WA has an enviable reputation when it comes to combatting one of the biggest health scourges of modern time – smoking. But has it lost its edge?
By Cathy O’Leary
Western Australia has long been recognised as a world-leader in tobacco control, adding its own weight to efforts at a national level to stub out smoking.
Its playlist has included graphic public education campaigns showing surgical removal of a smoker’s larynx, backed up by law reforms that have progressively restricted how cigarettes can be advertised, sold and used.
WA doctors have played a critical role in anti-smoking advocacy from the 1970s, when some risked criminal charges by defacing cigarette advertising on billboards under the cover of night.
In the early 2000s, a Perth cardiothoracic surgeon was filmed removing a lung cancer tumour, to be later used in television advertisements.
As a result of sustained efforts, rates of smoking in WA have been on a steady downward trend since the 1980s when about one in three adults smoked, to 2025 when rates hover around 10%.
But there are concerns that the state is not keeping up with crackdowns on rapid new markets of addiction such as e-cigarettes and nicotine pouches, which are targeting teenagers and young adults.
In a move that surprised many, the latest annual National Tobacco Scorecard by the lobby group Australian Council on Smoking and Health (ACOSH) which names and shames the states falling behind on tobacco and vape reform, gave WA a grade of ‘D’ – second only to the Northern Territory as the worst performer.
It has prompted calls for more action so that the progress made since the 1970s does not start to unravel.
Where it began
When public health stalwart Professor Charles Watson wrote the introduction to a 2008 publication on the history of tobacco control in WA, few people had even heard of vaping.
Many thought the battle to eliminate smoking, one of the leading causes of cardiovascular disease and lung cancer, had been largely won.
But Prof Watson, then chair of Cancer Council WA’s medical and scientific committee, voiced what would turn out to be a prophetic note of caution.
“In reflecting on progress in tobacco control in WA we can rejoice in the lives it has saved and the health it has given back to ex-smokers, but much remains to be done,” he wrote.
“There is still a need for concerted action, regular review of achievements, and the invention of new tactics.
“The simple fact is, tobacco is still a major killer despite the gains made over the past four decades.”
In 2025, the health system is still dealing with the legacy of decades of high rates of smoking and the demand for medical services is expected to rise with the launch of the National Lung Cancer Screening Program using low-dose CT scans to look for cancer in high-risk asymptomatic current and former smokers.
But now there are new kids on the block – nicotine products that can be legitimately used as second or third-line treatments to help people quit smoking, but have also developed into a lucrative new target for teenagers and young adults, many of whom have never smoked.
Only introduced to the American market in 2006, e-cigarettes were at the time hailed as a smoking cessation tool and safer alternative.
Similarly, nicotine pouches – small bags containing nicotine, sweeteners and flavours which are placed between the lip and gum – were first registered in the early 2000s as a medicinal nicotine replacement tool by a company later bought out by RJ Reynolds (now British American Tobacco).
However, vapes and nicotine pouches have now become the domain of the young. Illegal to sell over the counter in shops but regularly sold to children, nevertheless.
The downside of reducing smoking rates so much has been that tobacco companies and other industry players have been pushed to look to new products to make money.
As a result, there has been a significant rise in people who use vapes, particularly among teenagers and young adults. One in seven WA school students aged 12 to 17 have tried vaping.
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The ‘gateway effect’ to tobacco is now firmly established, with young people who vape three times more likely to take up smoking cigarettes.
Failing the smoke test
ACOSH Chief Executive Laura Hunter said that almost a year on from the Federal Government introducing world leading reforms, the results from the National Tobacco Scorecard showed a stark divide, with some states leading the charge and others lagging.
“If this were an exam result, you’d have to say some states and territories are struggling,” Ms Hunter said.
“The results show that while South Australia and Queensland are leading the charge, jurisdictions like the NT and WA are falling behind — and are needing to prioritise urgent updates to state tobacco laws.
