Why Hong Kong should accept e-cigarettes if it wants a smoke-free future

The Hong Kong government’s plan to remove e-cigarettes and other novel tobacco products from the market by prohibiting their sale, import and marketing is a regressive step in tobacco control.

It is likely to hinder, rather than help, efforts to reduce the smoking rate to 7 per cent by 2025. While it may be psychologically comforting to think a hardline stance on e-cigarettes will reduce the harm done by smoking, the opposite is probably true. Why so?

First, there is growing consensus in the scientific community that not only are e-cigarettes less harmful than traditional cigarettes, they are also more effective in helping smokers to quit. An independent expert review commissioned by Public Health England, a government body in the United Kingdom, concluded in 2015 that e-cigarettes were about 95 per cent less harmful than tobacco smoking.

In the United States, the National Academies of Sciences, Engineering and Medicine looked at more than 800 peer-reviewed scientific studies on the health effects of e-cigarettes, and concluded in 2018 that “while e-cigarettes are not without health risks, they are likely to be far less harmful than conventional cigarettes … and using e-cigarettes may help adults who smoke conventional cigarettes quit smoking”.

Most recently, a “randomised controlled trial” of 886 participants in the New England Journal of Medicine found e-cigarettes were twice as effective as conventional methods in helping smokers quit. The landmark study found the one-year smoking abstinence rate was 18 per cent for e-cigarette users, twice the rate for nicotine replacement therapy (NRT). The study is likely to have understated the real value of e-cigarettes as NRT is unpopular with smokers – only two to four per cent of smokers in any one year try NRT. By contrast, e-cigarettes are far more likely to be used by smokers to quit.