Will Australia slowly move from hostility to support for tobacco harm reduction

Australia was an early and vigorous adopter of what is now conventional international tobacco control policy. Cigarette taxes were increased 9 times in the last 10 years and Australian cigarette prices are now the highest in the world. Harm minimisation, defined as comprising supply, demand and harm reduction, has been the official national drug policy since 1985. Harm reduction is explicitly supported in the National Tobacco Strategy and the 2003 Framework Convention on Tobacco Control (which Australia has signed). Yet of all High Income Countries (HIC), Australia has been the most hostile in response to tobacco harm reduction, including vaping. It is the only HIC to require a doctor’s prescription for nicotine liquid for vaping. Almost all major Australian health organisations strongly support this approach. Further restrictions, not yet announced in detail, will be introduced on 1 October. Twenty eight government backbenchers, representing 25% of all government members of parliament, publicly criticised proposed new restrictions in June 2020 and December 2020, forcing the Health Minister to retreat. Australian smoking rates have missed official targets twice in recent years and have been almost flat since 2013. New drug harm reduction interventions such as methadone treatment, needle syringe programs and drug consumption rooms were also bitterly resisted for many years before being accepted and acknowledged as effective, safe and cost effective. Like tobacco harm reduction products, they were also strongly supported by compelling and increasing evidence. The significant decline in share price of major tobacco companies in recent years with the impressive growth in companies committed only to tobacco harm reduction products suggests that economic factors will also powerfully influence government policy in Australia and other countries. There is good reason to anticipate a political correction although this will probably take some time and involve many incremental steps.