A major turning point could be just around the corner for both smokers and vapers, following the outcomes of a landmark assessment of the UK’s current stop smoking services - the Khan Review. Commissioned by UK health secretary Sajid Javid and led by its namesake, Javed Khan OBE, the review takes a deep dive into cessation resources in the UK, and has identified 15 actions to level-up this remit.
Of these 15 actions, 4 have been identified as critical interventions, ‘must-do’s’ according to Khan, if the UK is to have a chance of achieving it’s goal of a smoke free 2030. A deadline that Mr Khan has identified will be missed by 7 years if the cessation landscape does not change in-line with the 4 critical interventions at least. The goal is to reduce smoking rates to 5% or below, and they currently sit at around 15%. While the 2030 deadline might be missed by 7 years, Mr Khan has said it could actually be as late as 2044, before the most underprivileged communities in the UK see a positive change.
Mr Khan himself has accepted that some of the recommendations will not necessarily make it through parliament for practicality reasons, and there have been mixed opinions throughout government in response the Daily Mail reports. With that said, Khan has also stated that only six of the 15 actions would rely on increased funding beyond the current budget. Regardless, the changes he has proposed are notably challenging, and would usher in a very different landscape for tobacco products and their consumers.
Quit For Good
The 15 actions identified by the khan report have been divided into 4 main areas of focus. The review states that in order to enact the level of change necessary to get smoke free 2030 back on track, this plan must be followed, with at least the one critical intervention being actioned from each area.
Quit for Good is Khans third step in the plan, and it focusses on providing the tools and support necessary for a person to quit effectively, long-term, without relapse. This section of his proposed plan, sees Khan place particular weight behind vaping as a cessation alternative, alongside plans to fund enhanced stop smoking services in general, and a targeted annual mass media campaign.
A Substitute for Smoking
The critical ‘Quit for Good’ intervention Mr khan has said must be enforced for his plan to succeed, is to offer vaping as a substitute for smoking, alongside accurate information on the benefits of switching – not just for the public, but for healthcare professionals too. The latter aspect of this point clearly suggests that Khan feels there is a significant lack of dependable education on vaping on all fronts. This is an issue that has seen significantly more media attention in the last 18 months, particularly following the implementation of a landmark NHS vaping trial, as well as a national rallying cry from the MHRA for UK Vaping Manufacturers to submit devices for medical licencing.
Some of the biggest issues that have effectively prevented vaping products from being considered as an official extension of cessation services to date has been a combined lack of education, and uncertainty surrounding the lack of long-term evidence of the effects of vaping vs smoking. In reality however the body of evidence is continually growing in vaping’s favour, and a significant number of healthcare experts including the NHS and Action on Smoking and Health (ASH) have begun standing behind it as one of the most effective cessation tools available to potential quitters. This has been fully evidenced in the UK Government’s E-cigarette evidence dossier which has been regularly expanded to-date, since first publishing the findings that vaping products contain 95% less harmful chemicals than cigarettes in 2015.
Mr Khan has stated in his review:
“There is lots of confusion, even misinformation, about vaping. The most common relates to its harm. I have spoken to the very best academics and scientists across the country and internationally. They all told me that vaping is far less harmful than smoking. In cigarettes, we know that it is not the nicotine that kills you but the other thousands of toxic chemicals such as tar and carbon monoxide. Vapes give smokers the nicotine they crave but protect them from the toxins they would inhale from a cigarette.”
He goes on to acknowledge that some might argue that “people should be encouraged to quit all forms of nicotine”, however he stresses that the “overriding public health priority” is to get people to quit “as quickly, completely and permanently as possible”. The review states that vaping shouldn’t be flippantly regarded as a “silver-bullet” solution, or that they are risk-free, however “the research we do have is clear that they are at least 50% and probably closer to 95% less harmful than a cigarette”.
Professor Linda Bauld, Usher Professor of Public Health at Edinburgh has said of the proposal:
“While not risk free, we know that vapes are far less harmful than smoking and they are an important tool to help people to quit. Considering the significant health benefits of stopping smoking, it is essential to get the right balance between helping smokers to quit while protecting young people from starting to vape.”
