New Zealand: the first tobacco-free generation?

Will New Zealand become the first smoke-free nation by 2025? To achieve this goal – and avoid the pre­ma­ture deaths of 4,500 New Zealan­ders each year – the coun­try could soon pro­pose a num­ber of ground-break­ing mea­sures, includ­ing a ban on the sale of tobac­co to any­one born after 2004. The lat­est WHO fig­ures, from May 2020, show that there are more than 1.3 bil­lion smok­ers in the world, and 80% of them are in low- and mid­dle-income coun­tries¹. The same data also shows that smok­ing kills 8 mil­lion peo­ple around the world each year.

The ban pro­posed by New Zealand Prime Min­is­ter Jacin­da Ardern’s gov­ern­ment has yet to be proven as effec­tive and suf­fi­cient. Also, whether it could even­tu­al­ly be import­ed into oth­er coun­tries. We put these ques­tions to Karine Gal­lopel-Mor­van, a mem­ber of the French High Coun­cil for Pub­lic Health (HCSP) and of the sci­en­tif­ic boards of San­té publique France. 

Will New Zealand be able to com­plete­ly abol­ish smoking?

New Zealand has a long his­to­ry of dis­ua­sive cam­paigns to reduce smok­ing, and they have been suc­cess­ful. Today, about 10% of non-Maori New Zealan­ders (and about 30% of Maori) smoke. This is extreme­ly low com­pared to France or Ger­many, where between 30 and 32% of the over-15s smoke occa­sion­al­ly and more than 25% dai­ly². Over­all, 29% of adults in Europe are reg­u­lar smokers. 

But New Zealand is not the only coun­try to envis­age a world with­out tobac­co – referred to as tobac­co endgame. It is also being con­sid­ered in Aus­tralia, Fin­land and Nor­way; coun­tries where smok­ing preva­lence is also very low (~12–15% of smok­ers). These coun­tries have adopt­ed the many mea­sures rec­om­mend­ed by the WHO, with­in the frame­work of the Con­ven­tion on Tobac­co Con­trol and have suc­ceed­ed in sig­nif­i­cant­ly reduc­ing the pro­por­tion of under­age smok­ers, to around 5% today. New Zealand wants to go fur­ther, and in 2021 pro­posed a plan to go smoke-free by 2025³.

How could New Zealand become smoke-free in 2025?

Var­i­ous mea­sures are pro­posed. Among the key pro­pos­als is the reduc­tion of nico­tine in tobac­co prod­ucts. This will have the dual pur­pose of reduc­ing the depen­den­cy of smok­ers (and there­fore mak­ing it eas­i­er to quit) and reduc­ing speed at which young peo­ple start­ing to smoke become addicted.

The last key mea­sure is to ban the sale of tobac­co to young peo­ple born after 2004 by 2025., with the aim of cre­at­ing the first smoke-free generation. 

Anoth­er key mea­sure is the reduc­tion in the num­ber of tobac­co out­lets, of which there are between 6,000 and 8,000 in New Zealand, since any shop can sell this prod­uct. This means that many out­lets are locat­ed in areas where the pop­u­la­tions most like­ly to smoke, such as Maori and the poor­est, reside. Reduc­ing the num­ber of out­lets, par­tic­u­lar­ly around sec­ondary schools, will reduce access to tobac­co, pre­vent youth ini­ti­a­tion and facil­i­tate cessation.

The last key mea­sure is to ban the sale of tobac­co to young peo­ple born after 2004 by 2025. The aim here is of course to cre­ate the first smoke-free gen­er­a­tion. Oth­er mea­sures are also pro­posed to achieve the desired objec­tive: rais­ing prices, ban­ning fil­ters (which are very pol­lut­ing for the envi­ron­ment), increas­ing the num­ber of social mar­ket­ing cam­paigns (such as the “No Smok­ing Month” in France), and reduc­ing the attrac­tive­ness of cig­a­rette shapes (in par­tic­u­lar by ban­ning cig­a­rettes with flavoured capsules).

Do you have any exam­ples of pub­lic poli­cies that have demon­strat­ed their effec­tive­ness on tobac­co marketing?

