ANNE KELSO:
Well, good morning. I'm Professor Anne Kelso, Chief Executive Officer of the National Health and Medical Research Council, NHMRC, and we play an important role providing health advice for the Australian community based on the best Australian and international evidence. And that work complements our role as the Australian Government's major funder of health and medical research in our universities, in our medical research institutes, and in our hospitals, producing the evidence we need to improve health and wellbeing of the Australian community.
So today we're here to release NHMRC’s latest national advice on e-cigarettes. We think this is timely. We know that many parents and schools and health practitioners and our chief health officers around the country are worried about e-cigarettes. Use of e-cigarettes or vaping by children and young people can affect their health and that will lead to future impacts on families, on the community, and on the health system. The 2022 CEO Statement on Electronic Cigarettes is the end result of an extensive analysis of the evidence on the harms and benefits of e-cigarette use. It replaces our previous version released in 2017. Now more has been learnt about e-cigarettes in the five years since the last CEO Statement. E-cigarette use has also increased over that time, particularly among young people aged 14 to 24. And we understand more now about the reasons that people take up electronic cigarettes. We know that the number of e-cigarette-related calls to Australia's poisons information centres has doubled between 2020 and 2021.
And so, this statement has been developed over the last two years. It's involved an analysis of many studies and systematic reviews by an expert committee. It's involved independent assessment of the methods used in the systematic reviews. There's been targeted consultation with the chief medical or health officers of the Commonwealth and each state and territory. And finally, there's been peer review of the statement by independent experts.
Now, the evidence in this statement can be used by governments to underpin policy decisions and public health messages. The summary of the evidence on the health risks from e-cigarette use will also be helpful, we hope, to people in the general community to make informed decisions about e-cigarette use. We hope this evidence is going to make its way into conversations around the country, whether it's across the dinner table, on the bus or in the car, at school assemblies, amongst friends, at sports training, anywhere where people get together as well as with people's GPs.
Now, if we turn to e-cigarettes themselves, the design and technology behind them continues to evolve, but the method is basically the same for all of them. E-cigarettes deliver substances directly to the lungs, and those substances can be harmful. Based on the review of the evidence that our committee has undertaken, we found that e-liquids can contain nicotine even if they're labelled nicotine-free. And I think we all understand that nicotine is the addictive component of tobacco cigarettes. But this isn't just about nicotine. More than 200 chemicals have been identified in e-liquids used in e-cigarettes, and they have the potential to harm people's health.
So for people who do not currently smoke, there are no health benefits of using e-cigarettes. Excuse me. So if you've never used e-cigarettes, now is not the time to start. The use of e-cigarettes can result in seizures, in poisonings, and a condition called EVALI, e-cigarette or vaping associated lung injury. Use of e-cigarettes can cause throat irritation, cough, dizziness, headaches, and nausea. And I'm afraid we don't yet know enough about the potential effects of e-cigarette use on conditions such as cancer, cardiovascular disease, reproductive health, respiratory health and mental illness. The evidence is not yet clear on the effectiveness of e-cigarettes as an aid to give up smoking. E-cigarettes are not a proven cessation aid for smoking. No brand of e-cigarette has been evaluated or approved by our TGA, the Therapeutic Goods Administration, as a smoking cessation aid. Smokers should try other smoking cessation aids in conjunction with health advice first, for example, from their GP or from quit services. Now, short-term e-cigarette use may help some tobacco smokers who’ve previously been unsuccessful with other smoking cessation aids. But not everyone finds that e-cigarettes are helpful for them to quit, and there's uncertainty around the evidence on the effectiveness of e-cigarettes as a smoking cessation tool. Research has found that when smokers use nicotine e-cigarettes, it was more common for them to become dual users of e-cigarettes and tobacco cigarettes than to quit. Dual users breathe in more chemicals and toxins than people who only use one type of cigarette. So I'd like to make an appeal. If you are thinking about e-cigarettes, please get the facts. The evidence is here.
