Thank you. [applause]. [background sounds]. Good afternoon everyone, im kate brown, im governor morgan and chair of the mba health and human services. Thank you governors for your great remarks and i appreciate everyones patience as we took such 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. That is the nicotine epidemic. In the Health Crisis 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 National Attention this last summer, we learned of the outbreak of lung injuries and deaths associated with ecigarettes, and vaping products. Many of this product may contain nicotine in addition with other chemicals. As of january 21st, 2020, until 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 blakey, president of the Public Health law center ns myers, president and ceo 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. They know others of you are saying 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 congress and the administration taking action. And wearing what 19 states in the district have already done to curb this crisis. [inaudible conversations]. Really good first step and unlike many of you believe that or 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 mans in the 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 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 improve rules for product testing and labeling and last week, i convened the first meeting morgan vaping like help group, to address the epidemic of vaping related illness in youth vaping in oregon. So would love to turn the conversation over two oh Ohio Governor of hawaii for opening remarks and will turn it over to our ellis. Senator brown, thank you very much. In ohio, we also raised the smoking age to 21. We raised the age of two vaping 21. We started for the first time actually taxing vaping as well. Were putting a lot of emphasis in regards to all addictions and education. We are doing something that is not been done at least in ohio before. We set aside six or 75 million for schools for wellness and certainly social and emotional learning. And certainly, big umbrella would certainly cover vaping in the ecigarettes is full tobacco. And really, i think that the vaping is to separate problems. Once an immediate problem that we see. Within about a hundred people so far we know of is been hospitalized in ohio with some fear respiratory problems because of vaping. Thats what we see and 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 period of time, but in the last several years, we are starting to really completely reverse that. Missing up to 25 percent of our teenagers who are vaping, becoming addicted to nicotine. What were saying, is there really are taking a playbook from big tobacco. Using the same techniques that tobacco use for many years to edit young people and get young people. 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. The really addicting a new generation. Same tactics of big tobacco use. The 30 flavors, doing all of the things he could to make it look cool. The device that looks like a flash drive. Not only does it look cool but its also pretty easy to hide from parents or teachers. As a very sophisticated marketing technique that very tragically is working very well. I thought the efforts to federal government has made, i think its a good beginning, we could probably go a lot further. In closing some of the loopholes there there. Released coming down the pathway. This is a huge challenge. If we look at the ramifications, 25 percent of kids becoming addicted to nicotine. We know how very addictive nicotine is. So very frightening thing. What longterm health of locations and certainly longterm implications in regard to medicaid for example. And the medicaid possibly face any state. Thank you governors in the nj for the opportunity to be here. My name is doug and 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 your Legal Counsel is russell 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, we truly believe that this laboratory of our democracy and is where we experiment until we get it right by the path forward for the nation. Theres nowhere that can be true then were virtually every major investment in history is originated at the state and local level. Never have we needed more 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 and children. A lot of blood sweat and two years people in this room, i know what that down to 5. 8 percent. Money been being single victory was almost within reach. If he cigarettes had not exploded upon the scene the last five years. Driven by slick design, fancy flavors that attract kids, and technology that allows nicotine for can make twice as potent as an cigarettes. We have now suddenly reached the point that well cigarette smoking is down to 5 percent, the use of ecigarettes is out there at 28 percent and continuing to grow. So we have to do something about it. My focus afternoon is going to be on balance between the federal responsibilities the state responsibility. Spent a decade decade now since Congress Gives the fda authority over Tobacco Products. In that time, but weve had is kind of a dance between fence and state to figure out the respective roles that each should play. Going to speak to the two latest steps in the dance. The new federal legislation raising the age of sale 221. In the amount or the announcement of last month by the fda by new enforcement policy unflavored ecigarette. 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 in case. 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, he just has to be said that theres going to be him out of confusion in most every state as this gets implemented because in most states, the 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, immediately. It is the law now. What is it say, says 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. While the fda will be enforcing before september when they have completed writing roles for enforcement. Can you enforce it. Well, if you enacted the law which is enacted within the law, you can enforce it. 