“In WA, we’ve seen regulations introducing the prescription-model for vaping products, a very welcome direction but the state tobacco laws haven’t been updated in seven years. Bringing these up to date will play a critical role in giving authorities the power to shut down illegal vape shops and introduce tougher penalties that deter offenders.”
Ms Hunter told Medical Forum that many people were shocked to see the report card for WA and she had received a lot of calls, including from Members of Parliament asking what was going on.
“As West Australians it was quite upsetting to people to see WA fall behind, but what this score card was capturing was that the Federal Government’s reforms that we saw passed by Parliament last year were world-leading,” she said.
“But without the legislation being updated in every state and territory, there’s a disconnect between the federal laws and the ability of the states to enforce them.
“There are some states yet to update their legislation and, because of that, it’s hamstrung all the compliance and enforcement teams within those states.”
Ms Hunter said states were judged on whether they could crack down on illegal sales and enforce state laws, and a critical area where WA lost marks was in enforcement and compliance on products such as vapes and nicotine pouches.
Under federal and state laws, vapes can only legally be sold with a prescription at a pharmacy. It is illegal to sell, buy or commercially advertise nicotine pouches.
In June, state budget estimates inquiry was told that since January 2024, WA authorities had carried out 1600 inspections and seized more than 190,000 vapes worth about $5.8 million.
But no on-the-spot fines had been issued for illegally selling vapes because the WA Health Department did not have the powers, although some prosecutions were going through.
In contrast, Ms Hunter said that in South Australia there have been more than 500 inspections conducted with closures of retailers who did the wrong thing and huge resourcing and investment into government taskforces that were seizing millions of dollars’ worth of illicit cigarettes and vapes.
Significant penalties had been introduced in Queensland, with large-scale seizures and stronger enforcement.
“You can pump as many resources as you like into compliance and enforcement, but at the end of the day if their hands are tied they can’t shut down retailers who are doing the wrong thing,” she said.
“Some states, like South Australia and Queensland, are doing a lot, they’ve updated their legislation, but others like the Northern Territory and WA are lagging.
Shonky retailers
“With WA being the only state that hasn’t updated its tobacco laws, it means that if you have someone who reports a vape shop for selling illegal vapes to kids in school uniform, it goes to the compliance team in the WA Health Department,” she said.
“They would have to go out and witness it in person, then they would have to go to a JP for a warrant, issue it to the store, and meanwhile the shop owner, who’s not stupid, has cottoned on quickly and the stock magically disappears.
“I’ve even seen retailers put all the stock into the boot of their car, and some retailers have secret knocks, whereby they get the stock and leave it in a certain spot and kids in school uniform walk out the store with vapes in between two packets of crisps. The retailers do it because they can get away with it.”
In South Australia, enforcement teams could shut down stores immediately and the penalties were “eye-watering”.
“This is really a scorecard on political will, and if politicians have a real fire in their belly and see the insidious tactics by the industry, they prioritise the necessary changes in the law,” Ms Hunter said.
“It’s like a game of Whack-a-Mole, where you deal with cigarettes and you get the lowest use in history, then the industry moves on and creates things like nicotine pouches.
“I went into a Subiaco convenience store and purchased a packet of nicotine pouches, even though they’re illegal, but for $25 they had all the flavours.
“I’m not a policy expert, and I appreciate that compliance enforcement is complex and they would need to work out the necessary laws from a WA context, but it can be done if politicians are serious about protecting the public, particularly kids.
“Vapes are not harm-free. There is now good evidence that if someone picks up a vape and they’ve never vaped or smoked before, they’re five times more likely to go onto cigarettes. From the tobacco industry’s angle, that’s a genius business model.”
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WA’s Police Commissioner Col Blanch has recently spoken out about the issue of illegal tobacco sales in WA, saying the penalties that could be imposed were too low.
Speaking to ABC Radio Perth he said he wanted the state to follow in South Australia’s footsteps to allow authorities to issue interim closures.
GPs have a role
Ms Hunter said there was still some scepticism or under-appreciation about the dangers of vapes, even among doctors.
