I think it’s really dangerous in that it seems to be more accessible. I didn’t have the opportunities that the kids seem to have now where kids underage can buy online, so they’ve found a loophole. The vaping industry has basically looked at all of the reasons why you shouldn’t smoke and then go, well, vaping doesn’t do any of those. If you would like to access products that have nicotine in them, you’re meant to go through a health professional and access them through a compounding pharmacy or order them from overseas with a valid prescription. That is not what is happening. We’ve got to stop thinking about vaping, and the other alternatives as treatments and consider them as consumer products. I’ve heard just from people in Facebook groups and YouTube comments that it doesn’t matter what the government does. They don’t want to go back to smoking. They will purchase their nicotine illegally on the black market if they have to. They’ll import products illegally, if they have to. They don’t want to go back to smoking. They’ll stockpile stuff if it got to that point. In Australia, we have decades of experience in decreasing the use of tobacco products, and this has not resulted in a black market, despite the fact that we have some of the most expensive cigarettes in the world. Welcome to Chasing Clouds, a QUO podcast series produced in collaboration with the Prince of Wales Hospital Foundation and the Head Neck Cancer Foundation.I’m Ally, editor-in-chief at The QUO, and your host for this series. Chasing Clouds is an evidence-based exploration into the social and public health impact of vaping and e-cigarettes in contemporary Australia. We draw upon the expertise of young people, doctors, educators, vapers, academics and frontline community organisations to bring to light what we need to do moving forward. How do e-cigarette companies get around advertising bans using social media? How connected are e-cigarette companies to Big Tobacco? How can we effectively reduce supply for teenagers? These are some of the questions we will be asking in this episode. We aim to remain neutral, because we’re not funded by the vaping industry, nor Big Tobacco. I think people vape to be cool. Like, it’s the exact same thing as cigarettes back in the day, I guess. Like, most people vape now. When we think about the legal, regulatory and advertising environment of nicotine e-cigarettes, we need to understand how they fit into the wider historical context of tobacco control in public health and realise that Australia is in a unique position. Public health expert, Associate Professor Becky Freeman, on what she thinks is necessary. I think it’s really important to acknowledge, too, that the prevalence of vaping, the behaviour of the vaping industry, the regulatory environment is really different in nations like Canada, US, UK, Australia. Whereas, normally we would put all those nations together and say, “Oh, we all do tobacco control in this way, and we’re in a very similar state”. I think what I’m saying would work in Australia might not necessarily apply to Canada and the US and UK. But in Australia, we are in a unique position that we have not yet seen the mass take-up of vaping products. It’s getting to be what we think is a problem among particularly 18[-] to 24[-year-olds] seems to be the highest users at this point. We have a chance to realise that we don’t face a big vaping, out-of-control problem in this country and we can do that as continuum with the regulations that we have, but tightening them up further. Certainly, in countries like US and UK, where vaping is a lot more entrenched, you have people who have been using vaping products for longer. The regulatory environment is quite different. Perhaps a public education campaign or cessation efforts would work. But I think in Australia, we need to stay the course on tightening down our regulation and really getting aggressive on tobacco control as well. Like, I… I get a little bit frustrated in that, Australia’s always held up as the leader in tobacco control, but our last really innovative policy position was for plain packaging back in 2012. That’s getting on 10 years now. We need to be a little bit more innovative, investing more in tobacco control. We need to be seeing those hard-hitting, emotional campaigns back on the air. We need to be thinking about how we allow tobacco to be sold in this country. Why is it available on in every convenience store, grocery store, every shop corner? We should be reducing the supply of tobacco products as well as addressing vaping, and I think they’re tangled together. I’m concerned that with the sort of uptake in vaping, and the way the tobacco industry has published… is positioning vaping to regain its credibility, we’re losing sight of the fact that we should also be continuing to address tobacco use, which we know will kill at least half to two-thirds of the people who continue to smoke. The solution looks very different for those who consider vaping an effective harm reduction tool that can save countless lives. Dr Colin Mendelsohn of the Australian Tobacco