Reactions on Twitter towards Australia's proposed import restriction on nicotine vaping products: a thematic analysis

Australia prohibits the sale of nicotine vaping products (NVPs) unless they are approved by the Therapeutic Goods Administration (TGA) and prescribed by a doctor.¹ The TGA has not approved any NVPs but medical practitioners can enable access via four pathways: i) prescribe for extemporaneous compounding where pharmacists prepare NVPs for the patient; ii) apply for TGA approval to prescribe and organise the supply of NVPs to the patient (Special Access Scheme); iii) apply for TGA approval to prescribe and organise the supply of NVPs to a class of patients (Authorised Prescriber Scheme); or iv) prescribe NVPs for the patient, who personally imports the NVP of their choice (Personal Importation Scheme).¹

On 19 June 2020, the Australian Government announced that within two weeks the personal importation of NVPs would be prohibited for 12 months, removing pathway four.² Although three pathways remained, this policy would impact the 27% of Australian NVP users who imported their NVPs from online retailers.³ Many took to Twitter to tweet against the proposed policy resulting in a ‘Twitter bombing’ – a social media strategy to make a topic trend.^{4, 5} Pro-vaping sentiment in Australia is largely expressed by NVP retailers, NVP advocates, NVP users, some politicians and some public health researchers.⁶ On June 26, 2020, the government delayed the implementation of the policy.⁷

Analysis of Twitter data may allow policymakers to anticipate and respond to the types of reactions to proposed public health policies. We conducted a thematic analysis to analyse the content of the tweets posted one week after the announcement.

Method

Results

The highest proportion of tweets opposed the policy (1021/1168, 87.4%), followed by neutral (131/1168; 11.2%) and pro-policy (16/1168; 1.4%). For themes, 59.8% (698/1168) criticised the government, 38% (444/1168) promoted ways to oppose the ban through activism, 30.8% (360/1168) cited potential adverse consequences of the restriction and 1.4% (16/1168) cited support for the policy (Table 1).

Among tweets that promoted activism against the restriction, 70.9% (315/444) encouraged sharing petitions and 34.9% (155/444) promoted arguments against the restriction. Among tweets that cited potential consequences of the restriction, most cited smoking relapse (272/360; 75.6%), followed by the impact of policy enforcement (31/360; 8.6%), illicit market (30/360; 8.3%), panic buying (13/360; 3.6%), impacts on NVP businesses (10/360; 2.8%) and difficulty obtaining prescriptions (10/360; 2.8%).

Discussion

In line with previous studies,^{5, 6, 10, 12} most tweets in our sample posted in the week after the announcement objected to the government's proposal to end the Personal Importation Scheme. The majority criticised the proposed policy and promoted ways to oppose it. Some tweets expressed concerns about smoking relapse among NVP users. A minority of tweets supported the policy.

Tweets criticising the government's proposed policy expressed their objection by using negative language towards the health minister and/or claiming that the policy was a collaboration between the government and ‘Big Tobacco’ to increase tobacco tax revenue. Activism against the policy included sharing petitions and personal stories with the hashtag ‘#vapingsavedme’. Support for free markets, limited government involvement in personal choices and the enjoyment of vaping were also cited. Previous research suggests public health groups and politicians often become a target for counter campaigns, with these comments often accompanied by toxic language and negative tones.¹³ Such incivility has been used to counteract public health messages about the potential risks of NVP use.¹³ Research is needed on how best to address such campaigns on Twitter.

Smoking relapse was the most frequently cited potential adverse consequence of the policy. People who had switched from smoking to NVPs were concerned about relapsing to cigarettes, which remained highly accessible. Other tweets claimed that the policy would encourage illicit purchasing of NVPs, cited difficulty in obtaining prescriptions, and argued that applying for permits and importation would deter doctors from prescribing. Panic buying and the risks of stockpiling large quantities of concentrated nicotine were mentioned. While some Twitter users cited the potential effectiveness of NVPs for smoking cessation,¹⁴ other arguments, such as the risk of increasing the illicit market,¹⁵ were not informed by evidence.

Our results are not representative of the general population and are potentially biased towards the views of more frequent Twitter users or interest groups including lobbyists, and/or bots. Previous research has found that the number of suspected ‘bot’ accounts has declined from 18.3% in 2012 to 0.23% in 2018, making it unlikely that our key findings were heavily influenced by this automated activity.⁶ The largely one-sided perspective from policy opponents may not reflect views in the wider Australian community.⁶

Conclusions

This brief report suggests that NVP policies will face opposition from Twitter users. Policymakers should anticipate the types of negative responses that policy proposals will receive on social media. Public health officials should deliver clear messages and cite evidence to counter the non-factual claims made by Twitter users, but also address any legitimate concerns with appropriate policy responses.¹⁶ Future research can continue monitoring and addressing social media policy advocacy strategies to understand how they may influence the development of and support for effective public health policies.