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 dissipate some questions involving what is called signer checks. If youre not familiar with that term, energetics arts since testing done synonymously that is required for you to continue to receive more federal law grants substance abuse. From santa and this may be done by the bunker for an agency in your State Government decreases by others and those not begun using someone to stand with her not that aligns with your state statures. There will be some sorting out that has happened. Is her way to clear it up. Yes. You get your legislature to bring you into alignment with the fence. And maybe speaking to that. Let me now turn to the other development. The newly announced enforcement policy from the fda with regard to flavored he cigarettes. The first thing i would like you to know is that this new policy is actually fda enforcement policy. It is not a band. And do i mean by that. This most likely would come as a surprise to most people, but the fact is under the federal Tobacco Control act, every ecigarette on the marketplace today, is in the market on lawfully. Let me repeat that. Every ecigarette in the marketplace today, is there unlawfully because you call them undocumented. License 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 is happened now with this new policy is a change. In the position and who said that theyre going to use their Enforcement Discretion differently there was are going after he cigarettes. The new policy as i say, is one use indiscretions to go after some products, some flavors and eisai kind of picking winners and losers as to who they are going to go after. It does allow me to go through all of the specifics of who it is because of time. But i can say this. The main cause of debating epidemics, is the polar air freshener all these flavored products. More than a thousand different flavors. Our appealing targets and not just familiar flavors like mental, and 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 the last year back and forth, the components of any changes, organized came and put pressure on the fda after it developed its policy. Manufacturers of these products, Tobacco Companies and as a result after a year of going back and forth, the empty has announced the policies that i can only describe as a bit of a mishmash pretty saying that they will act against some flavors and some types of products but not others. The reason we have this bit of a model is due to an understandable instinct on the part of the omb as they review 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 the kids make looked at the latest surveys and then try to target the types of products and flavors that they felt were most popular. In the end, its a 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 the 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 ready. And teen Drinking Program to ban preach brandy. Well that would be great for the first week. But you think the 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 legislature for solution talk about. An unpleasant, i couldnt get up the stage with also inviting the governors to think nominally about these immediate problems, just to back and think about a much bigger problem. If you address this issue, you will take an important bite out of his tobacco epidemic but we 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 and we have 500,000 americans dying every single year from this product. And no end in sight. And honestly doubt there is a Single Person in this room of any political philosophy, who was to see her grandchildren and great grandchildren grow up in a world surrounded by these addictive and deadly products. At home once the nda to be reconvening 50 years from now, with another workshop on what to do about Tobacco Products. But with constituency or trust, and you might just find this is one of those areas that the public might be out there ahead of the political professionals that the policy once. Thank you much. Thank you very much doug, match take it away. My name is matt myers im the president of the campaign for free kids. Thanks for the opportunity. We come at a time where there really is a crisis. And i want to thank governor baker and frankly a host of other governors here who have highlighted the importance that this has been taken and the strong action. You have heard numbers, but they are really important. Between 207 and 30 of all kids in the United States are currently using e cigarettes. Whats particularly disturbing is if you look at that population, and 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 detail 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 of 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 in some type of ecigarette solves the problem that doesnt thats why states like massachusetts and new jersey who have recently banned the flavor of ecigarette, 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 ecigarette needs to be a very high priority from a Public Health standpoint. Dont kid yourself, the only ecigarette the kids use our flavored ecigarettes. The dated that gets reported by extraordinary high and one study says 97 is actually low. You wont find a kid who uses a non flavored ecigarette. The industry knows it. Second, what is the new federal action actually covered . It only covered the ecigarette that come enclosed pods that already have flavored nicotine and them. What doesnt cover . That is very important for you to understand. I have in front of me as series of products that are called disposables. What they call him a 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 jule. That means that addiction potential is massive and doesnt 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 e cigarettes. 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 band. 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 arent 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 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. I think another point that i want to make in regard to it, i have worked on tobacco related issues for over 35 years. 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 from 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. If 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. Its your responsibility your opportunity here. Last year alone, one and a half million kids became addicted to e cigarettes in the year before. The year before that a million and a half more kids became addicted. We have more kids addicted to nicotine today, then 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 cigarettes are 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. 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 want to say, i think all of us in the Public HealthCommunity Stand ready to help you. Any conceivable way that we can. This is one of those issues that what you do over the next 12 to 204 months, will impact the health of our children for the next 20 years. Thank you. Thank you very much for your very insightful information. Let me do one click show intel. 