Harm Reduction Association on what he believes motivates tobacco control policy. The evidence is clear that vaping is not only the most effective treatment available, it’s actually the most popular. It’s the most popular quitting aid in Australia and the rest of the world. So, it has the potential to reach so many more people than say Champix or Varenicline, which is used only in a small number of cases. So, it has huge potential. Why is there an objection to it then? Well, the reasons are ideological. There’s the idea that people should just quit smoking. They shouldn’t have to use this halfway option, this safer alternative. There’s political barriers. There’s more political risk in allowing vaping than there is and banning it. Politicians can be seen as being tough against tobacco, whereas that’s not the issue. There are financial issues, there’s 17 billion dollars worth of tobacco tax up for grabs here. There are moral objections, a lot of people, and particularly in tobacco control, feel that it’s wrong for people to be using an addictive drug and that can’t be allowed. There are vested interests, so there are experts and organisations whose legacy is to get people to quit smoking, or they run organisations which are focused on fighting the tobacco industry, and eliminating smoking, and vaping isn’t part of the way they approach things. And it actually might be successful and they didn’t think of it. So, there’s always other stuff going on, including a fear of innovation. We, you know, we see that in so many ways, other areas. And there’s no question vaping will be accepted as it has been in other Western countries. And we’ve seen this before with harm reduction strategies. Strategies like methadone for heroin use, needle exchange programs, there’s relentless opposition and hostile opposition to these these methods, which… But they finally accept it, and we look back years later and say, “Well, why didn’t we do that earlier?”. The evidence was clear, but there’s all this other resistance going on, and it’s very hard to argue with that. You know, I think people who are opposing it are not arguing on the basis of evidence. They’re arguing on all sorts of other intangible facts, which they don’t admit to and may not even be aware of. ENT surgeon Dr Catherine Meller thinks policy needs to tread a fine line. Unfortunately, it’s a well-known fact that there are certain governments around the world who profit directly from the sale of cigarettes and e-cigarettes. So, it becomes very difficult politically to work out how to strike that balance between allowing those individual freedoms versus harm minimisation and avoidance of potential public health, I won’t take disasters, but a worsening overall of our public health. It’s a bit like seatbelts in cars, isn’t it? We’re not going to stop people from driving cars, and we appreciate there’s a risk when you do that, but we try to make it as safe as possible. In Australia, it’s illegal to use, sell or buy nicotine for use in e-cigarettes without a prescription. Retailers such as convenience stores or vape shops found to be selling nicotine vapes can be fined up to $1,100 per offence. According to the Department of Health, New South Wales health inspectors continue to target stores with over 26,000 nicotine vapes being seized in Australia in the month from January to February of this year [2021] alone. Despite this, shopfronts continue to sell nicotine vapes under the counter, and nicotine vapes are only a few clicks away, if you go online. Anyone, potentially of any age, can go online and import them to Australia from overseas. Natalie, whose 14-year-old son is an avid vaper, thinks that traditional cigarettes were harder to access in her youth. I think it’s really dangerous in that it seems to be more accessible. I feel like when we were growing up, traditional cigarettes were harder to get. You needed to have someone who was over 18 who could purchase that from a shop. And, you know, I feel like I didn’t have the opportunities that the kids seem to have now where, you know, kids underage can buy it online. So they’ve found a loophole to it. Associate Professor Dr Becky Freeman on why she thinks the current legislation doesn’t go far enough. When we look at the regulation of vaping products, first, let’s look at them globally. So if you take, for example, the United States, that’s had a very free market for vaping products, they were not limited in how they could advertise, who they could be sold to, where they could be sold. They now have essentially an epidemic of vaping among young people. And one of the leading companies that is owned by one of the big transnational tobacco companies has recently been found in a state-based court to have illegally marketed, intentionally marketed to young people. We don’t want that situation repeated in Australia. In Australia currently, you cannot sell vaping products that contain nicotine in just a shop. If you would like to access products that have nicotine in them, you’re meant to go through a health professional and access them through a compounding