So I now invite Australia's Chief Medical Officer, Professor Paul Kelly, to speak briefly on the importance of this CEO Statement. Thank you, Paul.
PAUL KELLY:
Thanks, Anne. And I'd just like to support Anne’s comments about how important this is as a public health issue. And it's five years on. It's hard to believe that it's five years since the last version of this statement, but there is a lot more that is known as Anne has suggested. And this update of the evidence to inform public health decisionmaking is very timely.
So e-cigarettes or vaping products are an emerging issue in Australia. The latest data shows that e-cigarette use is increasing, particularly and specifically in younger age groups. One in five people aged 18 to 24 who had never smoked reported having tried e-cigarettes. Only one in three people who have used e-cigarettes reported that they use them to help quit smoking. So most people are using them recreationally. Increased use of e-cigarettes is a shared concern amongst my fellow chief health officers and chief medical officers in all of the states and territories. In fact, one of our colleagues has said recently that e-cigarettes are the next big health issue after COVID, and I think that's a really important statement to take on board. Reducing the risks posed by e-cigarettes is complex and requires a multifaceted approach. So the release of this NHMRC CEO statement on electronic cigarettes is very important and most welcomed, as it outlines the best available evidence to inform policy makers on this issue. The CEO statement is backed by comprehensive evidence, as Professor Kelso has mentioned. What’s clear to me, from the statement, is that the only thing we should be breathing in is air. There’s no question that there are potential harms from e-cigarette use for those who have never smoked, and we know the harms of smoking. Please discuss this evidence with your children, with your nieces and nephews, your students, players in your football or netball team, your brothers and sisters. We need that conversation out there, we need these matters to be barbecue stoppers. The CEO statement on electronic cigarettes is for all of us. It provides advice about the health risks from e-cigarettes, as well as ways to make those informed decisions to have our daily lives more healthy, for ourselves and for our children. So thank you, Anne, for your leadership on this, and I think we’re happy to take questions.
QUESTION:
Yeah, so just a question for Professor Kelso, if I may. So we’ve just heard about the proportion of young people, and it seems like there are more people taking up smoking e-cigarettes. How much of concern is it for you that- and is there any evidence that people are taking up this practice in earlier years compared to smoking?
ANNE KELSO:
Well, I don’t at hand have the data on the take up of smoking. But we do know that the take up of e-cigarettes has increased over the last five years across almost every age group. And it’s particularly in that group of 14 to 24 years old. And I think we probably all have anecdotal experience of seeing how common this is now amongst young people.
QUESTION:
And how much of a concern is that then that they may not be able to knock that addiction? That it might be an issue further down the track for those young people.
ANNE KELSO:
I think it’s a very deep concern. And of course, it’s obviously the case that people are using nicotine containing e-cigarettes, and they may not know that they’re using nicotine containing e-cigarettes, because many of them actually have nicotine, even when they’re labelled nicotine free. So that is a concern. We know nicotine is highly addictive and we know how many people, once they are addicted, wish to give up. So I think that is a concern. I think we’re also very concerned about the direct damage to the lung of the many- the more than 200 different substances that we know that e-cigarettes can contain, and can in many cases, we know, will cause actual damage to the lung. And then there’s the very big concern of the so called gateway effect, that it leads people on to feel familiar with smoking, and then to think of taking up tobacco cigarettes. So there are multiple levels of harm, and young people are particularly vulnerable to the advertising and the other sorts of influences on them – peer group pressure – that can lead them down a path that they will regret in the future.
QUESTION:
And are you satisfied with the controls that are in place for young people trying to buy e-cigarettes over the counter?
ANNE KELSO:
NHMRC doesn't have a role in the regulation of access to e-cigarettes, and so that's a matter for government. We'll stick with the evidence that has been analysed by our expert committee.
