And that is why learning from each other in a bipartisan way is so important. And whether its infrastructure or economic development, there are lessons that we can learn one challenge we all have is Public Health. The vaping crisis is going all across this nation, spreading with a frightening facility among young people. We have two great governors who are going to speak to us about it now. It is my pleasure to introduce governor to wine from ohio and Governor Brown from oregon. [applause] good afternoon and chair of the nba health and human services. Thank you, governors, for your great remarks and i appreciate everyones patience as we took a set break. Im delighted that all of you are here today to join us to talk about a critically important issue that is facing our young people in our state. That is the nicotine epidemic. And the Public Health crisis that we all know is vaping. It is claiming too many lives and is making countless of our Community Members sick. While the nicotine addiction is not a new issue, the vaping epidemic gained National Attention this last summer, we learned of the outbreak of lung injuries and deaths associated with ecigarettes, and vaping products. Many of these product may contain nicotine in addition with other chemicals and additives. As of january 21st, 2020, a total of 2711 cases of hospitalizations have been reported from our 50 states due to ecigarettes and vaping products including 60 deaths confirmed in 27 states and the district of columbia. I am delighted that we have two panelists joining us. Doug blankey, president of the Public Health law center and matt myers, president and ceo of campaign for tobacco free kids. Thank you so much for joining us and good afternoon. [applause] i know that a number of the states are taking very aggressive action on this issue. In oregon, the vaping crisis has been really challenging among our 11th graders we have seen use of ecigarettes increased by 80 percent. Between 2017 and 2019. I know others of you are saying seeing these incredible statistics. Its an extremely costly and deadly epidemic. And i believe we need to take action to assure the safety of our young people, our constituents, our friends and family members. He was very encouraging to see it was very encouraging to see congress and the administration taking action. And mirroring what 19 states in the district have already done by raisings crisis the age to purchase these products from 18 to 21. Last month the fda announced they will begin to enforce policies on the selling of flavors of ecigarettes except for menthol flavors. It is a good step and i like many of you believe there are a few more steps that we can take. So i know a number of you have been extremely active in addressing the vaping epidemic through legislation executive orders, emergency bands, and a number of state actions. In oregon, we raised the legal age to purchase tobacco to 21 and we did that in 2017, and additionally in october, issued i issued issued an executive order to take immediate action on the vaping crisis. We have also strengthen our regulatory system and launched a Public Awareness campaign and improved rules for product testing and labeling and last week, i convened the first meeting of oregons vaping and Public Health workgroup to , address the epidemic of vaping related illness in youth vaping in oregon. So i would love to turn the conversation over to the governor of ohio for opening remarks and will turn it over to our panelists. Governor brown thank you very , much. In ohio, we also raised the smoking age to 21. We raised the vaping age to 21. We also started for the first time actually taxing vaping as well. Were putting a lot of emphasis in regards to all addictions and education. In regard to we are doing something that is not been done at least in ohio before. We set aside 675 million for schools for wellness and certainly social and emotional learning. And this big umbrella would certainly cover vaping in the cigarettes as well as tobacco. And really, i think that the vaping is to separate problems. Once an immediate problem that we see. We have had about a people so hundred far hospitalized in ohio with severe respiratory problems because of vaping. Thats what makes the news. But the longterm problem i think is much more serious. We have made some Real Progress in this country the last few decades in regards to our youth smoking. Numbers have come down dramatically over that. Of time. But in the last several years, we are starting to really completely reverse that. We are seeing up to 25 percent of our teenagers who are vaping, becoming addicted to nicotine. What we are seeing, is they really have taken a playbook from big tobacco. Using the same techniques that they areusing the same techniques that tobacco use for many, many years to addict young people and get young people hooked. This is something that matt myers and i dealt with when i was in the United States senate, we try to deal with those tactics. These folks are very good. Really addicting a new they arereally addicting a new generation. The same tactics big tobacco used. The fruity flavors. Doing all the things they could to make it look cool. They have a device that looks like a flash drive. Not only does it look cool but its also pretty easy to hide from parents or teachers. So this has been a very, very sophisticated marketing technique that very tragically is working very well. Applaud the efforts the federal government has made, i think its a good beginning, we could probably go a lot further. Fda could probably go a lot further