pharmacy or order them from overseas with a valid prescription. That is not what is happening. Unfortunately, because there is a strange regulatory loophole where you can sell vaping products in, you know, convenience store, grocery store, wherever, provided they don’t contain nicotine, they’re readily available to anybody. Technically, young people under the age of 18 aren’t allowed to purchase them. But the problem is vaping products that have nicotine in them and ones that don’t, look identical. They’re often mislabelled, so testing that has been carried out by health authorities in Australia. For example, New South Wales Health has found that vapes that are being sold commonly in convenience stores contain nicotine, even though they’re labelled as not. Often, shop owners either don’t understand the law or intentionally are flouting the law and are selling products knowing they contain nicotine in them. So, I think the easiest solution to this would be to simply not allow vaping products that contain nicotine in them to be freely sold on the market, either. And let’s have this very strict regulation that these addictive products, that might help a very small number of smokers, are available through health professionals and pharmacies. From the 1st of October, anyone wanting to import nicotine e-cigarettes into Australia will need a doctor’s prescription. It will be illegal to buy nicotine vaping products or nicotine e-cigarettes, both locally and from overseas websites without one. Associate Professor Becky Freeman doesn’t consider this a major change. In October, there’s a law change coming in at the national, at the Commonwealth level, to clarify that you will need a prescription for both locally purchased vaping products that contain nicotine, which should come from a compounding pharmacy and those that you import from overseas for personal use. That’s actually currently the law in most of the states in Australia anyway. This national law essentially harmonises that and adds clarity. So, it’s not a major change technically. I don’t think it’s going to have an impact on youth vaping rates. We’ll wait and see. We’ll see what the evaluation is. See what the data says. But given that most young people aren’t going through a provider to purchase these products anyway, they’re just buying them either online, from retailers based in Australia, or retailers are importing nicotine free products that actually contain nicotine. That law change doesn’t address that problem. For YouTube personality Sam Parsons, aka the Vaping Bogan, the October legislation is a double standard, given the availability of combustible cigarettes and certain nicotine replacement therapies or NRTs. It’s ridiculous, to be honest. I mean, you don’t need a prescription to go and buy a pack of cigarettes. You don’t need a prescription for the patches, gums, lozenges, which are all a therapeutic good, which is doing essentially… The lozenges and the spray, for example, that is an aerosol. It’s the closest thing to vaping. It’s using the same ingredients, propylene glycol, nicotine and the same flavours go into that spray, yet I don’t need a prescription to go and get that, but somehow vaping requires a prescription. Which is just, it’s another way the government going, “OK, we haven’t quite banned it yet, you can still get it, but we’re going to make it super hard for people to access”, and you’re going to have to go to your doctors. You’re still going to have to import nicotine from overseas, so they’re just quietly and slowly strangling the vapers and and cutting off smokers that could have access to that. It’s not the worst outcome, there are worse outcomes that could have been implemented, but it’s certainly ridiculous and has no basis in reality or science. It’s more enticing to the youth as well. If it’s illegal. “Oh this is now just like it’s not just, you know, something that that’s going to help me quit smoking, it’s suddenly a banned product”. It’s way more enticing for youth, and so having products that aren’t regulated, that are being sold legally, is just far, far more dangerous and harder for the government to control. The police aren’t going to be cruising around and inspecting nicotine. They’ve got a hard enough job with real, real prohibited substances. So, you end up with a black market. If they take a page out of the UK or out of even New Zealand’s notebook, and bring in regulations that allow products to be sold and marketed in a responsible way. Nobody’s advocating for under 18s to be vaping. I’m not saying that we should be encouraging teenagers to vape. That’s ridiculous. But when you don’t allow adults to have access to a life-saving product, that is proven to be far more effective than any of the traditional methods, you’re going to force those adults to access those products from somewhere else. And so it’s just this real sort of closed-minded, got the blinkers on, without actually looking at the real big picture and what other countries have successfully implemented. Going where the silence is. The QUO. An independent media publisher in control of our own agenda. We hold the powerful to account and are accessible to everyone. To support us, head to thequo.com.au, and our socials, using the handle @thequoau. 