Yes, for exam­ple, I worked for sev­er­al years on the neu­tral cig­a­rette pack, which was intro­duced in France in 2017 and has now been adopt­ed by many coun­tries (includ­ing New Zealand). It has no adver­tis­ing signs; the brand name is writ­ten in a stan­dard­ised way and the colour is as unat­trac­tive as pos­si­ble (dark green for France). 

One of the aims of the neu­tral pack­et is to elim­i­nate the mar­ket­ing func­tion of the pack­ag­ing – a par­tic­u­lar­ly essen­tial func­tion in attract­ing young peo­ple to smoke. Cer­tain inno­v­a­tive and attrac­tive pack­ag­ing designs were sold on the French mar­ket up until 2017: “phos­phatase”, whose char­ac­ter­is­tic was to light up at night and make health warn­ings dis­ap­pear; the pack­et bear­ing the effi­gy of Che to evoke rebel­lion; the tac­tile “high-tech/­cap­sule” pack, which reminds us that the cig­a­rettes it con­tains change flavour accord­ing to the smok­er’s desires, etc. 

Research car­ried out in France, and that of researchers in oth­er coun­tries, shows that neu­tral pack­ag­ing influ­ences smok­ers’ behav­iour and per­cep­tions. Fur­ther­more, the plain pack­et does not make teenagers want to buy it and reduces their desire to start smok­ing. The plain pack­et also pre­vents con­sumers from being mis­led about the real dan­ger of the prod­uct it con­tains: a prod­uct that kills one out of two reg­u­lar con­sumers. Final­ly, the neu­tral pack­et increas­es the effec­tive­ness of the health warn­ings on the pack­ag­ing. They are more vis­i­ble, bet­ter remem­bered, and con­sid­ered more cred­i­ble and serious. 

But to defend this com­mu­ni­ca­tion space that is pack­ag­ing, the tobac­co indus­try went so far as to sue Aus­tralia in 2012 when the coun­try decid­ed to impose it. They lost their case and were over­ruled by the Syd­ney High Court.

Will it ever be pos­si­ble to ban smok­ing in coun­tries where smok­ing preva­lence is above 30%, such as France or Germany?

Noth­ing is impos­si­ble. It is impor­tant to bear in mind that today a prod­uct like cig­a­rettes would nev­er have been accept­ed for sale in Europe, sim­ply because it kills 50% of its reg­u­lar users. Smok­ing preva­lence is high in Europe, but it has been decreas­ing since 2016 (except in 2020, a year made spe­cial by Covid-19), because there has been a real polit­i­cal will to achieve this objec­tive with the imple­men­ta­tion of effec­tive mea­sures (price increase, social mar­ket­ing cam­paigns, neu­tral pack­age, reim­burse­ment of nico­tine substitutes…).

If the next gov­ern­ments con­tin­ue in this vein, the per­cent­age of smok­ers could fall very quick­ly. In Great Britain, for exam­ple, the adop­tion over the last fif­teen years of very effec­tive mea­sures (price increas­es, mas­sive social mar­ket­ing cam­paigns, ban on adver­tis­ing and sales to minors, plain pack­ets, assis­tance deployed through­out the coun­try to help smok­ers quit, etc.) has had sig­nif­i­cant effects: the British have gone from around 30% of smok­ers to less than 15% today. If nec­es­sary, it might be pos­si­ble to move to a smoke-free France or Ger­many by 2030.

Wouldn’t a sales ban lead to an increase in black-mar­ket tobac­co sales?

As stat­ed in the pre­vi­ous ques­tion, there is no ques­tion of ban­ning tobac­co sales in France when preva­lence is close to 30%. How­ev­er, once it is close to 5%, a ban will become fea­si­ble with­out gen­er­at­ing large-scale illic­it traf­fick­ing, since few peo­ple will be inter­est­ed in the prod­uct. In this case, it will of course be essen­tial to help the remain­ing smok­ers to man­age their nico­tine depen­dence, for exam­ple with med­ica­tion and nico­tine substitutes.

Interview by Juliette Parmentier