Friday, April 17, 2020

COVID 19 - work in progress

Like many of us in public health, I've been rather busy with COVID-19. I thought it might be useful to bring together what I've been involved in in one place:

Papers and letters in scientific journals:

1)             Lloyd-Sherlock P, Ebrahim S, Geffen L, McKee M. Bearing the brunt of covid-19: older people in low and middle income countries. BMJ 2020; 368: m1052

2)             Anderson M, McKee M, Mossialos E. Covid-19 exposes weaknesses in European response to outbreaks. BMJ 2020;368:m1075

3)             Hargreaves S, Kumar BN, McKee M, Jones L,Veizis A. Europe’s migrant containment policies threaten the response to covid-19. BMJ 2020; 368: m1213

4)             Legido-Quigley H, Mateos-Garcia JT, Regulez Campos V, Gea-Sanchez M, Muntaner C, McKee M.The resilience of the Spanish health system against the COVID-19 pandemic.Lancet Publ Health 2020:

5)             McKee M, Stuckler D. If the world fails to protect the economy, COVID will damage health not just now but also in the future. Nature Med 2020: DOI: 10.1038/s41591-020-0863-y

6)             Murphy A, Abdi Z, Harirchi I, McKee M, Ahmadnezhad E. Economic sanctions and Iran’s capacity to respond to COVID-19. Lancet PublHealth 2020:

7)             Flear M, de Ruijter A, McKee M. Coronavirus shows how UK must act quickly before being shut out of Europe’s health protection systems. BMJ 2020; 368:m400

8)             Kentikelenis A, Gabor D, Ortiz I, Stubbs T, McKeeM, Stuckler D. Softening the blow of the pandemic: will the IMF and WorldBank make things worse? Lancet Global Health 2020:

9)             Boccia S, Ricciardi W, McKee M, Cascini F. How the Italian NHS is fighting against the COVID-19 emergency. Frontiers Public Health 2020: doi: 10.3389/fpubh.2020.00167

10)          McKee M. A European roadmap out of theCOVID-19 pandemic. BMJ 2020; 369: m1556

11)          Douglas M,Katikireddi SV, Taulbut M, McKee M, McCartney G. How can we protect against the wider health impacts of the COVID-19 pandemic response? Social distancing maycause significant adverse effects on health inequalities. BMJ 2020; 369: m1557

12)          Forman R, Atun R, McKee M, Mossialos E. 12 Lessons Learned from the Management of the Coronavirus Pandemic. Health Policy 2020;

13)          Anderson M, McKee M, Mossialos E. Developing a sustainable exit strategy for COVID-19:  health, economic and public policy implications. J Roy Soc Med 2020; 113(5): 176–178

14)          Sassano M, McKee M, Ricciardi W, BocciaS. Transmission of infections at large sports gatherings: a surprising gap inour knowledge Frontiers Public Health 2020; 7: 277

15)          Patel P, Hiam L, Sowemimo A, Devakumar D, McKee M. Ethnicity and COVID-19BMJ 2020; 369: m2282 

16)          Clark A, Jit M, Warren-Gash C, Guthrie B, WangHHX, Mercer SW, Sanderson C, McKee M, Troeger C, Ong KI, Checchi F,Perel P, Joseph S, Gibbs HP, Banerjee A, Eggo RM, CMMID COVID-19 working group. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Global Health 2020; 8: E1003-E1017

17)          Oh J, Kavanagh MM, Gottschalk K, Subramanian SV, Shibuya K, Hirschhorn LR, Alonso C, Torres I, Awoonor-Williams K, Minh HV, Bawah AA, Tran H, Kachur SP, Sáenz R, Barrios OA, Kwon S, Nam EW, Choi JW, Lee J-K, McKee M, Gostin LO. Announcement of launching the JGHS Commission on COVID-19 Response. J Global Health Science 2020; 2: e20

18)          Roberts CM, Levi M, McKee M, Schilling R, Lim WS, Grocott M. COVID-19: a complex multi-system disease Br J Anaesthesia 2020: DOI:

19)          Han E, Chiou ST, McKee M, Legido-Quigley H. The resilience of Taiwan's health system to address the COVID-19 pandemic. EClinicalMedicine. 2020 Jun 27:100437. 