19-year-old Milly doesn’t want to go back to traditional cigarettes after October. I’m actually quite curious to see what happens in October because one of the other reasons I decided to quit was because, you know, October is coming up very, very fast. And if I don’t have access to a vape that had nicotine in it, I don’t want to start smoking again. But seeing is… Like, there are so many stores. If you go into Brunswick here, or even around Carlton, that literally just say smoke and vape, like they sell vapes, and it’s just kind of like… It’s barely under the table, but… You have to provide your ID and everything, and I would be very, very curious to know if those stores still keep selling those products because I know the ones that I usually buy, they’re shipped in from China. And yeah, I have no idea what kind of like, yeah, regulation is going to go over like, you know, if they’re going to check packages or if… You know, they have like a private kind of shipping thing going on that makes it not be regulated, but yeah, I’m interested to know. Paul Dillon from Drug and Alcohol Research Australia on what he thinks the 1st of October may bring. I think the only thing that will happen is, at the moment, it’s incredibly difficult for Border Patrol, the border, to seize nicotine products because they’re not illegal. They’re illegal to buy or purchase, but to bring them in doesn’t appear to be illegal. I don’t quite understand, but there is very little, very few seizures coming into the country. If you read the TGA kind of recommendation and what’s going to happen, they say very clearly: if you order nicotine products and you do not have the correct permit, you don’t have a prescription from a doctor, we will be seizing them at the border. Implying that they haven’t been. If you look at the Australian Crime Commission report, which has all the kind of the seizure data for the last year, it looks like the only things that they ever really do seize are illicit tobacco, not so much nicotine products. So, I think it could, you could see the number possibly coming through reducing. But the trouble is, when you ban things, it, you know it doesn’t work very well. Yeah, I mean, I think it’s just going to make a whole pile of people who currently are bringing in their nicotine products from overseas totally illegally because they haven’t done through the TGA and everything else, because the prevailing lobby estimate that only between 1% and 2% of all vapers actually do have the permit. So, 98% of nicotine vapers are bringing it in illegal currently… Illegally. So, it just makes a whole pile of people, criminalises a whole pile of extra people because I don’t think they will go to a doctor. I don’t think they will. A lot of GP’s will refuse to prescribe it, I think. There’ll be a kind of a value put onto people bringing them in. And then what you’re going to find is you’re going to find that those people who are willing to prescribe nicotine for vaping, they’re going to become incredibly popular because they’ll be kind of like, “Oh, this one in Bankstown will actually prescribe…” Happened a few years ago with things like steroids, where certain doctors just became known as the place. Their entire surgery was based around just, you know, 10-minute consultations where they would just do a prescription and send the next person in. You get a lot of money doing that. Mark Brooke of the Lung Foundation Australia, thinks we need to learn from the cautionary tale of traditional cigarette availability and go harder on e-cigarettes. Our position on traditional tobacco products was that they should have been banned 50 years ago. On e-cigarettes in particular, you know, if the end goal is abstinence and quitting, then doing that with your health professional makes a lot of sense. Where we really are concerned is around chemical flavours and vaping and sort of one-time vaping pods and other devices being freely sold as a consumer product. We think all the regulations, the compliance around all of that industry, needs to be very carefully looked at. There was an article in the Tasmanian papers this week whether Corner Stores Association are pushing for vaping products to be sold on their corner store. Now, you know, I don’t go and get a heart transplant from an Ampol [petrol station]. I’m not going to go and take smoking cessation device information, now people will go, “But tobacco is already sold as a consumer product, and alcohol’s already …”. Our response to that is if we’ve learnt anything from those two, it’s not to do it with this one. And that’s a really important point that I think the detractors of the model that we’re putting forward say, “Oh, you’re being Pollyanna about it”, “It should be a freedom of choice”. But I’ve never met a hardened smoker who said to me, “I’d encourage young people to vape”. Never. Even the people that are using e-cigarettes to quit go, “Oh God, no, I’d never tell