The Associate Health Minister's trial of halving the excise tax on HTPs would have had minimal effect on achieving the Smokefree 2025 goal, says a new briefing. Photo: RNZ / Samuel Rillstone
The government's trial of heated tobacco products as a smoking cessation tool is in "tatters", public health experts say.
In a briefing by the Public Health Communication Centre, the authors claim Associate Health Minister Casey Costello's trial of halving the excise tax on HTPs would have minimal effect on achieving the Smokefree 2025 goal.
They also say the trial itself is no longer feasible, given most products do not comply with new safety requirements.
The briefing, Government struggling with evidence: HTPs, addiction levels, and Smokefree 2025, stated the government replaced "evidence-based measures" leading experts believed would greatly reduce smoking prevalence with a "price discount for an unproven alternative product now no longer available".
"The independent modelling informing her decision suggests HTPs will do very little to achieve the Smokefree 2025 goal," it said.
That goal is a smoking prevalence in the country of below 5 percent.
The briefing points out Costello's reference to Ministry of Health modelling suggesting about "7200 smokers over the next two years could switch to HTPs".
The authors said the modelling implied 3600 people were "predicted to stop smoking by switching to HTPs per year." They argued a further 80,505 people would need to quit smoking to "reach an overall population smoking prevalence of five percent," based on estimated population data from 2023 of over-18-year-olds.
One of the authors - Professor of Public Health at the Department of Public Health University of Otago Richard Edwards - pointed out the 7200 figure provided by the Ministry was a small percentage of the total required to reach the Smokefree goal.
"Even on those figures," he told RNZ, "it's not going to make a big dent for the heated tobacco products on that modelling."
He added there was little evidence HTPs could help people stop smoking, and said they would question if even the 7200 figure was correct.
"So it's not going to make a big contribution."
Edwards said taking the nicotine out of cigarettes would have made a huge contribution: "our modelling for the de-nicotinisation of cigarettes showed a huge effect".
He questioned why the associate minister was "looking at one lot of modelling, but not another lot".
Costello responded to the claims in a statement, saying the government had reduced the excise tax on HTPs to "see if this had any further impact on smoking reduction".
"Preliminary estimates from the Ministry of Health were that it may lead 7200 extra people to quit smoking over two years."
She said the government wanted to stop people smoking to reduce harm, and "if there are products that can lead people away from smoking cigarettes then that's a positive".
But she said "the place of HTPs in that approach is something else that has been exaggerated by some of the government's opponents".
"They were a product that was already in the market where we could make a change - reflecting the commitment in the coalition agreement to tax smoked products only - and review the outcome."
The products are however no longer in the market, due to Philip Morris - the sole supplier of HTPs in New Zealand - having to pull its device from sale.
Philip Morris has a monopoly in the HTP market in New Zealand with its IQOS which heats sticks of tobacco to a vapour rather than burning it.
The device is classified as a vape and has been caught by Labour's regulations requiring devices to have removable batteries and child safety mechanisms, which finally kicked in on 1 October.
The associate minister said work was under way to develop a better regulatory framework across smoked tobacco, vaping and other products. The government would also review whether the current legislation was fit for purpose.
"This includes considering a licensing scheme, the role of alternative products, and how regulations are balanced between products. A new regulatory regime could improve compliance, regulate all products in proportion to harm, and prioritise protecting young people."
In the short term, she said she was focused on the need to "strengthen and increase what has been limited enforcement capability".
The authors also questioned the associate minister's assertions around "hardcore smokers".
Costello has claimed her actions and the services she wanted the government to supply were intended to target "hardcore smokers" - people aged 45 to 64 who had been smoking for a long time.
The authors pointed to evidence from the NZ Health Survey they said showed smoking was softening rather than hardening.
"Claims about 'hardcore smokers' assume smoking has become more entrenched and thus requires a targeted approach," they wrote.
They argued this "assumption does not reflect the dynamic population profile of people who smoke".
Edwards said the associate minister had made the claim about hardcore smokers a few times, calling it a common sense notion "that as smoking prevalence comes down, you expect that the people who preferentially quit smoking are ... the lighter smokers".
But it did not necessarily work like that, he said, because many of those taking up the habit were often younger, lighter smokers.
"Furthermore, all the measures that are taken like increasing the price of cigarettes and making it less places where you can smoke and so on, actually increase people's motivation to quit.
"So the hardening hypothesis, it's sometimes called, doesn't actually work out in practice."
The briefing used data from the NZ Health Survey showing the "trends in markers of heavy smoking over time," including the number of cigarettes smoked per day, the percentage of heavy smokers and the quit rate in the last 12 months.
It showed the percentage of heavy smokers had decreased over the past decade, and the quit rate had increased over the past decade.
The authors suggested "if people had become less motivated to quit, we would expect the quit rate to decline over time; however, the data show significant increases in quitting".
"There's good data, and we show that in our briefing, that actually the ... population of people who smoke, is getting less hardened," Edwards added.
"So the common sense notion is just not right. So what the Minister's saying is not actually true. It's not borne out by the evidence."
The minister's office provided a graph with data from the NZ Health Survey showing smoking rates by age. It showed the 45-to-64-year-old age group had a higher smoking rate than those in younger groups.
Costello said in a statement the data "is clear" as was the advice she had received from officials.
"We've had great success in having people quit smoking over the last few years, and those people still smoking are disproportionately older and have been smoking for some time."
She claimed the quit smoking providers were saying the same: "most of their people they need to work with are older and many have tried to quit numerous times".
Costello hit back at the claims in the briefing, saying it was "completely accurate to describe this group as 'hardcore' smokers".
"It's true that we need to target this group of people - a disproportionate number of whom are Māori - and to provide them the tools and help to stop smoking."
When challenged that a hardened group of smokers still existed, and the minister was attempting to target them, Edwards acknowledged there had always been that group, "but what we would say is it's actually getting smaller, both in absolute terms - just because the prevalence of smoking is coming down - but also in proportionate terms, the proportion of smokers who might be called hardened has actually, if anything, been coming down".
The paper was co-authored by Janet Hoek, Andrew Waa, Jude Ball, Richard Edwards, Anna Graham-DeMello. They called on the Associate Health Minister to take an evidence-based approach.
In particular they pointed to the re-introduction of de-nicotinisation, a measure they said had a "robust evidence base predicted to bring rapid declines in smoking".