frankly in closing some , of the loopholes that are there, or at least moving down the pathway. This is a huge health challenge. If we look at the ramifications, 25 of kids becoming addicted to nicotine. We know how very addictive nicotine is. That is a very frightening thing with longterm Health Applications certainly longterm and implications in regard to medicaid for example. Costs we faceid in each state. Thank you. And over to our panelists. Brown,k you governor and thedewin, opportunity to be here. I lead a nonpartisan, nonprofit legal center in the twin cities where we have 15 attorneys specializing on these issues that we are discussing today. We are ready to help you and your staff and your Legal Counsel as you wrestle with these issues that we are discussing. Our folks are already working with your staff within your Health Department so please let us know how we can be helpful to you. We want to do that because like you and justice brandeis, we truly believe that the states are the laboratories of our democracy. Is where we experiment until we it get it right and find a path forward for the nation. There is nowhere this is more true than in Tobacco Control. Virtually every major advance in history originated at the state and local level. Never have we needed more never have we needed your leadership more than we do now. As the governors have said, this vaping crisis has exploded upon us. For 20 years, and more we made slow painfully slow but steady progress in reducing youth smoking. Twenty years ago when i was relatively new in this field, we had 28 percent of High School Kids smoking cigarettes. A lot of blood sweat and tears by many people in this room, we have now brought that down to 5. 8 . We might be saying victory was almost within our reach, if ecigarettes had not exploded upon the scene the last five years. Driven by slick design, fancy flavors that attract kids, and technology that allows nicotine that can be twice as potent as that in cigarettes. We have now suddenly reached the point that while cigarette smoking is down to 5 the use of ecigarettes is out there at 28 , percent and continuing to grow. So we have to do something about it. My focus this afternoon is going to be on balance between the federal response ability and estate responsibility. It has been a decade now since Congress Gives the fda authority over Tobacco Products. In that time, but weve had is kind of a dance between fence between the feds and states to figure out the respective roles that each should play. I going to speak to the two am latest steps in the dance. The new federal legislation raising the age of sale 221. To 21. And the announcement last month by the fda by new enforcement flavored ecigarettes. First of all, the age of sale. This new federal legislation which is often referred to by the nickname t21, was enacted in december. How does it affect you and your states . What do you need to know and what can you do about it or what do you want to do about it . First of all, it has to be said that there is going to be a certain amount of confusion in most every state as this gets implemented because in most states, there is a state law that doesnt necessarily align with the new federal law. Even if youre one of the states that had gone to 21, you may have exceptions for example for military personnel. So the new federal law enacted in december, when did it take effect . It took effect immediately. It is the law now. What does it say . It says that no one is allowed to buy or sell Tobacco Products of any kind to persons under the age of 21. No exceptions. So it is on the books. When will it be enforced . The fda will not be enforcing it before september, when they have completed writing the rules for enforcement. Can you enforce it . Well, if you enacted the law which is aligned with the federal law you can enforce it. ,if you have a licensing system for your retailers, that makes reference to their duty to comply with federal law, you can consider it a licensing action. Other than that, you no doubt will be in the gray area. You should also anticipate some questions involving what is called sinar checks. If youre not familiar with that term, energetics arts since with that term, the tests are done anonymously and required for you to continue to receive federal grants for substance abuse. Those will now be done using the 21 standard, whether or not it aligns with your state statute. Again, there will be some sorting out that has to happen with all of that. Is there a way to clear it up . Yes, if you can get your legislature to bring you into alignment with the feds. And matthew may speak to that. Let me now turn to the other development. The newly announced enforcement policy from the fda with regard to flavored he cigarettes. Flavored ecigarettes. The first thing i would like you to know is that this new policy is actually fda enforcement policy. It is not a ban. What to i mean by that . This may come as a surprise to most people. Under the federal Tobacco Control act, every ecigarette on the marketplace today, is in the market unlawfully. Let me repeat that. Every ecigarette in the marketplace today, is there unlawfully because you call them undocumented. Why is that the case . Because the design of the federal law once the fda , asserted authority over this product, if the law says nothing is to be sold until information is been submitted to the fda for their review and approval. None of these products have been approved. What is happening instead is that the fda is using its discretion when it comes to enforcement. To say they arent