someone to take it up”. So, there’s this sort of contradiction in their argument that we should make it freely available. You know, we’re not in the business of propping up small business or large business to make money at the expense of Australians’ lung health. So, our views are very clear that this is a sector that should really, you know, our own view is that it shouldn’t be sold at all in any form or setting, and the only place you can get an e-cigarette or a vape is via a recognised medical professional as part of a smoking cessation program. And even then, we have significant caveats on that. If we truly want Australia to be tobacco and vape and smoke free, then we have to have a pathway and we have to stand really firm now on liquids being used as chemical … as a consumer product. I think it’s the thin edge of the wedge for another 50 years of lung health misery in Australia and we’ll never sign up for that. Bruce Mansfield of the Minderoo Foundation on why importation restrictions are still needed. The big concern I have is that there was a second piece of legislation that was being considered last year around the importation of e-cigarettes into this country. And that, to me, is a significant loophole or problem with the current legislation, which is that there are no controls around the importation of e-cigarettes at the moment. That bill was put aside, and there is no plan by the government to put that bill up again. So, what it means is even with the TGA changes, if the importation remains as it is, which is freely available and there are no importation restrictions, all that’s going to happen is people are going to import these cigarettes from China, where we have no control over the quality or the source of those devices. And then more concerningly, what you find, particularly in that younger cohort, is young kids and adults through social channels will be marketed e-cigarettes and particularly single-use vape pens. And it’s very much a challenge at the moment, which is most of those single-use pens are either being purchased by young kids and young adults, either across social channels or just in the public domain where they meet someone and they just get this through a transaction that’s done socially. So, how do under-18s usually access nicotine vapes? Year 12 student Bella explains. Usually to get a vape you can either go to, like, a convenience store, like, just like sketchy ones. You can either get like a fake ID or there is just some dealers that you can get them off of. So, there’s lots of different ways you can get them. Yeah, I’ve seen it on TikTok before. They’re like websites and they like, hide it. So, it’ll be like, “Oh, you can get like these lollies, like this flavour”, and then it’s actually like the vape flavour, and then they’ll send it to you in discreet packaging. It’s mainly, like, if you go to apps like Snapchat, there’s always dealers on Snapchat and like, they make it really accessible as well. Like, you don’t need proof of like being 18. They can drop it off for you. You just have to have the money and that’s it. E-cigarette advertising is banned in Australia, but it’s incredibly difficult to monitor and regulate. It is estimated that 30% to 50% of global sales are online. E-cigarette companies have aggressively promoted their products through social media, online influencers and product placement in popular TV shows and movies that normalise and glamorise vaping and associate it with influential celebrities. One experiment here in Australia found that mock ads containing vapes were approved for targeted advertisement to 13 to 17-year-olds. Despite them clearly contradicting Facebook’s advertising policy. At the same time, sales take place on social media, with sites like TikTok offering a platform where companies can advertise to young people for free. JUUL, a San Francisco-based e-cigarette company that launched in 2015, used low-cost marketing through Snapchat, Instagram, Twitter and YouTube to dominate the American market. An investigation into their role in the so-called American youth nicotine addiction epidemic found that they recruited thousands of online influencers to market to teens and deliberately targeted children. Associate Professor Becky Freeman on how public health should respond to the challenges of trying to regulate online advertising. Look, I think it’s really important for people to understand that increasingly the vaping industry and the tobacco industry are tangled into one company. They’re not sort of distinct. You’ve got buyouts happening, you’ve got transnational tobacco companies investing in the development of e-cigarettes and pushing for, in the case of Australia, weaker regulations of vaping products. Now the tobacco industry has an incredible history of being very effective marketers and being very effective at skirting advertising bans. So, if you ban tobacco advertising on television and the radio, they start sponsoring more events and take out magazine ads and billboards. If you ban that level of advertising, they go, “Hmm, maybe we should start sponsoring a motor