“GPs would be seeing vaping a lot now, it’s an addiction, and it’s not like a fast-food drive-through habit to get burgers, this is a chemical addiction. One vape can contain the same amount of nicotine as you would get in nine packets of cigarettes, so it’s really potent doses,” she said.
“Australia has always taken a very cautionary approach around vapes but globally some countries have adopted a different model and allowed vapes to be sold alongside cigarettes. And as soon as you have an open retail market, the prevalence and use among teenagers skyrockets.”
Ms Hunter said Australia had come to a middle point where it had a pharmaceutical model for vapes, but it was a second or third-line treatment option.
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They were safer because they were limited to three ingredients and two flavours, and were in pharmaceutical-style packaging.
“I would be encouraging GPs to look at the evidence around combination nicotine replacement therapy first and foremost, even for giving up vapes,” she said.
“The RACGP has published some incredible guidelines around nicotine dependency that incorporates all of that. GPs have a huge opportunity to use evidence-based methods when they’re helping people get off cigarettes and vapes.
“GPs are going to be really important as we move forward and start cracking down on illicit use.”
The RACGP guidelines on nicotine vaping products urge doctors to minimise risk.
“The recommended first-line smoking cessation support includes TGA-approved pharmacotherapies and behavioural support. Nicotine vaping products (NVPs) are not first-line treatments for smoking cessation,” the guidelines state.
“NVPs may be considered with ongoing behavioural support for people who have tried to achieve smoking cessation with TGA-approved pharmacotherapies combined with behavioural intervention but failed and are still motivated to quit smoking.”
Ms Hunter said vapes had been painted as the holy grail for quitting smoking, but the real market was to addict a new generation of people to dangerous products.
“I struggle to find a 50 or 60-year-old smoker who’s been trying to give up cigarettes and then reaches for a unicorn milk flavoured vape – that’s not the market for vapes,” she said.
Upping the ante
Cancer Council WA (CCWA), which runs the Government-supported Make Smoking History program, said there had been some solid wins but more needed to be done.
Cancer Prevention and Research Director Melissa Ledger said important amendments had been made to the state’s tobacco laws in 2018 to ban the sale of flavoured cigarettes and splitable packs, and the sale of cigarettes to children.
Amendments to state legislation could have been delayed in anticipation of national vaping reforms, which came into effect in July last year and had brought big benefits to WA without duplication of efforts.
But CCWA wanted to see significantly increased resourcing for compliance and enforcement in relation to the illicit trade of tobacco, and to prevent the sale of cigarettes to children.
“We do wish to see some amendments made to state legislation to strengthen some area, to prohibit the sale and supply of e-cigarette products that are not prescribed or otherwise legally authorised, and strengthen legislative enforcement measures and penalties to effectively deter the unlawful sale of e-cigarettes and illicit tobacco,” Ms Ledger said.
When Medical Forum contacted the WA Health Department about WA’s poor grade in the National Tobacco Scorecard, it said some other states have recently updated their legislation, which has resulted in ACOSH recognising their progress.
A spokesperson said WA had benefitted from federal tobacco and vaping reforms, while WA laws had also been amended to require nicotine vapes be supplied only on prescription.
“The State Government is committed to complementing national tobacco and vaping reforms and is considering appropriate amendments to the Tobacco Products Control Act 2006,” the spokesperson said.
“This includes ensuring WA legislation is in lock step with the Commonwealth’s tough stance on vapes and on tobacco control.
“The department continues to conduct compliance activities in relation to the sale and use of tobacco products and the illegal supply of nicotine vaping products in both metropolitan and regional WA.”
In the past two years, it had inspected more than 3000 tobacconists across WA and seized more than 550,000 vapes, worth an estimated $21 million.
Ms Hunter said ACOSH would revise the scorecard next year.
“Across the board lots of people are concerned about smoking and vaping, and while we’re hearing about priority being given to the necessary reforms, our argument is let’s not delay it anymore, because we can’t afford to miss the boat.”
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