Response to Tobacco Free Ireland 2025: SimSmoke prediction for the end game

Abstract

Dear Editors, Li and colleagues are to be commended for their recent article 1 that uses the SimSmoke simulation model to predict that Ireland will fail to meet its target of being smoke free by 2025, which it defines as having a smoking rate of less than 5% 2. It is hoped that, despite the limitations inherent in any predictive computer modelling, their quantitative analysis of the forthcoming failure for Ireland to meet its own targets will spur the Irish Government into assertively tackling the tobacco epidemic in a more robust manner. Smoking remains a significant issue in Ireland, with The Tobacco Atlas estimating 5600 deaths per year from tobaccoinduced diseases and an economic cost of €2826 million associated with smoking for Ireland 3. The present response aims to elaborate further on some of the issues raised by Li et al. 1 , and to outline some areas of further vulnerability in Ireland's attempts to reduce smoking. Li et al. noted the higher smoking rate of Polish immigrants in Ireland 4. The Poles are Ireland's largest group of non-Irish nationals 5. However, it is perhaps also important to acknowledge the potential relevance of the high rate of smoking in Lithuania 3. Although data is lacking on smoking prevalence among Lithuanian immigrants in Ireland, smoking rates in Lithuania are significantly higher than in Ireland (38.1% among males and 22.2% among females), with Lithuanians being Ireland's third largest minority. It should be noted that a basic single ticket from Dublin to either Poland or Lithuania can be purchased routinely from a budget airline company for only €19.99. Thus, immigrant groups have potentially easy access in their country of origin to cigarettes and tobacco at a fraction of the price in Ireland and without the plain packaging requirements mandated by Irish legislation. One development that is not considered in the SimSmoke simulation is 'Brexit'; the United Kingdom's imminent exit from the European Union. It is noteworthy that repeated investigations into the illicit tobacco trade in Ireland have highlighted the significance of its magnitude 6. A government survey in 2016 estimated that the illicit cigarette trade in Ireland exceeded 20 million packets per year, representing approximately 5 packets for each man, woman and child 7. It should be noted that prosecutions related to illicit tobacco trade and smuggling in Ireland are extremely rare 6 , despite the high volume of such products consumed 6. Although it must be acknowledged that tobacco industry assessments of the scale of the illicit tobacco trade consistently overestimate the size of the problem 8-11 , it is still estimated that illicit cigarettes constitute 4.9% of all manufactured cigarettes smoked in Ireland 11. The potential impact of 'Brexit' is crucial given that previous investigations 12 on the impact of smuggling and the cross-border trade with Northern Ireland, which minimised this issue, were conducted in an era of large-scale ceasefires, political progress, a functioning Northern Ireland Assembly, and an o...

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