race or the arts”, and you ban that and they move on to online. So, it’s almost like if you turn off one tap, they’ll find another one that they can quickly turn on until you’re sort of a regulator running around trying to turn off all these taps. Online, obviously, is a poorly regulated environment for lots of kinds of activities. And the tobacco industry has taken advantage of that. So, if you were to hop on, if you’re a young person, you use TikTok regularly. If it gets into your algorithm that you’ve watched someone demonstrating a vaping product, how to use it, or maybe even promoting a particular brand, that’s going to appear in your algorithm more, right? Because that’s how these things work. And so you get increasingly targeted with images of vaping or paid placement of vaping products. And it’s not just TikTok, I’m not picking on the young person’s social media here. You can find Instagram influencers who have been paid by the vaping industry, either with free products or actual cash incentives to post about these products. Not always declaring that it is an ad, either. Facebook as well, Facebook Marketplace, very easy to purchase vaping products through that form. The thing that’s frustrating is that these social media platforms claim to be able to self-regulate and that they all have very strict policies about not allowing vaping companies or tobacco companies to advertise. But it doesn’t take a lot, you know, it doesn’t take a, you know, I guess, a computer hacker to be able to go on to these platforms and quickly find promotions. So, the platforms aren’t enforcing their own voluntary policies and governments are struggling on how better to regulate them as well. We’re really at an advantage in some ways in tobacco control and that we have a global treaty called the World Health Organisation’s Framework Convention on Tobacco Control. And it outlines exactly what we need to do to reduce smoking rates around the world. And one of the key cornerstones of that framework is a comprehensive ban on tobacco advertising, promotion and sponsorship. And it outlines, you know, the different kinds of activities, promotions, ads that the tobacco industry has undertaken and how countries should ban these. In the past ten years, it’s become increasingly apparent that countries that have ratified the framework convention are struggling to ban digital advertising, and it’s going to take cooperation between nations to make that happen. Australia can’t just ban online advertising of vaping and think, “Oh, job’s done, we banned it”, because what about all those sites that young people access that aren’t for Australian companies and don’t originate in Australia? We have no jurisdiction over those things, so we need global cooperation. That’s sort of the number one thing that’s going to be required to limit advertising. It’s also holding social media companies to account. If, you know, one of our major television stations, say Channel Nine, broadcast a tobacco ad, there would be swift action, including fines, threats of losing their licence, et cetera. Why don’t we hold social media companies to those same standards as other broadcasters? So, I think it’s taking what we know from traditional media, and instead of thinking, “Whoa, the internet’s too big and hard, and there’s nothing we can do about it”, applying those same standards to digital-based promotions and media, and having greater global cooperation. These companies are global corporations. Public health also needs to think globally. Paul Dillon on how e-cigarette companies market themselves as the polar opposite of Big Tobacco. We’ve done a great job of making smoking socially unacceptable, and everything about vaping has challenged that. In fact, the vaping industry has basically looked at all of the reasons why you shouldn’t smoke and then go, “Well, vaping doesn’t do any of those”, you know what I mean? So, you know, smoking is not glamorous, smoking is dirty, smoking affects other people around you. You know, you put all of those things. And then, of course, vaping, well, vaping is glamorous. If you look at the ads that we don’t see really in this country, but certainly in the States, they’re all, you know, I mean, they’ve used the classic one is the Audrey Hepburn Breakfast at Tiffany’s one. While I don’t know if you’ve seen that, but they use that same look with a vape. So, all of the kind of messaging that we’ve done around smoking, they’ve kind of reversed and said, “Well, we’re not any of those things”. It appears to have worked. Paul works directly with youth in schools across New South Wales, making them aware of how they’re being manipulated. Remember who these were designed for, people who were… This great worksheet that I created where I showed what originally a cigarette looked like, [and] what they look like now. And the original ones look like a cigarette. They were designed for people who wanted to quit smoking, and now they’re brightly coloured with cotton candy written on the side. Do you think that they may have changed who they’re marketing for? And so, that’s one of