20)          Toffolutti V, McKee M, Stuckler D. Is theCOVID-19 pandemic turning into a European food crisis? Eur J Publ Health 2020; doi:10.1093/eurpub/ckaa101

21)          McKee M, Gugushvili A, Koltai J, Stuckler D. Are Populist Leaders Creating the Conditions for the Spread of COVID? Int J Health Pol Management 2021; 10: 511-515.

22)          Rajan S, Cylus J, McKee M. What do countries need to do to implement effective ‘find, test, trace, isolate, support’ systems? J Roy Soc Med 2020; 113: 245-50

23)          McKee M. England’s PPE procurement failures must never happen again. BMJ 2020: 370: m2858

24)          Shanks S, Van Schalkwyk MCI, McKee M. Covid-19 exposes the UK’s broken foodsystem. BMJ 2020; 370: m3085

25)          Gugushvili A, Koltai J, Stuckler D, McKee M. Votes, populism, and pandemics. Int J Publ Health 2020:

26)          McKee M. Learning from success: how hasHungary responded to the COVID pandemic? GeroScience 2020:

27)          Vanoni M, McKee M, Bonell C, Semenza J, Stuckler D. Using volunteered geographic information to assess mobility in the COVID-19 pandemic context: cross-city time series analysis of 41 cities in 22 countries from March 2nd to 26th 2020. Globalization Health 2020 Sep 23;16(1):85.

28)          Han E, Tan MMJ, Turk E, Sridhar D, Leung GM, Shibuya K, Asgari N, Oh J, García-Basteiro AL, Hanefeld J, Cook AR, Hsu LY, Teo YY, Heymann D, Clark H, McKee M, Legido-Quigley H. Lessons learnt from easingCOVID-19 restrictions: an analysis of countries in Asia Pacific and Europe. Lancet 2020:  396: 1525-1534 

29)          Agius RM, Robertson JFR, Kendrick D, Sewell HF, Stewart M, McKee M. Covid-19 in the workplace. BMJ 2020; 370: m3577

30)          Crozier A, Rajan S, McKee M. Fixing England’s COVID-19 response: learning from international experience. J Roy Soc Med 2020: 113: 422-427

31)          Kontis V, Bennett JE, Rashid T, Parks RM, Pearson-Stuttard J, Guillot M, Asaria P, Zhou B, Battaglini M, Corsetti G, McKee M, Di Cesare M, Mathers CD, Ezzati M.   Nature Med 2020: 26: 1919-1928

32)          McKee M, Stuckler D. Scientific divisions on covid-19: not what they might seem. BMJ 2020;371:m4024

33)          Rajan S, Comas-Herrera A, McKee M. Did the UK government really throw a protective ring around care homesin the COVID-19 pandemic? J Long-Term Care 2020; 2020: 185-195.

34)          Palafox B, Renedo A, Lasco G, Palileo-Villanueva L, Balabanova D, McKee M. Maintaining population health inlow- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers Trop Med Int Health 2020: doi: 10.1111/tmi.13498.

35)          Lloyd-Sherlock P, Sempe L, McKee M, Guntupalli A. Problems of data availability and quality for Covid-19 andolder people in low and middle-income countries. Gerontologist 2020: gnaa153. 

36)          Burgess RA, Osborne RH, Yongabi KA, Greenhalgh T, Gurdasani D, Kang G, Falade AG, Odone A, Busse R, Martin-Moreno JM, Reicher S, McKee M. The COVID-19 vaccines rush: participatory communityengagement matters more than ever. Lancet 2020; 397: 8-10.

37)          McKee M, Rajan S. What can we learn from Israel’s rapid roll out of COVID19 vaccination? Israel J Health Pol Res 2021; 10: 5.

38)          Baum F, Freeman T, Musolino C, Abramovitz M, De Ceukelaire W, Flavel J, Friel S, Giugliani C, Howden-Chapman P, Huong NT, London L, McKee M, Popay J, Serag H, Villar E. Explaining COVID-19 performance: Whatfactors might predict national responses? BMJ 2021; ;372: n91

39)          Crozier A, Rajan S, Buchan I, McKee M. Put to the test: useof rapid testing technologies for covid-19. 2021;372:n208

40)          Barlow P, van Schalkwyk M, McKee M, Labonte R, Stuckler D. COVID-19 and the collapse of global trade: what policymakers need to know to build an effective public health response. Lancet Planetary Health 2021; 5: e102–07

41)          Burgess RA, Osborne RH, Yongabi KA, Greenhalgh T, Gurdasani D, Kang G, Falade AG, Odone A, Busse R, Martin-Moreno JM, Reicher S, McKee M. The COVID-19 vaccines rush: participatorycommunity engagement matters more than ever. Lancet 2021; 397: 8-10.

