New Zealand’s bold new tobacco control programmeBMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o62 (Published 18 January 2022) Cite this as: BMJ 2022;376:o62
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The plan “Smokefree New Zealand 2025” to reduce daily smoking prevalence from 12% to under 5% by 2025 is a long awaited first scale up for tobacco control.(1) Since 2005, the inaugural year of the WHO Framework Convention on Tobacco Control, greater than half the world’s countries had significant increases in smoking rates (2). In 2019, even rich parties of the convention, e.g. France, had over a third of those aged 15 to 24 year old marked as current smokers.(3)
The key measure of the plan is to decrease nicotine content in cigarettes. This is not aimed at promoting smoking cessation, as argued by Agrawal and Britton.(1) Low nicotine cigarettes are not effective at spurring abstinence, (4) but are aimed at precluding uptake by new users. Indeed, the marketing by Sano of the lowest nicotine level cigarettes on the US market in the 1960s was the only commercial failure the tobacco industry has seen.(5)
However, the plan has a major flaw in the cuirass. New Zealand is weak in regulating vaping, allowing up to 60 milligrams of nicotine per milliliter of liquid while the European Union has a 20 milligram cap. In New Zealand, 26% of students have fallen for the tobacco industry’s products of the future: e-cigarettes and heat-not-burn products.(6) How is it been possible that the tobacco industry successfully recycled its harm reduction concept despite previous devastating experiences with filters and low tar/light cigarettes?(7) Addicting a new generation is not harm reduction, even more as evidence for serious e-cigarette harms accumulates.(8)
1. Agrawal S, Britton J. New Zealand’s bold new tobacco control programme. BMJ 2022;376:o62. Doi: 10.1136/bmj.o62
2. GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet 2021;397:2337-2360. doi: 10.1016/S0140-6736(21)01169-7.
3. Reitsma MB, Flor LS, Mullany EC, Gupta V, Hay SI, Gakidou E. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and initiation among young people in 204 countries and territories, 1990-2019. Lancet Public Health. 2021;6:e472-e481. doi: 10.1016/S2468-2667(21)00102-X.
4. Benowitz NL, Nardone N, Dains KM, et al. Effect of reducing the nicotine content of cigarettes on cigarette smoking behavior and tobacco smoke toxicant exposure: 2-year follow up. Addiction. 2015;110(10):1667-1675. doi:10.1111/add.12978
5. Proctor RN. The golden holocaust: origins of the cigarette catastrophe and the case for abolition. Berkeley (CA): University of California Press; 2011.
6. Asthma Respiratory Foundation NZ. Alarming Results From NZ’s Biggest Ever Youth Vaping Survey. 1 November 2021. Available at
https://www.asthmafoundation.org.nz/news-events/2021/alarming-results-fr... Accessed 19 January 2022.
7. Braillon A. Electronic cigarettes: from history to evidence-based medicine. Am J Prev Med 2014;47:e13. doi:10.1016/j.amepre.2014.09.019
8. Farber HJ, Conrado Pacheco Gallego M, Galiatsatos P, Folan P, Lamphere T, Pakhale S. Harms of Electronic Cigarettes: What the Healthcare Provider Needs to Know. Ann Am Thorac Soc 2021;18:567-572. doi:10.1513/AnnalsATS.202009-1113CME
Competing interests: No competing interests
It is interesting that the NZ government chose tobacco as a target over something that is much more harmful, measured in monetary and societal terms: alcohol.
Perhaps the 600,000 odd New Zealanders are an easy target compared to alcohol drinkers (social and otherwise).(ref 1)
There is no doubt that while the $1.7b government revenue generated from tobacco is (slightly) less than the estimated $1.9B annual healthcare costs related to tobacco use, alcohol generated some $1.2B in revenue while costing the society $7.85B "from lost productivity, unemployment, as well as justice, health, ACC, welfare costs," etc. (ref 2)
It is estimated that every New Zealander drinks an average of almost 2 standard drinks per day (ref 3). NZ government acknowledged that:
• 85% of New Zealanders aged 16–64 had an alcoholic drink in the past year (Ministry of Health 2009).
• Three in five (61.6%) past-year drinkers consumed more than recommended guidelines for a single drinking occasion at least once during the last year (Ministry of Health 2009).
• One in six (17.7%) adults (aged 15+) have a potentially hazardous drinking pattern (Ministry of Health 2008). (ref 4)
In a country of 5M, if there is a need for prohibition of anything, the monetary and societal benefits from banning alcohol are far reaching much more than tobacco,
This is hard to swallow but perhaps banning alcohol is far more of a kill-joy and political suicide; one wonders how did the government make their choices?
Competing interests: No competing interests