Mr. Chris Macey:

I thank the Chair for the invitation to appear before the committee today. Our legislators, health authorities and health NGOs have forged a powerful alliance over many years that has made Ireland a leading global force in tobacco control. Through bold action, enabled by political consensus, many thousands of lives have been saved in Ireland, and countless more in other countries where policies pioneered here have been replicated. Today, the Irish Heart Foundation urges members to act boldly again to revitalise the faltering quest for a tobacco-free Ireland and to protect young people from the misery and destruction that nicotine and tobacco addiction causes.

We fully support this Bill, although we have made some suggestions to strengthen it in our submission. We greatly appreciate the Department of Health and everyone else who has been involved with moving this forward and all the efforts to get the legislation to this point. However, we do not believe it goes far enough. After falling from 41% to 13%, the smoking rate among 15- and 16-year-olds here is now increasing for the first time in a quarter of a century. Additionally, 39% of this age group have used e-cigarettes and 15.5% are regular users.

There is serious concern that this is the result of a gateway effect from soaring youth vaping rates,with Health Research Board, HRB, research concluding that adolescents who vape are up to five times more likely to take up smoking. Far from achieving a tobacco-free Ireland, we now risk losing the hard-won gains of the past 25 years, as the world's big tobacco firms that now control much of Ireland's vaping market seek to addict a new generation of young people to nicotine. To turn the tide of youth smoking back in the right direction and robustly address the dangers of vaping to young people, we believe four further measures are needed to be added to the Bill. These are: to increase the legal age of sale of cigarettes and e-cigarettes from 18 to 21; to outlaw all e-cigarette flavours bar tobacco; to ban all e-cigarette advertising and; to introduce plain packaging of e-cigarette products. We do not want to delay crucial provisions in the Bill that must be implemented urgently and therefore suggest complex age-of-sale legislation for tobacco could be enforced through subsequent amending legislation.

We believe a new age-of-sale law is justified on the basis of three key tests. First, is it proportionate? Yes, because of the unique harm smoking causes. Many young people move from casual use to addiction between the ages of 18 and 20. For every three young smokers, one will die of tobacco-related causes, while for every death, 30 more will suffer long-term chronic disease at some point. Will it be effective? Yes. Tobacco 21 laws effected in various US states before becoming federal law have reduced smoking among 18 to 20-year-olds by as much as a third. The US Institute of Medicine says 223,000 lives will be saved among those born between 2000 and 2019. In Ireland, that would equate to approximately 3,500 lives saved. We can also be confident it will work due to the hugely positive impact of increasing the age of sale here in 2002 from 16 to 18. Third, would it breach young people's rights? The answer to that is "No". The notion that young people automatically acquire all rights possessed by adults at 18 is incorrect. Those under 21 are already prohibited by law from activities such as adopting children, driving large passenger vehicles, supervising learner drivers and standing in national and European elections. This measure also has overwhelming public support. Our Ipsos MRBI poll found that 73% of Irish people aged over 15 support the move, including 69% in the 15 to 24 age group and 71% in the 18 to 24 age group. We regard this as a clear message to policymakers that the Irish public wants decisive action to end the blight of smoking for good.

As in the US, such a law would have to be accompanied by similar restrictions on e-cigarettes or we would risk further fuelling of youth vaping rates. The need for further tough measures on e-cigarettes is a product of the duplicity of an international vaping industry whose lobbyists promote e-cigarettes as a quit tool for long-term smokers, while their marketers relentlessly target young people with tactics that are as aggressive as they can get away with. The truth is e-cigarettes are far from safe as they can damage the heart, blood vessels and lungs, while exposure to nicotine can have long-term damaging effects on young people's brain development.

The industry's business model betrays everything. Would Marlboro manufacturer, Altria, have paid €12.8 billion for a 35% stake in Juul Labs, just to help long-term smokers quit, ultimately putting itself out of business? Of course not. The reality is underlined by its recent €40 million settlement with the state of North Carolina, after being sued for using deceptive practices targeting young people. Long-term smokers represent only a small part of the target market of big e-cigarette brands. The main objective – and profits – lie in addicting young people who have never smoked. By banning child-friendly flavours and advertising, along with plain packaging of e-cigarette products, the State could remove the key methods used to target young people. Many e-cigarette liquids are sold in bright, attractive packaging with cartoon characters. I have a couple of them here that I can show members. They come in various sweet, fruity flavours such as bubblegum and strawberry milkshake designed to entice young people. Vaping industry claims that such flavours are not intended for young people but are necessary to assist long-term smokers are nonsense. US research shows that almost 80% of youth users gave the availability of flavours as the reason why they vape. US Food and Drug Administration research also found that 97% of youth vapers had used a flavoured e-cigarette in the last month and were more than three times more likely to use fruit flavours as older adults. This was backed up by research we conducted with the Irish Cancer Society showing unanimous agreement among focus groups of third and fourth-year students that sweet and fruity flavours, along with bright colourful packaging, were aimed solely at young people.

Meanwhile, e-cigarette advertising is banned in print, radio and on TV but is permitted on billboards, public transport and at point of sale. This means young people are exposed to advertising near their schools, on high streets, in shops and on buses, trains etc., as part of their everyday lives. Research shows this advertising is effective. The bigger and hidden danger, however, is online. While online e-cigarette marketing is illegal, accounts are permitted on social media platforms like Instagram and Facebook. This enables targeting of young people by social media influencers and celebrities promoting e-cigarette brands. Companies claim they only engage with adult audiences, but research shows they circumvent these rules by using hashtags like #gaelicfootball, for example, to communicate with teenagers. Despite the success of tobacco control policies in Ireland, smoking still claims almost 6,000 lives here every year, more than have, sadly, died throughout the pandemic. Without decisive action now we will condemn this generation of children and young people to a similar and completely avoidable health catastrophe. We cannot let that happen.