42)          Van Schalkwyk M, Maani N, McKee M. Publichealth emergency or opportunity to profit? The two faces of the COVID-19pandemic. Lancet Diab Endocrinol 2020: S2213-8587(21)00001-2

43)          Murphy A, Mbau L, McKee M, Hanson K, Torreele E. Can we do for other essential medicines what we are doing for the COVID-19 vaccine? BMJ Global Health. 2021;6:e005158.

44)          McKee M. The UK’s PPE procurement scandal reminds us why we need ways to hold ministers to account. BMJ 2021; 372: n639

45)          Szocska M, Pollner P, Schiszler I, Joo T, Palicz T, McKee M, Sohonyai A, Szoke J, Toth A, Gaal P. Countrywide population movement monitoring using mobile devices generated (big) data during the COVID-19 crisis. Scientific Rep 2021; 11: 5943

46)          Turk E, Durrance-Bagale A, Han E, Bell S, Rajan S, Lota MMM, Ochu C, Lazo Porras M, Frumence G, McKee M, Legido-Quigley H. International experiences with co-production offer lessons for COVID-19 responses. BMJ 2021; 372: m4752

47)          Gugushvili A, McKee M. The COVID-19 Pandemic and War. Scand J Public Health 2021: doi: 10.1177/1403494821993732P1             

48)          Mansfield KE, Mathur R, Tazare J, Henderson AD, Mulick A, Carreira H, Matthews AA, Bidulka P, Gayle A, Forbes H, Cook S, Wong AYS, Strongman H, Wing K, Warren-Gash C, Cadogan SL, Smeeth L, Hayes JF, Quint JK, McKee M, Langan SM. COVID-19 collateral: Indirect acute effects of the pandemic on physical and mental health in the UK. Lancet Digital Health 2021: S2589-7500(21)00017-0               

49)          Kluge H, McKee M. Vaccinating the European Region: an unprecedented challenge. Lancet 20212021; 397: 1689-1691

50)          van Schalkwyk MC, Maani N, Cohen J, McKee M, Petticrew M. Our Postpandemic Word: What Will it Take to Build a Better Future for People and Planet? Milbank Q.  2021; 99(2): 467-502

51)          Chung SC, Marlow S, Tobias N, Alogna A, Alogna I, You S-L, Khunti K, McKee M, Michie S, Pillay D. Lessons from countries implementing find, test, trace, isolation and support policies in the rapid response of the COVID-19 pandemic: a systematic review. BMJ Open 2021;11:e047832.

52)          Mughal F, Mallen CD, McKee M. The impact of COVID-19 on primary care in Europe. Lancet Reg Health Europe 2021;  6: 100152

53)          Oh J, Lee HWJ, Long KQ, Markuns JF, Bullen C, Artaza Barrios OE, Hwang SS, Suh YS, McCool J, Kachur P, Chan CC, Kwon S, Kondo N, Minh HV, Moon JR, Rostila M, Norheim OF, You M, Withers M, Li M, Lee E-J, Benski C, Park S, Nam E-W, Gottschalk K, Kavanagh M, Huong TTG, Lee J-K, Subramanian SV, McKee M, Gostin LO. Mobility restrictions were associated with reductions in COVID-19 incidence early in the pandemic: evidence from a real-time evaluation in 34 countries. Sci Rep 2021; 11, 13717

54)          Ahmad R, Atun RA, Birgand G, Castro-Sánchez E, Charani E, Ferlie EB, Hussain I, Kambugu A, Labarca J, Levy Hara G, McKee M, Mendelson M, Singh S, Varma J, Zhu NJ, Zingg W, Holmes AH, COMPASS  study group.  Macro level influences on strategic responses to the COVID-19 pandemic – an international survey and tool for national assessments. J Global Health 2021;11:05011.

