In vaping, the special relationship is coming undone.
While US President Donald Trump has vowed to "do something very, very strong" after hundreds of reported cases of lung illnesses related to electronic cigarettes, public health officials in the UK, the biggest market in Europe for the products, endorse vaping as a way to wean people off smoking.
It's the prevailing view across Europe, where authorities are more sanguine because the ailments popping up in the US have largely been linked to vaping liquids laced with THC, the psychoactive compound in cannabis, which is off-limits in much of Europe. Use among European teenagers is also much lower than in the US, as is the nicotine content in popular vaping products.
"If you're a smoker and you have not stopped smoking, try vaping," Martin Dockrell, head of tobacco issues at Public Health England, said in an interview posted on his Twitter feed this month. The government agency has repeatedly said vaping is 95% less harmful than cigarettes.
The response to the vaping crisis underlines a deeper difference in the two regions' approach to smoking alternatives. UK health bodies are leading a push for acceptance of products such as Imperial Brands Plc's Blu and British American Tobacco Plc's Vype as a way to get people to quit smoking, which is linked to cancer, heart disease and other ailments. Conversely in the US, which has seen countless tobacco lawsuits over the past decades, cigarette alternatives are feared to be a possible gateway into smoking.
What aligns both regions is that smoking rates have fallen, while vaping numbers have climbed. In the US, about 13% of the population smoked cigarettes last year, down from some 18% in 2013, according to Euromonitor International. In the UK, the rate has come down to 14% from 19%, while declines have been slower in countries like France and Germany.
The UK is Europe's No. 1 vaping market, with 6.3% of the adult population using such devices, but far fewer British teenagers vape than their counterparts in the US About 1.6% of 11- to 18-year-olds said they used e-cigarettes more than once a week, according to a Yougov survey published by anti-smoking group Action on Smoking and Health in June. The Health & Human Services Department said Wednesday that the proportion of regular vapers among US high school students has risen to one in four, citing preliminary data from a new survey.
UK authorities said they received seven reports in 2019 of adverse reactions suspected to have been caused by vaping, with no fatalities. Meanwhile, there have been 380 US reports in recent months about the mysterious symptoms linked to the practice, including six deaths, according to the Centers for Disease Control and Prevention.
Vaping liquids that contain THC are hard to find in Europe, which may explain why the EU hasn't seen similar health scares as in the US State health officials in New York have pointed to vitamin E acetate as a likely culprit for the respiratory symptoms, as the substance has been found in some products used to inhale THC.
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Europe's effort to push cigarette smokers toward vaping and heated tobacco devices is rooted in a public health approach called harm reduction that gained acceptance in the 1980s for prevention of HIV and other diseases among sex workers and injecting drug users. The approach seeks to diminish the impact of risky behaviors by promoting infection-blocking tools like clean needles and condoms. The strategy contrasted with efforts like the "Just Say No" anti-drug campaign championed by Nancy Reagan.
"We are clear vaping is not without risks, but compared with smoking tobacco it is far less harmful," said Rosanna O'Connor, director of alcohol, drugs and tobacco at Public Health England.
European authorities have combined their embrace of e-cigarettes with tougher regulations - restricting marketing to children, for example, and imposing lower limits on nicotine content - that have made the new devices more acceptable to health officials. The UK prohibits vaping companies from targeting teens. Real or fictitious characters that could appeal to youths are banned, as are depictions of e-cigarette users who appear to be under 25.
The European Union also has lower limits on nicotine levels in e-cigarette fluid, permitting a maximum of 20 milligrams per millilitre, compared with 59 milligrams per millilitre in Juul Labs Inc.'s vape hits. In order to enter EU markets such as the UK, the US company has had to dilute its nicotine liquids there.
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London-based BAT, which on Thursday announced 2 300 job cuts as it repositions itself to focus on smoking substitutes, says it shares the US Food and Drug Administration's concerns that marketing of some flavoured vaping products could appeal to children.
"At the same time, it is hard to overestimate the role that the responsible marketing of flavors plays in helping adult consumers move on from combustible products to alternative tobacco and nicotine products," BAT said in a statement.
Juul recently opened shops on Chinese e-commerce sites Tmall and JD.com as it seeks to expand worldwide.
Michael R. Bloomberg, the founder and majority owner of Bloomberg News parent Bloomberg LP, has campaigned and given money in support of a ban on flavoured e-cigarettes and tobacco and supports efforts to reduce global demand for tobacco worldwide.
Some European countries have highlighted risks of e-cigarettes, including addiction and the possibility that they could encourage users to take up smoking. An August report sponsored by the German health ministry concluded that while they may help smokers quit, they should be regulated more strongly to reduce the public's use of the products and prevent cardiovascular risks.
Still, Europe's approach has been less adversarial, according to Jonathan Fell, principal at London-based investment manager Ash Park, which owns shares in Philip Morris, BAT and Altria.
"In the US there's still this mindset that what is the enemy is the tobacco industry, not the harms from smoking," he said.