going to enforce that law against most of those products yet. And what has happened now with this new policy is a change. In that position. They have said they are going to use their Enforcement Discretion differently and they will start going after some ecigarettes. The new policy, is one to use their discretion to go after some products. Some of flavors. You could say kind of picking winners and losers as to who they are going to go after. The time today does not allow me to go through all of the specifics of who it is sufficed suffice it to say, the main cause of the vaping epidemic is the proliferation all these flavored products. More than a thousand different flavors appealing to our kids. Not just family are flavors like menthol, but candy and fruit and even flavors like cotton candy or bubblegum flavors of products. As this problem gained more attention, and was considered by the fda for the last year, backandforth, opponents of any changes organized and put pressure on the fda as it developed its policy. Vaped shops manufacturers of , these products, Tobacco Companies and as a result after a year of going back and forth, the fda announced a policy i can only describe as a mishmash. Saying they will act against some flavors in some types of products but not others. Model isn we have this due to an understandable instinct on the part of the omb as they reviewed this process, to try to strike what they felt was a balance between the Health Concerns and voices of those saying that there would be economic consequences to any change. Whether it was really any evidence to back it up. So theres an attempt to strike a balance by targeting certain products on the theory these were the most popular products with kids. They looked at the latest surveys and tried to target the types of products and flavors that they felt were most popular. In the end you could say they may have tried to please everybody and ended up pleasing no one and confusing everyone. The example that comes to my mind is imagine governors, if you are going to address the problems of teen drinking, and you went to your legislature and you said we got a survey that says the most popular kind of liquor with teens is peach brandy. And so to ban preach brandy. Might teen Drinking Program is well that would be great for the first week. But do you think kids might find their way to strawberry wine or cherry vodka . Well, to us thats kind where we are with this new process. The resolution of that, the best resolution is to look back to the states, you and your legislatures for Solutions Matt will talk about. In closing, i cannot give up the stage without also inviting governors to think about these immediate problems, and to step back and think about a much bigger problem. If you address this issue, you will take an important bite out of the tobacco epidemic. But we have been taking bites out of this epidemic for more than 50 years. Since the first Surgeon General report. And here we are, 50 years later with 500,000 americans dying every single year from this product. These products. And no end in sight. Honestly, i doubt there is a Single Person in this room of any political philosophy, who wants to see our grandchildren and great grandchildren grow up in a world surrounded by these addictive and deadly products. Or he wants the nga to be reconvening 50 years from now, with another workshop on what to do about Tobacco Products. So my question for you, is this. Start a time to conversation about where we are going . Isnt it time to think about when and how we will begin a process of phasing out these products altogether, beginning with cigarettes . We will not do it this year. We will not do it next year. But in this century, hopefully, long before the end of the century. Long before the end of our lifetimes. Hopefully, sooner rather than later. And if that still something a crazy proposition, my request to you is to think about that with an open mind. And to float that question with some constituents that you trust. Your staff not your palooka consultants. But with constituents that you trust. You might just find this is one of those areas where the public night be out there i had of the political professionals and policy wonks and the pundits. Thank you by much. Thank you very much done. Matt, take away. Of tobaccoesident free kids. Week tom met a time when there really is an opportunity. At a i want to thank the governors who have highlighted the importance and taken a strong action. You have heard numbers but they are important. Between 27 and 30 of all kids in the United States are currently using e cigarettes. Whats particularly disturbing is if you look at that population, in very large numbers its kids who never would have smoked. Its an entire new population. The other critical fact to understand, is that the ecigarette of today is very different from the ecigarette of five years ago. It delivers nicotine more rapidly, more intensely, and more effectively than and i want to underline this any product ever delivered. So we are seeing a level of addiction among our children. Its not experimenting, kids are starting to use these products believing they are a safe alternative, and finding themselves within a week or two heavily addicted. That tale in high school after high school is i started it because it was cool, and im doing it because i cant stop. States have got to take the lead on this issue. The new federal law raising the age to 21, as it rolls out, is a tool, but it is not a solution. It will help you move forward, and frankly it is the lower right now so