55)          Commissioners of and collaborators with the International AIDS Society–Lancet Commission on Health and Human Rights.  Human rights and fair access to COVID-19 vaccines: the International AIDS Society–Lancet Commission on Health and Human Rights. Lancet 2021; 397: 1524-1527

56)          Iftekhar EN, Priesemann V, Balling R, Bauer S, Beutels P, Calero Valdez A, Cuschieri S, Czypionka T, Dumpis U, Glaab E, Grill E, Hanson C, Hotulainen P, Klimek P, Kretzschman M,  Kruger T, Krutzinna J, Low N, Machado H, Martins C, McKee M, Mohr SB, Nassehi A, Perc M, Petelos E, Pickersgill M, Prainsack B, Rocklov J, Schernhammer E, Staines A, Szczurek E, Tsiodras S, Van Gucht S, Willeit P. A look into the future of the COVID-19 pandemic in Europe: an expert consultation. Lancet Reg Health Europe 2021:

57)          Sempé L, Lloyd-Sherlock P, Martínez R, Ebrahim S, McKee M, Acosta E. Estimation of all-cause excess mortality by age-specific mortality patterns for countries with incomplete vital statistics: a population-based study of the case of Peru during the first wave of the COVID-19 pandemic. Lancet Reg Health Americas 2021:

58)          Koltai J, Toffolutti V, McKee M, Stuckler D. Prevalence and changes in food-related hardships by socioeconomic and demographic groups during the COVID-19 pandemic in the UK: A longitudinal panel study. Lancet Reg Health Europe 2021; 6: 100125

59)          McKee M. What went wrong in the UK’s covid-19 response? BMJ 2021; 373:n1309

60)          Rajan S, Cylus J, McKee M. What can we learn from European experiences of primary care under COVID-19? In: Basu S, Alpert JL, Philips RS. Primary care in the COVID-19 pandemic. Cambridge MA: Harvard Medical School, 2021. pp 310-40

61)          Sagan A, Thomas S, McKee M, Karanikolos M, Azzopardi-Muscat N, de la Mata I, Figueras J. COVID-9 and health systems resilience: lessons going forwards. Eurohealth 2020; 26(2): 20-24

62)          Rajan, S, Cylus J, McKee M. Successful find-test-trace-isolate-support systems: how to win at snakes and ladders. Eurohealth 2020; 26(2): 34-39.

63)          Karanikolos M, McKee M. How comparable is covid-19 mortality across countries? Eurohealth 2020; 26(2): 45-50.

64)          McKee M. O Międzynarodowych Doświadczeniach COVID-19 [International experience with COVID-19]. Menedizir Zdrowia 2020; 9-19: 24-28

65)          McKee M. Achieving zero covid is not easy, but the alternative is far worse. BMJ 2020;371:m3859

66)          Alwan, NA, Burgess RA, Ashworth S, Beale R, Bhadelia N, Bogaert D, Dowd J, Eckerle I, Goldman LR, Greenhalgh T, Gurdasani D, Hamdy A, Hanage WP, Hodcroft EB, Hyde Z, Kellam P, Kelly-Irving M, Krammer F, Lipsitch M, McNally A, McKee M, Nouri A, Pimenta D, Priesemann V, Rutter H, Silver J, Sridhar D, Swanton C, Walensky RP, Yamey G, Ziauddeen H. Scientific consensus on the COVID-19 pandemic: we need to act now. The Lancet, 2020. 396(10260): p. e71-e72.

67)          Gurdasani D, Bear L, Bogaert D, Burgess RA, Busse R, Cacciola R, Charpak Y, Colbourn T, Drury J, Friston K, Gallo V, Goldman LR, Greenhalgh T, Hyde Z, Kuppalli K, Majumder MS, Martin-Moreno JM, McKee M, Michie S, Mossialos E, Nouri A, Pagel C, Pimenta D, Popescu S, Priesemann V, Rasmussen AL, Reicher S, Ricciardi W, Rice K, Silver J, Smith TC, Wenham C, West R, Yamey G, Yates C, Ziauddeen H. The UK needs a sustainable strategy for COVID-19. Lancet. 2020 Nov 9:S0140-6736(20)32350-3. doi: 10.1016/S0140-6736(20)32350-3.

