Stuck in the Past: How Australia’s Health Institutions Betrayed Smokers and Ignored Harm Reduction
- Alan Gor
- Jun 15
- 7 min read
Updated: Jun 16
When Australia’s peak health organisations speak, policymakers listen. But what happens when those institutions entrench ideology, ignore global scientific consensus, and continue to promote outdated or misleading positions on tobacco harm reduction?
Over the past decade, international research has increasingly supported the use of nicotine vaping products (NVPs) as safer alternatives to smoking, with landmark reviews by Public Health England (now OHID), the Cochrane Collaboration, and New Zealand’s Ministry of Health concluding that vaping is significantly less harmful than smoking and effective for cessation. Yet, Australian health authorities have largely refused to evolve, holding to a narrative rooted in fear, precaution, and, in some cases, moral panic.
This blog examines the positions taken by major Australian health organisations from 2015 to 2024, revealing a pattern of ideological resistance, regulatory capture, selective science, and an unwillingness to adapt. They are stuck in the past, refusing to acknowledge the mounting evidence and real-world success stories that have emerged globally.
The Peak Bodies’ Consistent Caution and Contradiction
National Health and Medical Research Council (NHMRC)
The NHMRC, Australia’s leading body for health and medical research advice, is expected to guide public health policy with rigour, transparency, and scientific integrity. Unfortunately, when it comes to nicotine vaping, the NHMRC has repeatedly failed to rise to this standard, clinging to outdated caution, misrepresenting international consensus, and amplifying fear-based narratives.
Their original CEO statement in 2015 acknowledged the need for more research but stopped well short of recognising vaping as a harm reduction tool, even as the UK and New Zealand were moving toward evidence-based regulation. By 2017, they had doubled down on the same tired line: there was “insufficient evidence to support claims that e-cigarettes are safe,” ignoring mounting global research indicating their comparative safety over smoking.
Between 2020 and 2022, the NHMRC undertook multiple reviews through its Electronic Cigarettes Working Committee. Yet despite the volume of work, including evidence reviews on uptake, cessation, advertising, and toxicology, the outcome was another ideologically loaded statement in 2022. The updated CEO position claimed:
“E-cigarettes can be harmful” — without meaningfully differentiating between relative and absolute harm.
“People who have never smoked may be more likely to take up tobacco smoking if they use e-cigarettes” — parroting the debunked gateway theory, long discredited by real-world data from countries like the UK.
“There are no health benefits of using e-cigarettes for people who do not currently smoke” — while ignoring harm prevention for at-risk populations (e.g., young adult smokers or those with mental health conditions).
“There are other proven safe and effective options to help smokers quit” — despite Australia’s dismal success rates with NRT and prescription medications alone, and growing evidence that many smokers are only able to quit through vaping.
Even more troubling, the NHMRC cited poisoning data as a scare tactic, without contextualising the rarity of serious harm or the necessity of parental responsibility, proper packaging, and consumer regulation, not prohibition.
Their uncritical embrace of WHO talking points and opposition to proportionate regulation have positioned the NHMRC as an obstacle to progress, rather than a neutral, science-driven advisor. They continue to ignore successful models from Sweden, the UK, and New Zealand, and provide cover for political decisions that punish smokers and vapers instead of helping them.
The NHMRC should be leading the charge to reduce smoking-related death and disease. Instead, they’re stuck in the past, recycling outdated fears, ignoring lived experience, and failing the very people they claim to serve.
Royal Australasian College of Physicians (RACP)
As early as 2018, the RACP acknowledged that vaping is likely to be less harmful than smoking and may reduce the number of cigarettes consumed — but insisted the net public health effect “cannot be clarified with any degree of confidence.” Their 2020 submission to New Zealand struck a more measured tone, recognising the potential for vaping as a cessation tool. Yet a media release that same year retreated into prohibitionist messaging: “The RACP advises that not smoking tobacco or using e-cigarettes remains the safest option.”
In short, they acknowledge the potential, but prefer to recommend pharmaceutical cessation tools, despite these failing many smokers.
Australian Council on Smoking and Health (ACOSH)
ACOSH has been one of the most aggressively anti-vaping voices in Australia. In 2019, they claimed there was “insufficient evidence to recommend e-cigarettes as a safe and efficacious method to give up smoking”, and pushed the now-debunked gateway theory, citing the U.S. “youth vaping epidemic.”
In 2023 and 2024, ACOSH doubled down, urging full import bans, plain packaging, flavour restrictions (to tobacco only), and limits on nicotine levels — a policy wish list that closely mirrors the failed measures driving Australia’s exploding black market.
VicHealth
By 2017, VicHealth recommended e-cigarettes only be available as smoking cessation tools if approved by the TGA, despite the TGA never approving any vaping product for cessation, creating a self-defeating Catch-22. In 2024, VicHealth supported the controversial Therapeutic Goods and Other Legislation Amendment (Vaping Reforms) Bill, reinforcing its prohibitionist stance.
