"People smoke for the nicotine, but die from the toxins in tobacco smoke. This distinction creates the potential for harm reduction: providing people who smoke with access to substantially less harmful, smoke-free nicotine products such as vapes. The evidence is clear that vaping helps people quit and, although it is not risk free, it is much less harmful than cigarettes.

"Smoking rates declined slowly in New Zealand up until 2018/19 with impelementation of traditional tobacco control measures. In the next few years the rate of decline acclerated, especially among Māori, and in association with the rise of vaping. The adult smoking rate is now under 7% and, remarkably, the youth smoking rate is at an all time low – 1% in ASH year 10 surveys

"Unfortunately, misconceptions about vaping are common. Recent examples include papers from Australia and New Zealand, which suggest that “vaping causes cancer”. These papers generate powerful headlines and it is easy to imagine they may confuse people on the verge of using vapes to quit.

"Both papers have very serious limitations: they identify potential hazards rather than assessing the risk; they are based on unrealistic lab studies, often in animals, which find high levels of potentially toxic substances which would not occur with usual vaping. Although the papers acknowledge that the risks of vapes are lower, the question that matters is how much lower - 5% lower or 99.9% lower? A formal risk assessment put the lifetime excess cancer risk of vaping at 0.4% of that of smoking.

"The message in Nature Health paper highlights what could be achieved if the kind of comprehensive approaches that drove NZ’s rapid decline using alternative nicotine products were adopted and sustained in other countries."