68)          Gurdasani D, Alwan NA, Greenhalgh T, Hyde Z, Johnson L, McKee M, Michie S, Prather KA, Rasmussen SD, Reicher S, Roderick P, Ziauddeen H. School reopening without robust COVID-19 mitigation risks accelerating the pandemic. Lancet 2021: S0140-6736(21)00622-X 

69)          Bozorgmehr K, Jahn R, Stuckler D, McKee M. Free licensing of vaccines to end the COVID-19 crisis. Lancet 2021: /

70)          Lloyd-Sherlock P, Kandiyil N M, McKee M, Perianayagam A, Venkatapuram S, Pathare S et al. Pandemic lessons from India: inappropriate prioritisation for vaccination BMJ 2021; 373 : n1464

71)          Gurdasani D, Drury J, Greenhalgh T, Griffin S, Haque Z, Hyde Z, Katzourakis A, McKee M, Michie S, Pagel C, Reicher S, Roberts A, West R, Yates C, Ziauddeen H. Mass infection is not an option: we must do more to protect our young. Lancet 2021; S0140-6736(21)01589-0.

72)          Hargreaves S, Hayward SE, Noori T, McKee M, Kumar B. COVID-19: counting migrants in. Lancet. 2021; 398: 211-212. 

73)          Priesemann V, Balling R, Bauer S, Beutels P, Valdez AC, Cuschieri S, Czypionka T, Dumpis U, Glaab E, Grill E, Hotulainen P, Iftekhar EN, Krutzinna J, Lionis C, Machado H, Martins C, McKee M, Pavlakis GN, Perc M, Petelos E, Pickersgill M, Prainsack B, Rocklöv J, Schernhammer E, Szczurek E, Tsiodras S, Van Gucht S, Willeit P. Towards a European strategy to address the COVID-19 pandemic. The Lancet 2021:

Papers in press

van Schalkwyk M, McKee M. Research into policy: lessons from the COVID-19 pandemic. Eur J Publ Health 

Oroszi B, Juhász A, Nagy C, Horváth JK, McKee M, Ádány R. The unequal burden of COVID-19 in Hungary: a geographical and socioeconomic analysis of the second wave of the pandemic. BMJ Global Health

Monti M, Torbia A, Mossialos E, McKee M. A new strategy for Health and Sustainable Development: domestic policies, pan-European cooperation, and global governance after the pandemic. Lancet

Jit M, Ananthakrishnan A, McKee M, Wouters O, Beutels P, Teerawattananon Y. Multi-country collaboration in responding to global infectious disease threats: lessons for Europe from the COVID-19 pandemic. Lancet Reg Health Europe

Ramon Martinez, Shah Ebrahim, Lucas Sempe and Martin McKee. Potential impact of COVID-19 on human mortality tool. This allows you to apply the age specific mortality seen in Italy or China to age distributions worldwide
Link to description
Our monitor is bringing together structured reports on how countries across Europe are responding to the COVID-19 pandemic. You can select themes and countries to generate your own pdf. We are also adding thematic analyses, for example on testing practices across countries.

I am a member of the Independent SAGE, convened by Sir David King. Our first report was published on 12th May 2020 
Our second report, on reopening of schools, is here
Our third report on FTTIS is here

Lloyd-Sherlock PG, Kalache A, McKee M, Derbyshire J, GeffenL, Casas FG. WHO must prioritise the needs of older people in its response tothe covid-19 pandemic. BMJ. 2020 Mar 23;368:m1164. doi: 10.1136/bmj.m1164.

Martin McKee: Words have consequences, especially during a pandemic. BMJ Opinion

Michael RobertsMarcel LeviRichard SchillingWei Shen LimMichael PW GrocottMartin McKee. Covid-19: a complex multisystem clinical syndrome. BMJ Opinion 

Martin McKee. The questions we need to answer before easing lockdown. BMJ Opinion

Raymond Agius, John RobertsonMarcia StewartDenise KendrickHerb SewellMartin McKee Covid-19: Rigorous investigation of healthcare workers’ deaths is indispensable.  BMJ Opinion 

Martin McKee. Trust is essential in a pandemic, but the British prime minister is squandering it. BMJ Opinion

Selina Rajan Martin McKee. Learning From the Impacts of COVID-19 on Care Homes in England: A Pilot Survey  LTC COVID responses

Vishal Arora, Martin McKee. Covid-19 has decimated independent US primary care practices—how should policymakers and payers respond? BMJ Opinion

Martin McKee: The UK’s response to covid-19 does not inspire confidence in its ability to protect health as we drift into a No Deal Brexit. BMJ Opinion

Martin McKee: Will Boris Johnson’s “Moonshot” become lost in space? BMJ Opinion

Martin McKee, Iveta Nagyova: Could Slovakia's mass testing programme work in England? BMJ Opinion

