The sight of people holding something to their mouth and puffing out plumes of smoke is something we have become used to.

The negative health and associated effects are also not breaking news.

Health workers across the globe have for decades continued to wage a David and Goliath war with the cigarette industry marketing machine in what must have appeared a long-term vain attempt to emphasise the significant health and economic impact that smoking represents.

In June this year, the World Health Organization reminded us that tobacco damages nearly every organ in the body, causing cancer, heart disease, stroke, lung disease, reduced fertility, weakened immunity and premature death.

Tobacco “kills more than 7 million people each year, including over 1.6 million non-smokers who are exposed to second-hand smoke” it says.

“All forms of tobacco use are harmful, and there is no safe level of exposure.”

On 17 July, however, in some good news for the collective Australian David in this battle, the office of the Minister for Health and Ageing, Hon. Mark Butler, issued a press release with some encouraging news.

“Smoking and vaping rates are declining or stable, according to the 2025 Australian Institute of Health and Welfare’s long-running comprehensive study on smoking, vaping and drug use, the National Drug Strategy Household Survey,” it reads.

“Daily smoking rates among people aged over 18 years or more have fallen to a historic low of 5.8 per cent, well below the government’s 2025 target of 10 per cent.

“This represents 500,000 fewer daily smokers than three years ago.”

The report includes that “…only 5.6 per cent of all people aged over 14 years are smoking daily, down from 8.3 per cent in 2022-2023.”

So, Australians seem to be taking action to look after themselves and reduce the significant and preventable strain on the nation’s healthcare system.

Yet what about those ‘other’ cigarettes? The ones that seem to emit even more ‘plumes’ as they pass by than the much-maligned tobacco cigarette.

Is this decline in tobacco use because those addicted to nicotine are opting for vapes instead?

And surely, replacing tobacco for the water which causes these vapour ‘plumes’ they are healthier?

Well, that was the intention.

The first commercially successful electronic cigarette was invented in 2003 by Hon Lik, a Chinese pharmacist, and a smoker himself, who was apparently motivated to invent a safer alternative after his father died of lung cancer.

In 2003, Chinese pharmacist Hon Lik designed the first e-cigarette device as a smoking cessation aid to help people quit traditional combustible cigarettes, using water vapour to deliver the nicotine.
According to Professor Clive Page OBE, from the UK, who was recently visiting Australia, “… the starting point, I think, was not unreasonable.”

“Cigarettes could have up to 3000 harmful chemicals in them,” he says.

Professor Page is widely respected in the UK and internationally as a leading expert in pharmacology and respiratory diseases.

He argues, however, that as ‘Goliath’ took more of a beating in recent decades than their bottom lines would like, the tobacco industry have considered how to expand their market and moved into e-cigarette or ‘vape’ manufacturing.

In doing so, he believes they deviated from the original saline carrier designed to help people quit smoking, to flavoured products, which are appealing.

“They added flavourings and colourings to the to the vape solution, so you now have ridiculous things like pomegranate flavour and orange flavour and strawberry …to make it smell and supposedly taste better,” he says.

“But … the colourings, and the flavourings …are actually largely food colourings and food additives.

“So, they’ve only really been assessed as to their safety as things added to food which you ingest.

“You don’t put them in your lungs.”

Professor Page says that his colleagues around the world continue to report increasing levels of serious lung injuries from vaping, or EVALI (E-cigarette or Vaping Product Use-Associated Lung Injury), particularly in young people. He states that whilst nicotine is certainly harmful, these injuries are not from nicotine.

“It’s actually because of all the additives that are put in there that have never been tested for safety by the inhaled route,” he says.

Professor Page, who specialises in developing medicines and testing them for their safety in respiratory medicine, would like people to understand how vulnerable their lungs are.

“Lungs are the mechanism for taking in air in the atmosphere to deliver oxygen into your blood so that you can stay alive,” he says.

 “And so, anything you do that damages the lung makes it more difficult in the long term for oxygen to get into the blood.

“This can have long-term consequences.”

“Once lungs are damaged, they do not regenerate like the liver and some other tissues in our body.”

Therefore, he maintains that inhaling myriad chemicals, such as colourings, flavourings, chemicals released when cheap components are subjected to heat, benzoic acid and vitamin E acetate, is an unacceptable exposure, even in non-nicotine vaping products. Both benzoic acid and vitamin E acetate are highly dangerous when inhaled.

The sale of e-cigarettes in Australia is regulated by Commonwealth and jurisdictional laws.

From 1 October 2024, people aged 18 and over can now only buy vapes from participating pharmacies with a nicotine concentration of 20mg/mL or less, subject to state and territory arrangements.

According to the Department of Health, Disability and Ageing, people who require vapes with a higher nicotine concentration, and people under 18 years, need a prescription to access vapes, subject to state and territory arrangements, 2024.

Professor Page was pleased to hear last week that in Australia, after years of rising vape use among Australians 14 and over, for the first time ever the daily vaping rate has now ‘…stabilised at 3.6 per cent in 2025 and the proportion of current vape users has lowered from 7 percent in 2022-23 to 6 per cent in 2025.’

The fact, however, that anyone would use a vaping product even once continues to alarm him.

“If I want to add even one flavouring to a medicine, I have to ensure that this flavouring is assessed for safety through the proper measures,” he says.

“But these products delivering multiple ingredients directly to your lungs, do not”.

Minister Butler says that whilst recent data on smoking and vaping is encouraging, more needs to be done.

“These results show our world-leading vaping reforms are making a difference, but we know there is still more work to be done to protect Australians from the harms of smoking and vaping,” he says.

Professor Page believes that regulators should insist that if nicotine is going to be used in a vape, “…it should be restricted to a safe solution like saline.”

“These people selling vape products are adding them in without any consideration of their safety and any formal assessment of their safety that I’m aware of,” he says.

And whilst regulators have a role to play, the truth is that in a David and Goliath battle that affects Australians’ health, each Australian has the opportunity to decide what goes directly into their own lungs.

Anyone seeking help to quit smoking or vaping can call the Quitline on 13 QUIT (13 7848), visit quit.org.au, or download the free My QuitBuddy app.