May I ask you to introduce yourself by sharing a bit about your personal background and how you got involved in vaping advocacy?
Nathalie Dunand : I started a "classic" career as a computer consultant and switched later to human resources after the birth of my third child. My experience with vaping turned a lot of things upside down in my life. First, I quit smoking, a miracle for me after more than 30 years of smoking. Amazed, I began researching vaping and tobacco control. What I discovered astounded me: obscurantism, denial, lack of courage, extremism of some anti-smoking actors, pursuit of bad objectives. How different from the exchanges, the support, the empathy within the communities of vapers. I started to contribute daily to the Vaping Post information site, informing, decoding news about vaping and tobacco harm reduction. Today my contribution is more occasional. A feeling of profound injustice led me to become involved in pro-vaping NGOs: I joined the European Free Vaping Initiative Initiative (EFVI) and in 2016 I participated in the creation of the French non profit SOVAPE (one right click on the text and you can get it translated into English).
Q1. Before we look at the most recent declarations made during World No Tobacco Day, can you tell us what the situation is in France as far as smoking and vaping are concerned ?
Nathalie Dunand: Smoking prevalence remains very high in France. According to the latest Eurobarometer survey, France is the third highest country in Europe by the rate of smokers but also the second country regarding vapers. Things are changing. The Health Minister announced on World No Tobacco Day that the number of smokers has dropped by an unprecedented one million in a year.
The pressure on smoking has increased in recent years with a series of measures taken by successive governments, that came into force three years ago, with the introduction of plain packaging, the reimbursement of nicotine substitutes, sharp price increases. Tobacco harm reduction has not been part of these policies and vaping spreads by word of mouth, the work of associations and a few health professionals.
This said, from a political and regulatory point of view we are better off than many countries of the European Union: vaping is growing, and is said to be the first aid used to quit smoking by the French , in 27% of all attempts (before pharmaceutical nicotine substitutes, 18%), according to the studies published in the Weekly Epidemiological Bulletin of May 29, 2018 .
Despite the data, the Health Minister remains overly cautious and has difficulty recognizing the role of vaping in the impressive decrease in the number of smokers that she announced on the occasion of the smoke-free day.
Vaping continues making progress, pushed by the consumers, doctors, major associations in the field of addiction and also by business professionals passionate about their products.
Q2. The main headline for World No Tobacco Day in France, was France had one million fewer smokers in 2017 (AFP wire), with an excellent summary by Philippe Poirson in his blog Vapolitique, that mentions vaping was preferred by 27% of quitters to help them in their attempt. During a radio interview the Health Minister, Agnès Buzyn, did say she thought vaping was less toxic and could help to quit but... How do you assess today the status of vaping for the French government?
Nathalie Dunand: I think things will change. The facts are stubborn and for the first time we have indisputable data that demonstrate the role and potential of vaping in smoking cessation. If the Minister ignored it, François Bourdillon, the Director General of Santé Publique France mentioned it and it is very important.
The authorities still have to admit officially that vape is infinitely less dangerous than cigarettes, the Health Minister's recent statements you mentioned go in this direction and it is also very important because in France, as elsewhere and even in the United Kingdom, a majority of people still think that vaping is as harmful if not more harmful than smoking combustibles.
Politicians seem concerned about dual users, the people who smoke and vape, and about the gateway effect, a theory according which vaping leads to smoking. A new survey of Parisian teenagers conducted by Professor Bertrand Dautzenberg shows that this gateway effect does not exist and that on the contrary it makes smoking less fashionable among young people. In this population too, smoking has decreased significantly in one year, which is incompatible with a gateway effect.