the things that we know works with smoking is the deceptive ways that tobacco companies have managed to get customers. So, that’s a very… Young people respond to that quite well. JUUL commands a 42% share of American e-cigarette sales. Currently, 35% of JUUL is owned by Altria, one of the world’s biggest tobacco companies and the manufacturer of Marlboro cigarettes. Altria’s subsidiary company, Philip Morris International, PMI, recently committed to a smoke-free future by 2030, which is in line with Altria’s vision to transition adult smokers to smoke-free alternatives. In a 2019 report to shareholders, PMI revealed that 92% of their total research and development expenses in 2018 related to non-combustible cigarette alternatives. They also have three e-cigarette brands in their product line. Meanwhile, Altria paid $27 billion of dividends to shareholders between 2016 and 2020. The transition to a smoke-free future may be viewed as a socially responsible drive towards harm reduction. But is it enough? Is their goal to diversify their market share? To reduce harm? Or both? Associate Professor Becky Freeman doesn’t think we need PMI to achieve a tobacco-free future. Philip Morris, in particular, has recently come out and said, you know, we could have, you know, the UK and then in response, Australia, the Australian affiliate, also came out and said we could be tobacco free in Australia in the next 10 to 15 years if we allowed e-cigarettes to be, you know, very loosely regulated and promoted at will and sold cheaply, et cetera, et cetera. And I want to push back against that. I think we can get to a tobacco-free nation in Australia in the next 10 to 15 years without the requirement that Philip Morris is allowed to sell its addictive and deadly products on the market, however they like. I think the Australian governments, the state governments, could aggressively implement tobacco control measures and make it a tangible goal that we become a smoke-free, tobacco-free nation and we don’t need Philip Morris driving that bus to make that happen. And we don’t need Philip Morris to benefit financially from Australia, allowing them to come in with new, untested, unproven products. Mark Brooke of the Lung Foundation Australia echoes this sentiment. You know, if we really want to be global citizens, then let’s talk about the predatory behaviour of these organisations. That, on one hand, in the last couple of weeks have said, “We want England to be smoke free by 2030”. But then at the same time, are putting up billboards in the Philippines to attract a new audience where the regulations are not as tight. So, how should the relationship between Big Tobacco and e-cigarette companies inform policy? Paul Dillon believes we must focus on supply. We have to reduce supply. The access that young people and as I said, that number of times, I don’t give a stuff what people do in their in their 20s or 30s. If you want to 510 thread vape vendor (b2b.eleoem.com wrote in a blog post) because you are nicotine dependent, whatever, that’s your choice. But the access that really young kids… I have had an area health service who contacted me and they were having they just had a report of year two’s vaping. Year two’s! These kids are like seven or eight. And I think when you’ve got such young people who have access to it, via either the web or social media apps, certainly you’ve got to try to reduce that access. Now, how do you do that successfully? I think that’s the question. Bruce Mansfield of Minderoo thinks that moving the minimum sale of tobacco products to 21 will reduce supply to youth. The only way to stop the vaping epidemic in the US, and the data that’s come through now has proven that it actually worked, was to increase the minimum sales age of all tobacco products to 21. Now that’s the case in the US, and that’s one of our cornerstone policies, which is, we believe, all tobacco products, the minimum sales age should move to 21 because then it moves them away from high schoolers. Because then both you can’t purchase it as a high school student, nor can you get it from your peers because if you take it at 21, the likelihood of a 16, 17 or 15year-old hanging around with a 21-year-old is a lot less than maybe a 16 and a 19-year-old or a 16 and an 18-year-old. And what we’ve seen in the US is the best evidence base for it, if you just move that to 21, you are 95% less likely to ever smoke. You won’t take up the addiction in the first place. For the Vaping Bogan, Sam Parsons, the genie is way too far out of the bottle for a policy of prohibition to make vaping go away. I’m generally a pretty optimistic person. I think that vaping will continue regardless of what the government does. The genie is so far out of the bottle at this point, and I’ve heard just from people in Facebook groups and YouTube comments that it doesn’t matter what the government does, they don’t want to go back to smoking. They will purchase their nicotine illegally on the black market, if they have to. They’ll import products illegally, if they have to. They don’t want to go back to smoking. They’ll