QUESTION:
Professor Kelly, can I just ask you, just on the comments that we saw this morning from the Health Minister about the possibility of text messages alerting people- COVID positive patients for possible antiviral treatments. What are your thoughts on that? What was your response?
PAUL KELLY:
So the Minister gave a very long press conference yesterday, talked a lot about COVID and where we were up to with that and winter planning. So I'll leave those to him. In terms of the use of treatments for COVID, absolutely. It's a very important thing and I completely back the statements made by the Minister yesterday.
QUESTION:
Professor Kelly, sorry, you said before e-cigarette use is the next biggest health issue after COVID. That's quite a strong statement, and I think many people might be surprised by that. Are you concerned with the amount of education that is around e-cigarettes either in schools or government advertising, that sort of thing? Do you think there needs to be more?
PAUL KELLY:
So I was- actually attribute that to one of my colleagues, one of my state colleagues. But I do agree it is a public health concern. I've been concerned about e-cigarettes for quite some time and it's something that we absolutely need to talk more about. And I think the statement that's been released by the NHMRC today lays out on a page and supported by some social media as well. I think that there's been rolled out as part of the- a part of this process to get people to talk about this matter in a way that probably hasn't been done enough in recent years. The evidence to me is that- is growing about the gateway issue that Professor Kelso mentioned. People who take up e-cigarettes are more likely to start to continue on with smoking for the rest of their lives. And we know the devastation that has had in Australia over many decades. Nicotine is a very addictive drug, and we need to make our efforts very strong with our young people to protect them from that lifelong issue, if that's the way it's led.
QUESTION:
Sorry, just back on the COVID treatments. We saw from the Health Minister as well that 150,000 doses have been administered out of, I think it was 1.3 million in storage. Do you support expanding the treatment for people under the age of 65 for, you know, treatment for the greater population?
PAUL KELLY:
So we have medical advice and clinical advice in relation to the usage. As you know, both of the medications that the Minister talked about yesterday, oral medications are available on the Pharmaceutical Benefits Scheme. They can be given by a script from a GP or other medical provider. That has led to an increase in the use over since 1 June when the second of those became available on the PBS. What yesterday was about, and we'll continue to work with the government on these matters of course, is to get that message out to people who are eligible and as well as to GPS and others that can prescribe to make sure that that use is optimised. I think there are- and the minister talked about that yesterday, so I won't repeat his message, but a very important part of that message was one that we've been talking about, which is making sure that people who are in that high risk group, so mostly older people, people with chronic disease at high risk of severe COVID, have that conversation with their medical provider now. Don't wait for the time you may be diagnosed with COVID, because early treatment is the key. Have a COVID treatment plan, just like we deal with asthma and other matters.
QUESTION:
Sorry, just one more. There’s been in a couple of stories with the antiviral treatments. People are- yesterday the Minister mentioned that many people don't know that much about it, but when people do try to access it, there's a few barriers when they're having to get a PCR test, having to see a GP, and that adds time. You know, of course you’re saying you need to get in early. Is that why you're saying that it's important to plan for this beforehand? Or what's your advice to people in that vulnerable category who might have it?
PAUL KELLY:
So just to pick up on one of those things, a rapid antigen test or a PCR is enough to be eligible for that. And then the at risk categories are well known now by general practitioners and others. We need to increase, as the Minister said yesterday, that awareness in the community, and I'll just stress again and reinforce what the Minister said yesterday is that now's the time if you're in those vulnerable groups to have that conversation, so you know exactly what you're going to be doing in those circumstances, know exactly where you can access those medications and know exactly how to use them. The earlier the better. They are absolutely proven to decrease the risk of severe disease and even death for people who are in those vulnerable groups. It's not for everyone. It's not needed for everyone. Most people with COVID will have a relatively mild disease, particularly if they've been vaccinated. This is not an alternative to vaccination. It is an extra protection for vulnerable people.
Okay, thanks very much.
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