that those of you who have contracts with the federal government can begin to report immediately to the federal government, violations. You have to wait for new regulations, it is not complicated. All they have to do is a wordprocessing search and change 18 to 21. And if they were as efficient as Governor Cuomo said they should be, it would happen tomorrow. Equally important, i dont want anyone to be misled into thinking that the partial action taken with regard to some types of ecigarettes solve the problem. It does not. That is why states like massachusetts and new jersey who have recently banned the flavor ed ecigarettes. Rhode island and montana have emergency orders in place to do so. And a number of other states that now have legislation pending or considering legislation pending to ban the sale of flavored ecigarettes needs to be a very high priority from a Public Health standpoint. Do not kid yourself. Useonly ecigarettes kids our ecigarettes. They data that get reported, while store nearly high, in one study it says 97 , is actually low. You wont find a kid who uses a non flavored ecigarette. The industry knows it. Second, what has the new federal action actually covered . It only covered the ecigarette that, in closed pods that already have flavored nicotine them. In what doesnt it cover . That is very important for you to understand. I have in front of me a series of products that are called disposables. Theyre called single use, but thats a misnomer. Each of these is a product to kid purchases for eight to 9, and then throws away after use. But what a single use mean . Each one of these is roughly a pack and a half to two packs of cigarettes worth of nicotine in it. It comes with high doses of nicotine often than juul. That means the addiction is massive the addiction potential is massive. And does it come in flavors . This one is blueberry, this one is mango, this one is cotton candy, this one is pink lemonade. None of these are touched by the new federal priorities. Second, here are two products that are also ecigarettes. You probably would not have known it. Looks like a highlighter a young girl wouldve brought home. Im not sure what this looks like but it certainly doesnt look like in ecigarette. In each case that comes with an empty container, therefore its not covered by the ban. And what is available for this empty containers . Here is a liquid nicotine that you pour into here, this one is cotton candy. Ive got one that strawberry, every flavor you can imagine. These are not covered. What you need to know is over 10 of the kids are already using these products. So that these products will serve as tomorrows product for the kids. It is not going to take the kids very long to figure out that if you like flavored ecigarettes, they are as available today, as they were yesterday. They are not covered by the new and by the time fda gets around theyre not covered by the new fda rule. And by the time fda gets around to it, your kids will be more addicted than you can conceivably imagine. I dont want anyone to think that what has happened here, lessens the need for action at the states and local level. There is another point i want to make in regard to it. I have worked on tobacco related issues for over 35 years. I have worked with then senator dewine for almost a decade to get fda jurisdiction over these products. In those 35 years, i have never seen a crisis hit our teenagers with the depth and breadth and seriousness of the ecigarette crisis. There is not a high school, middle school, or community in this country that isnt facing it. The other thing that is important to understand, is those who manufacture these products and sell them, are very loud and they are a very small number. The reality is, when you actually pull this number, whether you are in a republican or democratic rural or urban, western or eastern state, the numbers show that parents in this country are demanding more action and will favor anybody , who takes action. This one is not a republican or democratic issue, and its not a conservative or liberal issue. Moms and dads across this country are terrified. Partially because of serious lung diseases, but even more so because they are seeing their kids suffer symptoms of addiction and withdrawal more intense, more serious and more immediate than we have ever seen before. So, i have a single caution to all of you. If ever, this was not the time for you to let the federal government take over. Your response ability here. Your opportunity here. Last year alone, a million and a half more kids became addicted to ecigarettes than the year before. They are before that, a million and a half more kids became addicted. We have more kids addicted to nicotine today, than at any time in this century. This is one of those crisis that we know how to reverse it. Enact legislation on your own to raise the age of 21, ban all of the flavored products without exception. What the industry doesnt tell you, is that prior to the introduction of these flavors, those adults who were trying to quit were using tobacco flavor. Therefore, we are not taking products away from them. Last point, the Surgeon General last month issued a report on e cigarettes. What it found was very important. It found that the evidence was inadequate to conclude that ease that ecigarettes are actually effective in helping adults quit. So that by tackling this problem and protecting your kids, you will hear rhetoric. But the data says you are not interfering with the effort of adults who want to quit. To quit. The fda has a role to play there, i hope they