stockpile stuff if it got to that point. A lot of people already are because they don’t want to go back to smoking. So, like we’ve seen in some places in the US, where various states have tried to ban things, it’s created a black market, which is far worse for the government than having a regulated industry where the government in the UK can regulate how much nicotine is in bottles and it all comes out of vape shops. You don’t have people selling vape products out of the back of their car, which is happening in places where the government’s gone full prohibition on it. And that’s what would happen here in Australia. But I’m optimistic that the government will kind of leave us alone once they’ve done the prescription model. I’m hoping that they won’t continue to try and strangle us anymore. But who knows with the government. If we continue to do it that way and they’re still losing money to vapers quitting smoking or smokers quitting via vaping, then they may try something else. But as long as the public is still aware of what they’re trying to do, I’m confident that we can push back enough to continue to have access to the products. Dr Alex Wodak of Harm Reduction Australia thinks legislation needs to focus on making e-cigarettes as accessible as possible to quitting smokers. Where we need to end up is that we want to make it as easy as possible for people who currently smoke to switch to vaping. And that means that we’ve got to stop thinking about vaping and the other alternatives as treatments and consider them as consumer products, like cigarettes. Cigarettes are considered a consumer product. The Therapeutic Goods Administration, the TGA, doesn’t regulate smoking. In fact, the Poisons Standard in Australia excludes tobacco containing nicotine from its remit. Most changes in government policy occur incrementally and slowly, and so we probably won’t get there in one go. But that’s where we need to end up. With tobacco regarded as a consumer product, regulated by the Australian Consumer and Competition Council, the ACCC, and not regulated by the Therapeutic Goods Administration. That’s a monstrosity. Associate Professor Becky Freeman on where she would like tobacco control to move in the future. I think tobacco control, I mean, we’ve had such incredible success in Australia in reducing smoking. If you think back to a few decades ago when, you know, 35% of the country was smoking, and now we’re down to, you know, 15% of adults, and youth smoking rates are negligible. Young people just don’t smoke anymore. It’s really, it’s exciting. It’s a public health win. But to get to that next level, when we get down, say below 5% to near-negligible levels of smoking on a population level, and I’m including in those lower socioeconomic groups where we haven’t done as good a job as well. We need to get aggressive about supply of tobacco products. We’ve done really well on the demand side of things, so making it less attractive to smoke, less people wanting to smoke. So, we’ve made them really expensive. We’ve made the packages really unappealing. We’ve banned all the advertising. We’ve run really emotional, high-impact mass media campaigns, which actually have been off the air, for the past few years, they need to be brought back. But what we haven’t done is say, “Hang on a second. Why do we allow cigarettes to be sold in grocery stores where we buy things like eggs and milk and cheese? Why are they available 24 hours a day, seven days a week from a corner grocery store?”. So, let’s talk about how we can remove these products from our communities and make them less accessible, address the supply of them. The other thing that has never really happened in Australia, which I think would be incredibly impactful, would be to hold the tobacco industry to account for the health damage they’ve done. So, in Canada, for example, the tobacco industry is in the process, it’s been a very long process of being sued for the healthcare costs that have been inflicted by their products. We should do that in Australia as well, and use that money to fund community cessation programs to fund public health programs and to increase the equity of tobacco control programs. Harm reduction includes policies, programs and practices that aim to reduce the harms associated with the use of psychoactive drugs in people who are unable or unwilling to stop. The focus is on the prevention of harm, rather than the prevention of drug use itself. In episode three, we ask whether the use of nicotine vapes should be considered a form of harm reduction and whether vaping is an effective way to help smokers who have tried everything and just can’t quit. Here’s a taste of what’s to come with Dr Alex Wodak. Anybody who’s taken a bet against harm reduction tends to lose it in almost all countries. It often takes a while, but the people who were implacable opponents of methadone treatment, of needle syringe programs, of medically supervised injecting centres, and many other innovations in the harm reduction, drug harm reduction world, they lost almost every debate in almost every country.