25 February 2020
In this blog, Christina Cosma of the IFoA’s E-Cigarettes Working Party, discusses the challenges the group has faced when trying to understand the risks posed by E-Cigarettes versus traditional cigarettes.
“Safe doesn’t exist…But electronic cigarettes are low risk compared to regular cigarettes. It’s the equivalent of having a four-wheel-drive Volvo compared to a high-powered motorcycle with bald tires in an ice storm.”
This quote, from a former advisor to the WHO on Tobacco Control, David Sweanor, demonstrates the sentiment of the “safer alternative” argument, one that has been promoted by many different groups, from public health officials to medical professionals as well as utilised in lobbying by tobacco companies, promoting their new alternative smoker products.
However, this is yet to be definitively proven. Once upon a time, cigarettes were promoted as ‘good for your health’ and it was not until years later that a more accurate, darker picture began to emerge of their true impact on health. Decades on, with a stagnating quit rate, the invention of the e-cigarette has led to a shift in the landscape, creating somewhat of a smoking revolution, with the hope that this could dramatically reduce the risks associated with smoking, and potentially lead to a material reduction in the smoker rate.
When we started this working group back in 2016, e-cigarettes had just about made it mainstream – it was no longer a niche habit, but rather something seen every day – outside offices, on nights out and many vaping shops had popped up on local highstreets. Research, however, was still in its infancy, with published studies showing inconclusive results or only initial findings and many studies disagreeing, making it exceptionally hard for the public, and the insurance industry, to really know the true effects of e-cigarettes and vaping.
Despite this, the views expressed by a number of different public health bodies in the UK as well as some experts in the field were optimistic. They were, by and large, promoting and encouraging smokers to make the switch to e-cigarettes – touting numbers such as the “95% better” Public Health England figure that we all have heard, as well as them even being offered on a trial basis on the NHS as part of a smoking cessation study.
As a working party, we quickly realised that this was an ever-moving, ever evolving area of study, with legislation and regulation struggling to keep up. Some providers in the UK had still not got up to speed with the rising popularity of e-cigarettes and were still very much referring to traditional cigarettes when using the term ‘smoker’, with a number not even mentioning e-cigarettes during their underwriting process.
Fast forward then to 2020, there are 3.6 million people vaping in the UK alone, with the number of vapers projected to reach almost 55 million worldwide next year. This comes against a backdrop of controversy whereby a mysterious illness linked to vaping emerged last summer. It was later named as EVALI (e-cigarette vaping associated lung injury), and resulted in emergency hospitalisation and tragically, in a number of cases in the US, death. Whilst the link to vaping cannot be denied, there are a few key things that need to be considered, namely the lack of regulation in the US. US vaping liquids allow the inclusion of a number of substances which are banned in the UK such as Tetrahydrocannabinol, more commonly known as THC, the component responsible for the “high” of marijuana. The majority of these vaping illness cases had reportedly been using e-cigarettes to vape THC, something that is strictly prohibited in the UK.
The resultant “hangover” from the global negative coverage of e-cigarettes from the US, is that here in the UK, both in the general public and as an insurance industry, we are even more hesitant, despite four more years of research and experience and find ourselves unsure of what we really think the true risk is and also in what direction the evidence will next take us. The development of technology to distinguish between cigarette and e-cigarette smokers could aid us to the correctly categorise smoker types within our books of business, however, the bottom line is that until more in-depth research emerges, the pricing for different smoker types still eludes us, leaving e-cigarette smokers waiting for our next move…
…which even then, as an industry we cannot seem to agree on!
To read more on our research, findings and insights from the working party, please read our sessional paper, E-cigarettes – No smoke without fire?