play it. But in the end, if action is not taken quickly, we are all going to wake up in ten years and wonder how 30 million of our kids became addicted to these products. I think all of us in the Public HealthCommunity Stand ready to help you including we at the campaign for tobacco free head comeback of free kids. The campaign for tobacco free kids. What you do over the next 12 to 24 months will impact the health , of our children for the next 20 years. Thank you. [applause] thank you very much for your very insightful information. Let me do one click show and tell. Many people think im wearing an apple watch, let me push a button on this watch, pick up the top which actually tells time take it apart, and it is an ecigarette. Put it together, smoke it, and its not covered by the new fda action. So if you want a clue how clever this industry really is, if we dont get ahead of it, boy will they get to our kids quickly. Thanks. Oh my gosh. Holy smokes, i see lots of hands going up. Governor polis. Thank you. I was a cosponsor of that henry waxman built 10 years ago that gave Regulatory Authority on Tobacco Products. In seeing some of the stuff which i had not seen before, the watch and all of that, how do we make sure whatever we are doing, that we are not playing a whack a mole. Where we are doing it around something is vaping and all of a sudden its back in another form and another way we never thought about it. Is it the nicotine content in any medium or is there some way that we cannot just deal with todays and yesterdays problems but do so in pop up the next day a way that it does not pop up the next day in a different way that we never thought of. Its a great question, and there is a series of steps. None of which of our perfect but several of which will guarantee results. One is, you need to ban all flavored ecigarette products and the devices that deliver them. Clearly without exception. I want to credit massachusetts and new jersey, they did a good job, others have got there and there is model legislation to do it. If you have the authority to do if you have the authority to do so, the reality is the crisis is also fueled by the fact that these companies are delivering higher levels of nicotine. In the United States, the nicotine delivered is three times the legal limit of what is permitted in the European Union and the united kingdom. There is a lot we dont know about the perfect level, but we do know that in the European Union and in the uk they are not seeing the youth crisis we have seen. It is in part because they limit it to 20 milligrams of nicotine per milliliter. Juul has 59 milligrams. Milliliter. Per and several of the products ive shown you here, all of which are made in china, to to reference back comments in an earlier session. This has an even higher level of nicotine. So get rid of the flavors because they attract kids. Limit levels of nicotine if you can. So that those kids who experiment become heavily do not become heavily addicted. And have no exceptions. Thank you. Governor baker you have been extremely active. We would love to hear Lessons Learned and any challenges you can share with the rest of us. Well first of all, its funny how these jobs work. You get surprised. On this whole issue with vaping, we just started to see some of the data that was coming out of the national cdc and the fda about injuries and deaths associated with vaping. And then last fall in Early September we started collecting it through our own department of Public Health. One of the things we learned is nobody in the medical community ever asked anybody if theyve vaped, when they showed up with a long injury because it never occurred to them that might have caused it. Once they started the numbers , started to climb. At the end of september we had a pediatricians and and researchers just said tell us what you know. And the overwhelming message we got from all of them, was a vaping, the fundamental act of vaping by itself has risk. Because it is a liquid chemical compound that you are vaporizing and then pulling into your lungs, which are not built to deal with liquid the first in place, and then pushing it out. Theres a lot of evidence than theres a lot of evidence that in the legal products and they black market products, there are microbial toxins in there that are just not good for your lungs. The message they gave to me was you need to do something now. We talk a lot about what to do. We eventually decided to put a ,emporary ban in place, 40 days which was admittedly a big stroke of action. But honestly, i could not figure out any other way to get peoples attention and at the same time create some urgency around doing something. For my fellow governors, i guess there wered say is, a lot of people really unhappy with me what i did this, and i heard from them. But the thing you should know is parents, teachers, school nurses, almost anybody in the medical community would literally chased me down on the street, in a hallway, or in a restaurant to give me a hug and thanked me for what i was doing. To people who are closest this know that it is an enormous problem, and they were so glad that somebody was finally putting it in front of the public. Our legislature acted within 30 ban,of us executing the and our legislation basically bland bands, restricts where you can purchase the products to over 21 locations, and gives the department of Public Health the ability to make sure we create what i would call a Public Information campaign that lays out a lot of the issues associated with what some of the dangers associated with may bring