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 as a cosponsor that henry waxman built ten years ago they 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 wacko 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 due to the way that doesnt 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 theres model legislation to do it. Too, if you have the authority to do so, the reality is the crisis is also been 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 and 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 use crisis we have seen. It is in part because they limited to 20 milligrams of nicotine. Milliliter, jule has 59 milligrams. Milliliter. And several of the products ive shown you here, all of which are made in china, to reference back to 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 experimented dont 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 aped with a ship showed up with a long injury because it never occurred to them that might have caused it. Once they started at sea and calm the numbers started to climb. At the end of september we had a bunch of people in pediatricians, researchers, and 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 vaporizin vaporizing, pulling into your lungs, which are not built to deal with the code and the first place, and then pushing it out. Theres a lot of evidence than about the legal products in the 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 talked a lot about what to do and decided to put temporary ban in place, 40 days, which was admittedly a big stroke of action. But honestly, i couldnt 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 would say, there are a lot of people who are really unhappy with me when i did this and i heard from them. But the thing you should know, parents, teachers, school nurses, almost anybody in the medical community would literally chase me down on the street or in the hallway or in a restaurant, and gave me a hug and thanked me for what i was doing. The people who are closest to this know its an enormous problem. And they were so glad that somebody was finally putting it in front of the public. Our legislature acted within 30 days of us executing the ban and our legislation bands flavors, really restricts where you can purchase these products with over 21 locations, and gives the department of Public Health the ability to create a sort of Public Campaign that lays out a lot of the issues associated with the dangers with vaping are. But the most compelling comment i got from that first meeting with all those clinicians was a woman who was a cancer dock and her husband was a pediatrician. She said her kids believed that vaping was safe. Not safer, safe. And i think one of the greatest challenges we have in this space is to help people understand that really easy to use, Nicotine Products that deliver a pack and a half of nicotine and a cartridge, probably arent safe. In addition to some of the issues associated with what we dont know yet about longterm use associated with vaping. Thank you governor, your leadership on this issue is critical. The other reason to get rid of flavors is flavors are part of what makes a kid think its safe. If it tastes sweet and goes down smoothly, how harmful can it be . The Surgeon General in january issued a report, these are not safe. Theres a lot we dont know but what we do know is inhaling high doses of nicotine was particularly with young lungs is by nature harmful to the longterm health. The other thing is these are perfect Drug Delivery devices. No one should kid themselves that these devices are out there. Kids are going to figure out what else goes in them, so that the crisis we had last summer may or may not have been largely caused by other substances in it. But if you have a device that delivers substances as well, you can be pretty sure somebodys going to figure out how to deliver it. Thank you. Governor lamont you have been very active please tells what youre doing in her home state of connecticut. I thought cigarette addiction was may be behind us ten years ago and now i see it has just been turbo charged by the vapes flavor babes, and the explanation of how powerful and addictive this is. Governor baker said a lot of people think its safe. I think were sending a mixed message out there right now. I love would love the fda be bold and clear what we can deal will be cant do, what is safe to what is unsafe, some people think his prey safer than cigarettes or get you off of cigarettes, its mixed messaging out there. One of the things i am trying to do because i come from a small state, is work with charlie and Governor Cuomo and work with tom wolfe and some of our neighboring states to see what we can do on a regional basis. What i can try to outlaw inset 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. Meyer said, theres a good year in and yeah and between states laboratories democracy the feds, and 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 enacted, rhode island we are having an emergency rule in place that will hopefully become permanent, hopefully with connecticut. Near city recently banned these and anyone under new did new jersey do it to . New jersey already did at the second week of january of this year new jersey did it. And legislation has been introduced in maryland, delaware, the district of columbia. We have the potential to have real change and have the impact of it. And hopefully, thats only the beginning. 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 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 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 a crisis. The mere existence of flavored vape liquid in the market creates immediate peril to use and no other administrative act to remove it from the hands of youth. Seven and they want 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 as afternoon for the 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 governors joining us and room to zero six at governor hovens chairs Initiative Advisory council roundtable. And with that we are actually adjourned early, so please enjoy your few minute break and we will see you all at the chairs initiative roundtable. Thank you all very much. [background noises] [background noises] morn out from the National Governors association with a look at infrastructure and economic prosperity. During this portion premieres from canada their infrastructure priorities and offered ways for the u. S. And canada can Work Together on issues like the environments, trade, and energy. This is 40 minutes