It has had a uniquely strict response to Covid, and New Zealand is set to be an outlier again — this time when it comes to smoking.
acinda Ardern’s government is planning to ban the sale of cigarettes to future generations — specifically, anyone born after 2008. From 2027, when those children turn 18 and would, in normal circumstances, be allowed to buy a pack of 20, they will be turned away. The idea, says health minister Dr Ayesha Verrall, is to “make sure young people never start smoking”.
Many health professionals in New Zealand have welcomed the “world-leading” reforms, which also include a limit on the number of places where tobacco products are sold.
“It will help people quit or switch to less harmful products and make it much less likely that young people get addicted to nicotine,” according to Prof Janet Hook, of the University of Otago, in Dunedin.
Anti-smoking experts in Ireland are watching New Zealand’s approach with great interest. Taoiseach Micheál Martin, who as health minister in 2004 introduced the ban on smoking in the workplace, has described the plans as “very interesting” and “clever”. He has also said that it is important to “prevent young people from ever taking up a cigarette” and that “no barriers” should be put in the way of achieving that goal.
His comments come at a time when the HSE is reportedly considering measures to eradicate smoking in Ireland. A complete ban on the sale of tobacco and a significant reduction in the number of outlets allowed to sell cigarettes are among the steps being explored.
The HSE is also looking at the idea of making tobacco manufacturers pay for the enormous health cost to the State associated with people who are sick or dying as a result of tobacco use. About 100 people die every week in Ireland as a result of smoking-related illnesses, according to the Irish Heart Foundation.
Surveys are to be conducted in the first quarter of this year to test public support for strategies to bring about the “endgame” for smoking. The results will feed into a report for the HSE’s Tobacco-Free Ireland Strategic Programme Plan 2022.
For Chris Macey, director of advocacy and patient support at the Irish Heart Foundation, the elimination of smoking is an urgent goal and one that can save up to 6,000 lives a year. For Macey, New Zealand offers a blueprint.
“There’s a Public Health (Tobacco and Nicotine Inhaling Products) Bill before the Oireachtas at the moment and we [Irish Heart Foundation] don’t think that bill is ambitious enough. What we need is an endgame and the great thing about what they’re doing in New Zealand is that they’ve drawn a line in a sand and saying, ‘From this point on, it’s not going to be possible to smoke’.”
The Irish legislation would ban the sale of vaping products and other nicotine-inhaling devices to under-18s.
“What we’ve been arguing for most strongly is an increase in the legal age of sales from 18 to 21,” Macey says. “That was brought in on a federal basis in the United States in 2019 and it’s been really successful there. It’s reducing smoking among 18- to 21-year-olds by as much as a third.”
He believes New Zealand’s plans are laudable, but for similar measures to work in Ireland there would need to be a high level of public buy-in.
Professor Luke Clancy believes Ireland has a long way to go before smoking becomes a thing of the past, given recent trends. He has long been regarded as Ireland’s foremost anti-smoking campaigner.
The consultant respiratory physician was a key player in the Dublin coal ban of the 1980s as well as the prohibition of smoking in the workplace in 2004. He has published over 300 papers in an ongoing quest to make Ireland tobacco-free.
“We’ve been surveying young people’s smoking consumption since 1995 and we’ve been doing it every four years,” he says. “Each time we did it, there was a drop in smoking. Back in 1995, over 40pc of girls smoked. Now it’s down to 13pc. But when we did the most recent survey, in 2019, the prevalence in boys went up and the rate for girls stayed about the same but did not fall.”
The most recent HSE survey, conducted in March to June 2021, found 16.1pc of Irish people smoke. The age group comprising the greatest number of smokers (21.5pc) are those aged 25 to 34.
Vaping is partly to blame for the recent increase in young smokers, Clancy believes. “E-cigarettes [consumption among young people] went up very significantly that year. We know that if you smoke e-cigarettes, you’re four times more likely to try cigarettes. It’s a real concern.”
Macey also believes there is not enough scrutiny of such products, especially as they tend to be targeted at young people. “What we want in this bill is a ban on e-cigarette flavours, we want a total ban on advertising of them and want them to come in plain packaging. Right now, the packaging is being used to entice young people.”
Clancy believes there have been strong anti-smoking initiatives, but not enough of them.
“Look at what works. We know that putting the price up works. We know that banning advertising works. We know that plain packaging works. We know that not allowing children to smoke works,” he says.
“Back in 2004, we became a world-leader when we brought in smoke-free workplaces. We were all excited about it and it did fantastic [in terms of reducing the number smokers]. But what have we done since?”
The doctor believes the Government’s eye has been off the ball for years when it comes to tobacco. He is especially critical of Health Minister Stephen Donnelly.