vaping are. The most compelling thing i got from the first meeting with clinicians was a woman who was a cancer doc and her husband was a pediatrician. And she said her kids believed vaping was safe. Not safer, safe. I think one of the greatest challenges we all have in this space is helping people easy tond that really use Nicotine Products that deliver a packet a half aipac and a half of nicotine in a ,artridge are probably not safe along with some of the issues we do not yet know about associated with longterm vaping. Your leadership on this issue is critical. The other reason to get a flavors is flavor is part of what makes a kid think it is safe. And goes downove easily, how harmful can it be . The Surgeon General engine were issued a report. These are not safe. There are a lot of things we do not know. What we do know is inhaling high youngof nicotine with lungs is harmful to their longterm health. The other thing is these are perfect Drug Delivery devices. No one should kid themselves either. If these devices are out there, kids will figure out what else goes in them. The crisis last summer may or may not have been caused by other substances in it. If you have a device that delivers substances this well, you can be sure someone will figure out how to deliver it. Thank you. Governor lamont, you have also very active. Please tell us what youre doing in your home state of connecticut. Thank you, Governor Brown. I thought maybe cigarette addiction was behind his 10 years ago. But now i see it is turbocharged by vaping. I would follow on what governor baker said where a lot of people think it is safe. I think we are sending a mixed message right now. I would love the fda to be boldly clear in terms of what we can do and what we cannot do and what is safe and what is unsafe. People think it will get you off of cigarettes. There is some mixed messaging. I come from a small state. Work with our neighboring states and see what we can do on a regional basis. What i can try to outlaw and set for one small state doesnt make as much sense if you all you have to do is drive 30 miles across the border to take care of that. We will take the lead as mr. Myers said. Hopefully the feds keep following and send a clear message for us. I think that is terrific and there is a real opportunity with massachusetts having acted. Have an island, we emergency rule in place that will hopefully become permanent, hopefully with connecticut. New york city recently banned these. New york state has legislation to do so. New jersey already did it the second week of january of this year. And legislation has been introduced in maryland, delaware, the district of columbia. We have the potential to have real change and see the impact of it. And hopefully, thats only the beginning. The end, as governor lamont said, we all hope the fda would come around so we have a National Solution to this, and we would hope they would do it in a way that is consistent with the underlying premise for the design of regulation. Which should be test the product first before you put it into the marketplace and try it out on our kids. Just as we do with pharmaceuticals or medical devices. Governor bullock. We know in montana about 30 of our High School Students are regularly using vape, 16 of our middle school students. I think we can easily get blinded by statistics. I would encourage any of you to call a School Resource officer or principal and find out what is actually happening in the schools. I decided i could not wait for legislature so i did an emergency rule, and i thank matt for providing his experts because it was also immediately challenged in District Court. We didnt make it about government versus business, we made it about pediatricians and kids. One of the lines from that opinion was despite statements from officials of the federal level that some regulatory action will be taken to address the youth nicotine crisis, none has occurred. The mere existence of flavored vape liquid in the market creates immediate peril to u youth. And no other administrative act to remove it from the hands of youth. If anyone wants to see both the rule of the District Court opinion it has great language about the risks and why we as governors need to take action to reach out, ill be more than happy to get it to you. Thank you, governor bullock. Any comments for panel . Any other governors questions or comments . Well, i want to say thank you to our extraordinary panelists who have joined us this afternoon for their passion and determination. We really appreciate their participation. I want to say thanks to all of you for joining us this afternoon. But i am required to do a Public Service announcement before we close out this particular session. And that is on behalf of governor hogan. We look forward to all of the room 206 joining us in at governor hogans chairs Initiative Advisory council roundtable. And with that, we are actually adjourned early, so please enjoy your a few minutes break and we will see you all at the chairs initiative roundtable. Thank you all very much. [indistinguishable conversations] Congress Returns this week from the president s day recess. Tomorrow, the senate gavels in at 3 00 eastern. Wisconsin governor Tammy Baldwin delivers the traditional reading of washington a pressure yes farewell address. Farewellgtons address. The first votes of the week are expected on wednesday. On the agenda, a bill that would ban the sale of flavored Tobacco Products. Watch live coverage of the house senate. N and the during his state of the state address, Governor Newsom spoke about e