10 years of preventive health in Australia. Part 4 – extending gains in tobacco control

Looking back on tobacco control 10 years ago

Ten years ago, tobacco plain packages, with larger, new graphic health warnings, were firmly embedded in Australian law, and evaluation data were beginning to be published. The impact of this then-ground-breaking law was immediate, with calls to the smoking Quitline increasing by 78%¹ and people who smoked finding their now unbranded packs less attractive and no longer aspirational.² Although international legal challenges to the law continued to wind their way through lengthy and costly processes, eventually the tobacco industry ran out of road. In 2020, the World Trade Organization (WTO) denied the final appeal to deem the laws a violation of trade law.³ Australian plain packaging laws have been noted as significantly shifting the tobacco-control landscape, and what was once an innovative policy is now de rigueur best practice.

In 2013, the current smoking rate for people aged ≥18 years was 16.4%, and in the latest Australian National Drug Strategy Household Survey 2022–23, this figure was 11.1% – a 5.3% decline in smoking prevalence and a relative change of 32.3% in adults smoking daily, weekly, or less than weekly in the past 10 years.⁴ With nearly a third fewer smokers than 10 years ago, could Australia just set the wheel to autopilot and watch the rates continue to trickle down, or worse, stagnate? This would not only be a lost opportunity to accelerate the end of smoking, but also a gift to the tobacco industry to introduce new products, attract a new generation of users, and continue its legacy of addiction and death.

Vaping dominates the agenda

For the past few years, the tobacco control discourse in Australia has been largely hijacked by the high-profile surge in vape sales and use. Vaping products were only emerging as a public health issue in Australia 10 years ago. The vaping products available were complex to use, required refilling, and were mostly being used by adult smokers and former smokers. The products on the market at that time were not the colourful, cheap, disposable, lolly-flavoured, and high-concentration nicotine devices that now dominate and have driven teenage (age 14–17 years) ever use of vapes to triple from 9.6% in 2019 to 28% in just 3 years.⁵

In June 2024, the Australian Government passed legislation that closed significant loopholes in vaping legislation that had allowed falsely labelled non-nicotine vapes to be freely sold in general retail outlets such as convenience stores, petrol stations, and tobacconists.⁶ As of 1 July 2024, all vaping products, regardless of nicotine content, can only be accessed from a pharmacy with a prescription. In late-breaking amendments negotiated by The Greens, as of 1 October 2024, a prescription is no longer required, and vapes are now available behind-the-counter for adult users. The vapes sold in pharmacies are packaged like medicines; come only in tobacco, mint or menthol flavours; and have strict limits on nicotine concentration. Pharmacists are required to offer support and provide advice on quitting smoking to all people purchasing vapes. This is a very welcome end to ‘raspberry-ice-pink-unicorn’ illicit vapes that were being openly sold to teens by general retailers.

Current tobacco control reforms

After Australia passed the landmark plain packaging laws, tobacco policy legislation largely stalled. Significant annual tobacco tax increases were implemented that have seen the price of a typical packet of cigarettes increase from about A$24.00 in 2015 to A$50.00 in 2024.⁷ But these tobacco tax increases were not bolstered by other crucial supports such as national quit smoking campaigns⁸ or policy advances to address online marketing of tobacco, particularly through social media. In 2023, this inertia was finally addressed with the passage of a package of reforms that will be fully rolled out by 1 July 2025.⁹

These policy reforms include: the now tired graphic warnings will be refreshed with a diverse and far larger library of warnings; warnings will be printed on cigarettes themselves; packs will include inserts about how to quit smoking; and manufacturers will no longer be able to add menthol or other additives that enhance the palatability of tobacco products.¹⁰ These measures help Australia to catch up with other leading tobacco control nations, such as Canada and primarily focus on tighter regulation of tobacco products. These reforms also demanded a new level of accountability and required reporting from the tobacco industry, including disclosing tobacco product ingredients, tobacco product sales volumes, and promotional activities. These laws passed with surprisingly limited fanfare and with support across the political spectrum, likely owing to the acrimonious and high-profile debate around vaping regulation.

Although these new tobacco control reforms are vital and will continue to drive down smoking rates, especially as they form part of a comprehensive approach to tobacco control, the elephant in the room remains. We allow cigarettes to be sold in every community, all across Australia – no part of the country is too small or too remote to escape the tobacco industry sales force.

The future of tobacco control

The now strict controls on the supply of vapes, particularly limiting where and to whom they can be sold, highlight the comparative lack of control on the supply of cigarettes. Cigarettes continue to be readily available in outlets of all descriptions from grocery stores to newsagents and pubs. In late 2024, Victoria and New South Wales, the last two states to not have a tobacco licensing scheme in place, finally announced plans to implement a scheme, and Queensland’s licensing system has only been in force since 1 September 2024.¹¹ Tobacco licensing highlights how essential it is that national and state/territory governments work together to reduce tobacco use. Australia has had much success in adopting measures that reduce the appeal of and demand for tobacco products. However, it is increasingly intolerable to continue selling such highly addictive and deadly products alongside everyday groceries and household goods.

In 2023, the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) marked its 20th anniversary of coming into force.¹² Parties to the WHO FCTC agree that it is time to reflect on what forward-looking measures now need to be considered that expand or intensify approaches to tobacco control.¹³ An expert group is preparing a report for the next Conference of the Parties in 2025 that will consider a broad range of measures including how and to whom tobacco products can be sold, what types of tobacco products can be sold, and what structural changes could be made to the tobacco industry. Although calls to address the ready supply of tobacco products are not new, no country has yet to implement significant measures that limit where and how easily tobacco is sold.

This presents an opportunity for Australia to once again implement transformative policies. In early 2024, the tobacco industry successfully interfered in public health policy and aided in undoing world-first reforms in Aotearoa New Zealand that would have seen a ban on tobacco sales to anyone born after 2009, alongside a radical reduction in the number of tobacco retail outlets.¹⁴ Our national tobacco strategy aims to bring smoking prevalence to no more than 5% by 2030, which could be readily achieved with continued innovation and focus as outlined.¹⁵ A ‘set it and forget’ approach to tobacco control is not possible when the tobacco industry continues to develop new products that exploit vagaries in public health policy.¹⁶ In the race to end the tobacco epidemic, we should accept nothing less than first place.