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