Martin McKee: “NHS” Test and Trace under fire—a system flawed by design. BMJ Opinion

Martin McKee: How can we hold political leaders accountable for failures in pandemics?. BMJ Opinion

Martin McKee: The UK’s PPE procurement scandal reminds us why we need ways to hold ministers to account. BMJ Opinion

Martin McKee: Covid-19 vaccine wars: developing the AstraZeneca vaccine was a triumph, but then things went wrong. BMJ Opinion

Martin McKee: What did we learn from Dominic Cummings’ evidence to MPs on the covid crisis? BMJ Opinion

Martin McKee: What Dominic Cummings said next—the case for an urgent inquiry into England’s pandemic response gets stronger and stronger BMJ Opinion

Martin McKee: Martin McKee on “Spike: The virus versus the people”. BMJ Opinion

Media (selected)
Washington Post 23rd March
BBC Radio Ulster: 24th March , 2nd April
Daily Telegraph 6th March
BBC Radio 4 The World Tonight 13th April
Sky News 15th April
Toronto Globe and Mail 3rd April;  20th April
Sydney Morning Herald 4th May
Därför kan en ekonomisk kris skada folkhälsan mer än det nya coronaviruset. [Therefore, an economic crisis can harm public health more than the new corona virus] Dagens Nyhater 20th April
Tragiczny błąd Zachodu w walce z koronawirusem Rzeczpospolita [In Polish: A tragic mistake by the West in the fight against coronavirus] 4th May
Discussions/ podcasts
BBC World Service The Real Story. Discussion with Zeke Emanuel, Ben Cowling, Emma Frans and me. 17th April
The public health response to COVID19. BMJ podcast 
BBC Radio 4 The Briefing Room. 23rd April 
BMJ podcasts

Letters to newspapers

Letter to Financial Times critiquing Oxford study

Letter to Financial Times calling for a public inquiry:

Friday, August 17, 2018

E-cigarettes - more evidence of English exceptionalism

The House of Commons Science and Technology Committee has just published a report on e-cigarettes. Those involved in tobacco control outside England are amazed at its conclusions although not entirely surprised as the England has long been an international outlier on this issue, far out of step with the rest of the world. For example, two major reports, from the US National Academies ofScience and, only a few days ago, from Australia, highlight how much is not known. The American Heart Association agrees that " the potential health effects unknown, especially in long-term users" and has made a series of recommendations that are almost the opposite of those in the Commons report. And it's not just in the Anglophone world. leaders of the European Respiratory Society recently responded to a paper on e-cigarettes in England saying "(A) There is little evidence that e-cigarettes are an aid to smoking cessation and much evidence that tobacco manufacturers are advertising e-cigarettes as a bridge to starting nicotine and as a vehicle for long term continuation”; and “(B) no-one, expert or otherwise, can credibly assert that e-cigarettes are safer than tobacco in the long term, given that they contain a whole new tranche of unregulated and unstudied compounds being inhaled into the lung."
It is especially astonishing that the 95% safer figure is used, given that it has no credibility internationally. There are serious questions about the funding of the meeting it came from and it is simply impossible to know how safe a product is when it has only been used widely for a relatively short time. It took decades to discover the health effects of smoking. 
The World Health Organisation has said explicitly that a precise figure cannot be given, referring to "Unsubstantiated or overstated claims of safety and cessation". Also, as reported earlier this week in a study from Birmingham, new evidence is appearing weekly raising concerns about safety.
It is equally astonishing to see the claim that they are a proven smoking aid given the recent publication of a large controlled trial in the New England Journal of Medicine concluding that "Among smokers who received usual care (information and motivational text messages), the addition of free cessation aids or e-cigarettes did not provide a benefit. ". Moreover, there is now lots of evidence from observational studies that they reduce quitting.
The suggestion to increase nicotine is especially worrying given that organisations such as ASH have argued that the UK is safe from the rapid increase in use of Juuls by schoolchildren seen in the USA because of the lower levels permitted here. The report simply dismisses concerns such as that by the former chair of the American Academy of Pediatrics Tobacco Consortium, who has said “Juul is already a massive public-health disaster". But then, the report ignores the considerable evidence that these products are a gateway to smoking.
Fortunately, other countries are not following England's direction, despite massive pressure from a very well funded Big Tobacco operation. Instead, they are waiting for the results on our giant experiment on our people.