Dear Editors,

Li and colleagues are to be commended for their recent article1 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 tobacco-induced diseases and an economic cost of €2826 million associated with smoking for Ireland3.

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 Ireland4. The Poles are Ireland’s largest group of non-Irish nationals5. However, it is perhaps also important to acknowledge the potential relevance of the high rate of smoking in Lithuania3. 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 magnitude6. 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 child7. It should be noted that prosecutions related to illicit tobacco trade and smuggling in Ireland are extremely rare6, despite the high volume of such products consumed6. Although it must be acknowledged that tobacco industry assessments of the scale of the illicit tobacco trade consistently over-estimate the size of the problem8-11, it is still estimated that illicit cigarettes constitute 4.9% of all manufactured cigarettes smoked in Ireland11.

The potential impact of ‘Brexit’ is crucial given that previous investigations12 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 open border. The prospect of border controls between Northern Ireland and the Republic of Ireland may foster political instability and paramilitary activity, particularly in the context of the current impasse in Northern Ireland politics. It is important to note that the illicit tobacco trade has long been linked to paramilitary activity, including that of groups in Ireland13-15 and elsewhere16. Paramilitary groups often have the infrastructure, networks, resources and the drive to develop production and importation of illicit goods, including cigarettes15-16. Concern about illicit tobacco products has already been raised among many retailers in the border region17, a contested area with a long history of lawlessness and ineffective policing18-19.

The verdict of the SimSmoke simulation of Ireland’s impending failure to reach its 2025 Smoke Free target is undoubtedly correct. However, the simulation may, in fact, significantly over-estimate the future decrease in tobacco consumption rates in Ireland. One determining factor for such an over-estimation arises from Ireland’s population becoming increasingly diverse, with some immigrant groups having relatively easy access to cheaper cigarettes in their country of origin. A second factor for an over-estimation in the decrease in tobacco consumption is the potential growth of political instability and paramilitarism as a consequence of ‘Brexit’ that may result in an increase in the illicit cigarette trade.