“His focus seems to be entirely on the pandemic, but what about the other health issues? I have written to him saying, ‘Look, 6,000 people die every year from smoking. When the death rate from Covid was at its worst, it was about 4,000 a year. Who was giving smoking the same attention?’ The two things that Ireland need to do better are smoking cessation [strategies] and social media [awareness campaigns].”
Clancy says with an estimated 80pc of smokers keen to give up, cessation initiatives paid for by the Government would be of enormous benefit. He argues that only a tiny fraction of the revenue from tobacco sales is devoted to helping people quit.
He is also convinced that the battle to win the hearts and minds of today’s teenagers will not be won on traditional mainstream media platforms, but on the likes of Snapchat and TikTok. “The message isn’t reaching them at the moment,” he says.
He is less enthused by New Zealand’s plans than one might expect.
“First of all, it’s not new,” he says. “The Tasmanians had the idea initially. What’s good about it is that people are talking about it. The idea doesn’t seem outlandish to them.
“But I think it has real problems. It sounds fine on paper, but what happens years from now when, say, a 24-year-old cannot buy cigarettes, but a 25-year-old can? It raises questions about equity. What kind of a society would that be and who would police that?”
It is a question that has been the mind of John Mallon, the spokesman for the smokers’ rights organisation Forest Ireland (FI). An offshoot of the UK-based Forest, FI is part-funded by the tobacco industry.
“I’m not a pro-smoking lobbyist, but I’m very much along the lines of freedom,” he says. “We’re living in the western world. We’re not in a dictatorship, we’re in a democracy. And in a democracy, people have freedom and one of the great aspects of capitalism is choice. So, if you want to smoke, you have a near endless choice of different things to smoke. If you want to quit, you have a variety of aids to help you to give up. But what they’re trying to deny now is a choice and that’s not right.
“I think governments have a duty to inform consumers of dangers associated with all products — not just cigarettes, not just tobacco products. Today, for instance, I see the World Health Organisation saying that they’re going to categorise red meat as cancer-causing [in fact, the EU’s new food promotion policy labelled red meat a “cancer risk”].
“Are we going to ban the sale of it? Or make it more expensive so only rich people can afford it? We’re seeing that this week with the controversy around with minimum pricing on alcohol coming into effect.” Mallon smoked for 49 years, having started as a boy, but has not had a cigarette for three years. He says he still misses of smoking but decided to give up when he hit his 60s.
“Smoking is legal and I’ve always had the right to smoke and the right to quit. It’s a question of choice,” he says.
“My two adult children neither smoke nor drink. My advice to them was not to smoke, but there was always that understanding that when they turned 18, it was their choice what they wanted to do. You can’t live your children’s lives for them. I’ve always felt that children will gravitate to something that’s forbidden to them, so if you making smoking sound like a dangerous thing, you’re actually making it very attractive to a child.”
Mallon believes that any attempt to ban smoking here, or to limit the ease with which people can buy tobacco products, would drive illegal sales through the roof.
“With prices going up every year, all you’re doing is playing to the criminal class, to the smugglers, and there’s an awful lot of smuggled cigarettes for sale in Ireland right now.”
It is a subject that Benny Gilsenan is passionate about. The retailer runs a convenience store near Croke Park and is spokesman for Retailers Against Smuggling, a lobby group with 3,000 members.
“We believe smuggled cigarettes account for about 25pc of the market,” he says. “The level of cigarette-smuggling dropped dramatically in the early stages of Covid when there were strict rules on travel — and our sales in the shop went up by in excess of 50pc at that time. But after the travel restrictions were lifted, the sales have dropped back as the illegal stuff becomes readily available.”
Gilsenan says that only 10pc of cigarettes smuggled into Ireland are detected by customs and gardaí — and the number is growing. “When the price of cigarettes goes up in every budget, some people start to look elsewhere. They can’t afford or justify the price. There wasn’t nearly as much smuggled product back in 1998/99, for instance, when the price of an ordinary pack of 20 cigarettes was £3.03. Now, the average price is around €15. It’s a huge difference.”
But campaigners such as Macey believe the price increases have nudged many people to either quit completely or to reduce their consumption.
“Effective as it is, it won’t work without a lot of other measures,” he adds, however, “and there’s a sense that because we made great strides with advertising bans and the workplace ban that the work is done.
“The tobacco industry never sleeps. They’re massively powerful. They’re hugely influential with PR and public affairs lobbying efforts that are largely hidden from us.
“Think of how they push e-cigarettes. This battle has to be constantly fought. We know the harm that tobacco does. Nobody can be in doubt about that any more. We see the huge number of people who die from it and get seriously ill and we have to draw a line in the sand and say, ‘Enough’s enough’.”
“If we don’t we’re looking down the barrel of yet another generation becoming addicted to nicotine.”