Australian Dental Association (ADA)
The ADA’s 2022 fact sheet stated flatly: “The use of e-cigarettes or personal vaporisers (vaping) is not encouraged as a replacement for tobacco smoking or as a method of quitting tobacco smoking.” No nuance. No consideration of smokers who can’t quit with gums, patches or pills.
Pharmaceutical Society of Australia (PSA)
In 2024, the PSA opposed making nicotine vapes Schedule 3 (Pharmacist Only Medicines), arguing pharmacists shouldn’t be forced to dispense unapproved, unregulated products without patient data. Yet they supported the government’s broader intent to remove vapes from retail settings, a stance that paradoxically reinforces prohibition while rejecting the only legal supply model available.
This position protects pharmacists’ reputations, but leaves smokers with few, if any, viable alternatives.
Royal Australian College of General Practitioners (RACGP)
The RACGP has cautiously supported vaping as a last resort, if first-line therapies fail. Their 2021 guidance (Recommendation 15) acknowledged that NVPs may sometimes be reasonable. By late 2023, they had slightly strengthened this stance, upgrading the certainty of evidence for vaping’s effectiveness to moderate.
In 2024, the RACGP supported the amended vaping reform legislation, but their conservative position remains riddled with caveats, reinforcing stigma around vaping while failing to embrace its proven utility for harm reduction.
The Lone Voice of Reason: RANZCP
In both 2018 and 2023, the RANZCP stood alone in promoting vaping as a legitimate harm reduction tool, particularly for people with mental illness, who have some of the highest smoking rates in the country. Their 2023 position recommended that nicotine vaping products become a common tool in the arsenal of psychiatrists to reduce smoking-related harm among vulnerable patients.
The RANZCP also sensibly advocated for regulation, safety standards, and ongoing research, striking the right balance between pragmatism and caution. Their stance stands in stark contrast to the prohibitionist postures of most other medical bodies.
Entrenched Dogma: The Thoracic Society and Others
Thoracic Society of Australia and New Zealand (TSANZ)
In 2020, the TSANZ declared vaping products “unsuitable” for any use other than potential quitting attempts, but refused to endorse any specific product, thereby again invoking the TGA Catch-22. In 2024, TSANZ backed the government’s punitive vaping reforms, again citing harm but ignoring comparative risk with cigarettes.
Their position continues to ignore the real-world consequences of denying safer alternatives: high smoking prevalence in disadvantaged groups, increased dual use, and a thriving illicit vape market.
Stuck in the Past — While the World Moves Forward
The science has moved on, but Australia’s peak health organisations haven’t. The majority remain stuck in a time when vaping was new, poorly understood, and genuinely a cause for concern. But now, over a decade of global research has clarified the picture: nicotine, while addictive, is not the cause of smoking-related cancers; vaping is far less harmful than smoking; and, crucially, it helps people quit.
Meanwhile, countries like Sweden have adopted a pragmatic, consumer-focused approach to harm reduction, promoting safer nicotine alternatives like snus and nicotine pouches. As a result, Sweden is on the cusp of becoming the first “smoke-free” nation in Europe, with adult smoking rates below 6% and among the lowest tobacco-related disease burdens in the developed world.
New Zealand and the UK have also embraced vaping as a public health tool. Their policies reflect the best available evidence, and their success is measurable: declining smoking rates, increased quit attempts, and significantly less black market activity compared to Australia.
Why This Matters: The Consequences of Institutional Intransigence
These organisations have failed to:
• Distinguish clearly between harm reduction and abstinence-only approaches.
• Update their guidance based on the totality of global evidence.
• Acknowledge the failure of pharmaceutical cessation products for many smokers.
• Consider the unintended consequences of their positions, such as fuelling black markets or increasing relapse to smoking.
Their stances have reinforced a moralised, punitive framework around nicotine use, rather than a public health model focused on compassion, science, and individual autonomy.
Where to from here?
As the vaping wars rage on, Australia needs health institutions that:
• Engage honestly with emerging evidence, rather than cherry-picking studies to confirm biases.
• Acknowledge their past missteps and course-correct when the evidence demands it.
• Centre the voices of people who smoke or vape — not just bureaucrats, academics, and pharma-aligned lobby groups.
• Support proportionate regulation, consumer access, and safety standards, not de facto prohibition.
There are hopeful signs. The RANZCP’s evidence-based, harm reduction approach could be a model for others. International best practices from New Zealand, the UK, and even parts of the EU show that supporting vaping for adults while protecting youth is possible.
Perhaps the clearest example is Sweden. With a comprehensive harm reduction strategy that includes snus, nicotine pouches, and vaping products, Sweden is on track to become the first smoke-free country, with a smoking rate below 5%. This success was achieved not through bans and stigma, but through pragmatic policy, product diversity, and public trust.
But first, Australia’s peak health organisations must admit the truth: They got it wrong. And the longer they double down, the more lives will be lost unnecessarily to smoking-related disease.