Nathalie Dunand: For the Mois Sans Tabac 2017, Santé Publique France set up numerous Facebook groups on different themes, such as the patched group or the group of those motivated to quit for their children, giving smokers a place for sharing their experience and difficulties; those groups where hardly animated. For the vapers group, the Health Agency allowed Sébastien Béziau, Vice-President of SOVAPE and long-time activist to manage the support for visitors. Sébastien recruited a team of volunteers to help people who wanted to adopt vaping to stop smoking. They had to answer to a wide range of questions: about the type of materials to choose, the type of liquid, the nicotine rate, the maintenance of the products, and the side effects of quitting, of vaping.
This support group was composed of smokers and vapers. A great deal of educational work was carried out through personalized advice, documents specifically created and made available, explanatory videos produced by participants in the operation and live Facebook videos with specialists in smoking cessation, addictions and a nutritionist.
Strict rules had been imposed by the Health Agency, particularly concerning advertising, which was totally prohibited. This made it difficult sometimes for instance, when talking about devices as it was impossible to quote a brand, or material etc.
SOVAPE regularly surveyed participants to assess their success. We observed much higher success rates than with conventional methods. Almost half of the sample had quit by the end of the month, and 38% five months later. The combination of vape and self-support, with conservative assumptions, would give, according to our data, ten times more chance of success than quitting alone cold turkey.
Q4. On February 28, Professor David Khayat (a well known oncologist) said in a radio program he had changed his mind about vaping, that he thought it was the future for tobacco control. I don't think he spoke out during World No Tobacco day. Physicians can be quite influential and effective champions for tobacco harm reduction. I remember the appeal in favor of e-cigs signed by 100 physicians in November 2013. What is the situation now?
Nathalie Dunand: We are seeing some progress as a growing number of physicians are encouraging their patients to switch to vaping. On the other hand, we also sometimes have maddening feedback from doctors who are totally opposed to vaping and are poorly informed or misinformed.
In the media, some voices emerge and are heard from the general public. We are fortunate to have personalities from the medical and addiction field, who are given the floor and can express themselves very clearly on the subject.
On the other hand, from my perspective, the political environment, the influencers of political decision-makers don't seem inclined to accept the arguments in favor of tobacco harm reduction. They remain on positions anchored in fixed thought patterns. They may deny it, but I have perceived in some I have encountered a palpable dislike of smokers.
These advisors are very reluctant to accept the potential health benefits of vaping, some of them simply deny them. They seem terrorized by the risk of "re-normalizing" smoking and the gateway theory. They are not that directly present in the media but seem to have the ear of politicians.
Q5. What do you consider the priorities for the French vaping advocates in the coming months? Are you going to meet with the Health Minister or the new Director General of Health? Is the working group about vaping going to be reactivated? Are you going to be participate again in the Mois sans tabac? via a Facebook group? with any public funding from the Euros 100 million supposed to finance smoking reduction?
Nathalie Dunand: As of today I cannot answer those questions. I do not have anything specific to report, only encouraging clues. We'll see.
Q6. Is there anything you would like to add?
Nathalie Dunand: Reaching out to public officials remains difficult and even if we have some support, our visibility in the media is limited. Nobody knows exactly what the advertising ban will cover but the planned penalties are very high: that does not work in our favor. Among all initiatives taken by vapers, one remains emblematic for me, the "1000 messages for the vape". By the end of 2015, in less than a week, more than a thousand French people posted a comment in support of vaping on then Health Minister, Marisol Touraine's blog. The messages were essentially personal testimonies, stories on quitting smoking thanks to vaping. Crowdfunding led to a printed book, with forewords from French and international physicians, a few leading tobacco control advocates, a few journalists and film makers. We sent copies to all the government members, all the MPs, the media, to no effect: zero feedback, not a word from the officials.
In May 2016, Jacques Le Houezec organized in Paris the first Vape Summit. This event opened a door, with the previous administration. Under the impetus of then Director General of Health, Professor Benoît Vallet, we succeeded in establishing a dialogue that took the the form of a joint working group led by the Health Ministry. Unfortunately, after Vallet was replaced on January 3, 2018 by Jérôme Salomon the work of the group has been interrupted.