Last week two more documents were released by Health Canada which set out how the department plans to address the health consequences of tobacco use and vaping. The first is Health Canada's Forward Regulatory Plan for 2022-2024, and the second is the internal evaluation of Health Canada's activities, including management's response to the recommendations made by the evaluators. These, together with the Departmental Plan that was released in March, and revisions to Canada's Tobacco Strategy, released in February, reflect evolving federal priorities for this file.
This post reports on these four documents.
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THE FORWARD REGULATORY PLAN 2022-2024
In the official plan made public last week, Health Canada reports that it is working on 5 new regulations under the Act:
- Tobacco Products Labelling Regulations (planned since 2015, and expected this spring)
- Tobacco and Vaping Reporting Regulations and Vaping Products Reporting Regulations (planned since 2017 and now deferred until spring 2023)
- Order Amending Schedules 2 and 3 to the Tobacco and Vaping Products Act (Flavours) and Standards for Vaping Products' Sensory Attributes Regulation (planned since 2021, pre-published in 2021 and now awaiting finalization)
- Amendments to the Tobacco Access Regulations (Age Verification for Online Sales) (Planned since 2021 and deferred from fall 2021 to winter 2023 )
The new regulatory plan includes 3 key changes from the plan released this time last year (available on the third-party legacy website frp.policygeek.ca):
- Health Canada has dropped plans for regulations on vaping product package and design features. These regulations, which appeared on last year's list, would have placed "certain limits on what promotional elements can appear on vaping product packages. They would also impose restrictions on design features that are appealing to youth to prevent their use in the manufacture of vaping products." They no longer are part of the department's plans.
- Reporting regulations for vaping and tobacco manufacturers will be combined. ("They would merge the two sets of reporting regulations into a single one.").
- The department is no longer indicating when it will finalize regulations on vaping flavours. Federal measures to ban the sale of vaping liquids that have flavours other than mint-menthol or tobacco (and to prohibit additives other than a specified list associated with these flavours was pre-published in Canada Gazette last June, along-side a companion regulation for Cannabis products. Health Canada regularly provides timelines in its forward plan -- but for this regulation there is no hint on when the next steps will be taken.
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THE 2022-2023 DEPARTMENTAL PLAN
Among the activities identified for action in the coming year are:
- the regulatory developments listed above
- raising awareness and public education of the potential harms associated with vaping, particularly for youth;
- monitoring national trends in vaping and smoking and conducting public opinion research to better understand youth vaping.
- compliance and enforcement activities of websites, social media, retailers, manufacturers and importers.
- modernizing the Pan-Canadian Quitline and developing voluntary standards for smoking cessation
- public education activities to raise awareness of smoking cessation resources.
- providing up to $3.5 million for "community organizations that undertake prevention, protection and/or cessation efforts vs. the use of tobacco and vaping products."
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| Health Canada highlights new activities to address tobacco use and vaping. |
The annual Departmental Plans trace an evolution in Health Canada's public approach to vaping products. In the first two years after legalizing vaping products, the department planned "work towards addressing the risks and potential benefits of vaping products." (emphasis added) After 2020, identification of "potential benefits" had been dropped and measures to "address the rapid rise in youth vaping" were added. This year the department also identifies activities to support cessation efforts by vapers.
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THE DEPARTMENTAL EVALUATION
Following guidelines for all federal departments, Health Canada's programs are periodically evaluated for their relevance, results and efficiency. The 5-year review of the department's tobacco control efforts was scheduled for 2021, and the report "Evaluation of the Health Portfolio Tobacco and Vaping Activities 2016-17 to 2020-21" was released on April 26, 2022.
This 57-page report is rich with detail, and offers an explanation of the structure and function of the department's work that has not previously been disclosed. In developing the report, the evaluators reviewed 500 internal files and conducted interviews with 46 key informants from which they developed their analysis and made their recommendations.
It is in the management's "response and action plan" to these recommendations that more detail is provided for activities over the next few years.
The recommendations with which Health Canada's management agreed.
In the final version of the evaluation report, 4 recommendations are made. The "Management Response and Action Plan" (MRAP) shows agreement with all of these recommendations and the steps that will be taken to implement them.