Ultimately Khan states that the verified evidence that quit attempts are by a large far more successful when attempted with vaping products, cannot be ignored. As highlighted in ASH’s 2021 report into e-cigarette use in the UK, well over 90% of current vapers are ex-smokers, and the proportion who have quit in favour of vaping permanently continues to grow.
Other nations are called on in the review to further bolster this point – “A 2022 report from Australia concluded that “use of e-cigarettes for a smoking cessation attempt appears to be associated with greater success among Australians who attempted to quit tobacco in 2019 compared with Australians attempting to quit without e-cigarettes”.
You can learn more about the effectiveness of vaping and other NRTs in our guide, Finding the Right Alternative.
Better funded Stop Smoking Services (SSS)
Alongside ensuring quitter shave access to tools like vaping, the Khan review also calls for levelled-up funding for SSS in the UK. He recommends that an additional £70 million be annually injected into SSS, as soon as possible. This is to ensure that they offer a consistently effective service, with vital quality support for quitters. There is significant evidence that vapes and Nicotine Replacement Therapy like patches rarely work effectively by themselves, in reality a holistic approach in conjunction with regular help and support from SSS organisations, lending credence to Khans recommendation.
Ultimately Khan wants to see a healthy SSS, with adequate funding to provide the level of care required to achieve the nations goal of a smoke free 2030. He notes that “Well-funded SSS are extremely cost-effective and form a key part of improving health outcomes and reducing the health inequalities gap.“
“They significantly improve people’s chances of quitting smoking for good. This should be reflected in effective local commissioning, with updated guidance showing what the universal offer for every SSS should be, weighted to smoking rates in local areas to allow us to level up the communities which need it most. An effective helpline is vital to provide a route into quitting: a central point of contact for the public and a central number for advertising campaigns.”
Anti-Smoking Media Campaign
The final aspect of the Khan “Quit for Good” plan, is to fund a £15 million annual mass media campaign, intending to create “a climate that supports quitting”. This is very much a “hearts and minds” aspect of Khan’s actions. He notes there are “deadly misconceptions held about smoking and vaping that stops smokers quitting. For example, many people wrongly think smoking relieves their stress, but the science shows us that it is quitting that reduces anxiety and depression” – you can learn more about this reality in our blog Nicotine & Mental Health.
Khan relates the current issues in smoking cessation to the COVID pandemic, highlighting the effectiveness of media campaigns in promoting public health and safety messages throughout lockdowns and beyond – a campaign that cost significantly more than Khan would ask for his stop smoking campaign.
He says “Industry-funded influencers make out that smokers are young, cool, affluent, and healthy. But the truth is that year by year England’s smoking population gets older, sicker, and poorer. As is the story across the stop smoking landscape, spending on stop smoking campaigns has gone down dramatically. Marketing budgets have dropped from £23 million to £2 million, over the past 10 years. Yet, at the height of the COVID-19 pandemic, the government was reported to have spent upwards of £50 million on marketing the key messages, with great success. When there is a will to save lives, money can be found.”
Ultimately Khan wants to build an “always on” media hub with constant social media, television real-world messaging, ads and promotions driving people away from tobacco products and towards services that can help them achieve that goal.
The Bigger Picture
The impact of a media campaign and additional funding for SSS will certainly go a long way in shifting perceptions and bolstering the support available to potential quitters. One of the most significant upsets from this section of the review is the firm positioning of vaping as a must-do action for government.
This is a major win for lobbyists who have campaigned tirelessly to separate tobacco and vaping in people’s perceptions, and to debunk harmful myths that are preventing said people from engaging with one of the most potentially beneficial tools in the modern cessation arsenal.
Time will only tell if we might see EDGE Devices appearing in an SSS near you in the not to distant future. For now parliament must carefully consider the evidence-backed recommendations put forward by the review, and decide which, if any will pass into law.
There is much to be said about the outcomes of the review and the implication for our lifestyles, join us as we explore these 15 new proposals and how they could impact us all in our Khan Review blog series examining the key areas for change: Stop The Start, Invest Now, and System Change.