Finland has demonstrated that is it possible to reduce the number of smokers without seeing a surge in e-cigarette users, an issue which has become a public health dilemma for the tobacco control community in recent years.
E-cigarettes have taken global markets by storm – according to market research conducted by Euromonitor, they were estimated to be worth $19.3 billion in 2019 and rising year on year. The number of people who vape was 41 million in 2018 and is likely to have increased since. Many countries across the European Region have struggled to contain the rising popularity of these products, and instead have simply seen a transferral of nicotine addiction from tobacco products to e-cigarettes.
Determination of the Finnish Tobacco Act
Finland, however, is doing things differently. Twenty years ago almost a quarter of Finns smoked daily. In 2018 this number dropped to just 14%. At the same time, e-cigarette use remained moderate – only 1% of Finns said they were daily users in 2018.
Meri Paavola was one of the architects of the new regulations that made this possible. She was part of a small team at the Finnish Ministry of Social Affairs and Health that orchestrated the fresh legislation on e-cigarettes. In 2016 the government was determined to reform the Finnish Tobacco Act to nip the rising prevalence of e-cigarettes in the bud.
In many parts of the world tobacco control has enlarged its focus to prevent nicotine addiction. “Finland was the first country in the world to set the tobacco endgame aim in legislation,” Meri explains, referring to the 2010 Finland Tobacco Act, which sought to end the use of tobacco products by 2040. “In 2016 this was broadened to cover all nicotine products. In practice, it means ending the promotion of products based on harm reduction. It is important to note the links between and the addictiveness of both tobacco and nicotine products.”
Finland introduced pioneering e-cigarette regulations which covered flavour bans, age limits for buyers, prohibitions of marketing, displaying and distance selling, import restrictions and bans on use in non-smoking areas. Through a combination of swift action and stringent regulation, Finland has enjoyed drops in traditional smoking habits without seeing a contingent rise of e-cigarette prevalence.
Putting vulnerable groups at the heart of policy
“Legislation is a very important way of protecting vulnerable groups from e-cigarettes,” explains Dr Paavola. “For example, candy flavours in liquids used in e-cigarettes clearly target children and adolescents.” Following the revisions to the Tobacco Act, liquids used in e-cigarettes are available exclusively in tobacco flavour in Finland.
The theme for this year’s World No Tobacco Day is the protection of youth from industry manipulation, to prevent them from both tobacco and nicotine use. Young people who use electronic nicotine delivery systems risk developing a nicotine addiction, given that habitual use of these products is primarily established in adolescence. E-cigarettes are not harmless – the nicotine found in them can have long-term effects on the developing brain. Protecting young people is therefore a value at the heart of the tobacco control approach taken in Finland, especially as e-cigarettes are relentlessly marketed to young people.
Dr Paavola says that there has been pushback against the new measures from the e-cigarette industry, with several appeals lodged in 2018 and 2019 against the flavour ban on products in vape shops. There was also controversy surrounding an e-cigarette retailer using marketing on buses, but it was swiftly prohibited by the national enforcement authority.
Reducing e-cigarette prevalence in children is vital to preventing nicotine poisoning; several studies have also suggested that certain flavours themselves are harmful to health, proving the need for putting flavour bans at the core of any new regulations. It is more important than ever to remain vigilant in the face of innovative marketing strategies by the industry and to respond in kind with inventive tobacco control legislation.
Comprehensive measures
Finland points to the wide-reaching nature of the e-cigarette measures as a significant factor in its success. “The whole is more than the sum of its parts,” adds Meri, “it is impossible to say how significant one of these provisions has been on its own. We think that comprehensive policy has been very important”.
Finland’s new “endgame” legislation sets an ambitious goal of 2030, seeking to bring both tobacco and nicotine products below a prevalence rate of 5% within the next decade. The Tobacco Act will be revised again this year to ensure that tobacco control remains ahead of the industry and that protections are in place for all Finns.
*This article was updated on 25 May 2020 to clarify that the ban on characterizing flavours and aromas applies to liquids used in e-cigarettes.