#1 Communicate to partners and stakeholders Health Canada's action plan for the Department's contribution to achieving CTS goals and for addressing youth vaping.* The department will establish interim targets for smoking prevalence in 2025 and 2030 by April 2023 and communicate them by September 2023.#2. Enhance information technology systems and data analytics capacity to support program activities.* Health Canada will migrate to a new IT system (National Integrated Compliance & Enforcement Management Solution (NICEMS - IP 626)) by September 2023.#3 Examine resource distribution between tobacco and vaping activities.* Health Canada will establish "a risk-based approach for compliance and enforcement activities for tobacco products and vaping products" by December 2022.#4 Review and update the Health Canada website to reflect the most up-to-date science and public health advice on health risks and benefits of vaping.* Health Canada will review its website by last week (April 30) and will update it by August 31, 2022. A process for regular review will be established by the year's end.
The recommendations with which Health Canada's management did not agree.
An earlier draft of the evaluation report (dated August 2021) made 5 recommendations, two of which did not survive in the final report (dated December 2021).
The first recommendation was reworded, to remove reference to the need for the department to have a "clear path" and "action plan" in order to reach the 5% prevalence target. This echoed an analysis by Les Hagen and Robert Schwartz that was published last fall (Is “less than 5 by 35” still achievable?) .
This recommendation did not appear in the final evaluation, and was replaced instead with one that focused on communication, not planning.
Original text: Recommendation 1: Develop a detailed action plan for achieving CTS goals and for addressing the rise in youth vaping. The goal of less than 5% tobacco use by 2035 is an ambitious target and Health Canada has not articulated a detailed action plan for reaching it. While the program does have some operational and performance measurement documents, they do not set out a clear path for reaching the long-term goal or include interim targets. With the rapid rise in youth vaping, it is also important for Health Canada to articulate a plan to address it. It would be helpful to develop a comprehensive action plan that includes short-, medium- and long-term targets for reaching the CTS goal and for youth vaping. Collaborating with key stakeholders in the development of this plan could bring helpful perspectives and create cooperation and buy-in from relevant groups.
Final text: Recommendation 1: Communicate to partners and stakeholders, Health Canada’s action plan for the department’s contribution to achieving CTS goals and for addressing youth vaping. Health Canada and its partners have an ambitious target of less than 5% tobacco use by 2035. In addition, youth vaping rates remain a concern. While Health Canada does have internal planning and performance measurement documents related to both these issues, these plans have not been communicated to stakeholders in an integrated way. As a result, some key stakeholders have the impression that Health Canada has not defined a coordinated, department-wide plan. Several key informants indicated that having knowledge of Health Canada’s plan could help inform their own work and the work of other groups, and help assess progress on the issues of tobacco use and youth vaping. In communicating this plan, Health Canada should coordinate with Health Portfolio partners and key stakeholders to facilitate cooperation and buy-in from relevant groups.
The fourth recommendation in the draft report related to the benefits of additional regulations, in line with the recommendations of the Chief Medical Officers of Health, was deleted altogether.
Original text: Recommendation 4: Building on the regulatory work currently underway, consider additional regulatory options to help address the rise in youth vaping, and support program objectives and needs. The program has already moved forward with many new regulations to help address youth vaping. As the program continues its regulatory work, attention should be given to explore recommendations for action related to vaping made by the Council of Chief Medical Officers in 2020. The program should also explore ways for regulations to further support compliance and enforcement activities, for example through a wider range of enforcement tools, as well as supporting research and surveillance activities through industry reporting.Final text: (No such recommendation is included)
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CANADA'S TOBACCO STRATEGY
In May 2018, Health Canada replaced the Federal Tobacco Control Strategy, which had been in place since 2001 with a revised Canada's Tobacco Strategy. In February 2022, that 2018 document was officially archived, and replaced with new text on the department's website.
The revised version is very concise -- with only 480 words it is less than half the length of the 2018 version (1,130 words) and one-sixth as long as the FTCS (3,150 words). As shown in a side-by-side comparison of the two texts (downloadable here), the approach - or its description - has evolved over the past four years:
- Harm Reduction is being re-framed. The term "harm reduction" has been dropped, although the concept of vaping product offering "a less harmful option than smoking" remains.
- Some regulatory directions have been dropped. There is no longer reference to plans to "further reduce the appeal and addictiveness of tobacco, including taxation, price-interventions, and the regulation of nicotine content."
- Working with Indigenous groups has been reworded and given higher profile.
- Reference to industry accountability has been dropped.
