Depending on who you listen to, it's either a public health solution, or a public health crisis.
And regardless of the answer, vaping is quietly booming in popularity — particularly among young people, who may never have touched a cigarette in their lives.
At the same time, the question of what to do about vaping is on the minds of many in health policy.
Health ministers from across the country are meeting today to discuss the issue, and the TGA recently finished consulting on ideas for a further restrictions on access to nicotine vapes.
It had nearly four thousand submissions from around the country.
The head of the TGA, Professor John Skerritt, has warned that vaping is "emerging as one of Australia's most significant public health problems".
But advocates for looser restrictions point to high schools awash with illegal vapes as evidence the current rules are not working.
And they look across the ditch at New Zealand, where a much more liberal approach has been taken in the hope those looking for a nicotine hit will vape, not smoke.
So what sort of change is needed?
The lay of the land
Under the current rules, nicotine vapes should be pretty hard to access.
They are only available in Australia to adults with a prescription, issued for the purpose of helping a patient quit smoking.
And they are only allowed to be sold in pharmacies, not in convenience stores, supermarkets or service stations like cigarettes.
Those buying them with a prescription also have the option of importing them from overseas, so long as they meet certain TGA standards, and can buy up to three months of supplies at a time.
In its consultation paper looking at potential changes to vaping rules, the TGA acknowledges the current restrictions are not really doing their job.
"Evidence is emerging that the reforms are not meeting these aims. Children and adolescents are continuing to obtain [nicotine vapes] in higher numbers," it said.
It suggests the black market for nicotine vapes in Australia is, in practice, the "dominant market".
That might be nicotine vapes that are imported legally with a prescription, and then on-sold person-to-person.
Or it might be walking into a convenience store and buying a vape that isn't supposed to contain nicotine, but is in fact packing plenty of it.
Numerous studies have found non-nicotine vapes, which are legal in most states and territories for people over 18, in many (or even most) cases turn out to have nicotine in them.
How many people are vaping?
Hard data on the current use of vapes is hard to come by.
According to the Australian National University, as of 2019, a little over one in 10 Australians aged over 14 had ever tried a vape.
And the numbers skew strongly toward younger people — over one third of regular e-cigarette users were under 25, and half were under 30.
The Cancer Council's Generation Vape study looked particularly at teenagers aged 14-17 in New South Wales, who shouldn't legally be allowed to acquire a vape with or without nicotine.
Nearly a third had tried a vape at least once, and more than half of those had never tried a cigarette.
Over half had also knowingly used a vape containing nicotine, and another quarter could not be sure.
By comparison, daily smoking rates have steadily fallen in recent decades, down to 11 per cent in 2019.
People aged between 40 and 60 are the most likely to be smoking each day.
Professor Skerritt told a Senate Estimates committee last week, the growth in vaping is reversing what had been a very consistent trend.
"While we're seeing smoking levels dropping in this country, the total nicotine use in this country is doing something it hasn't done for 50 years. And that's going up," he said.
Different approach across the ditch
Different countries across the globe are taking very different approaches to regulating nicotine vapes.
In more than 80 countries, there are no regulations at all, while about 34 countries have banned them altogether.
In Singapore, for example, vapes are completely illegal with or without nicotine.
Australia and New Zealand have both decided to make nicotine vapes available, but with two very different sets of rules.
Both countries see vapes primarily as tools to help people quit smoking, and discourage those who don't already smoke from taking up nicotine vapes.
But they differ dramatically in how available they make nicotine vapes.
While Australia has pursued a prescription-only model, New Zealand allows nicotine vapes to be sold to people over 18 in convenience stores, much like cigarettes.
Convenience stores can only sell a limited number of vape flavours (tobacco, menthol and mint), while specialty vaping stores can offer a much wider range.
The New Zealand approach prioritises getting smokers off cigarettes and onto vapes, on the grounds that nicotine vapes are far less deadly than tobacco.
Smoking rates are falling, hitting 8 per cent late last year — the lowest level for the country on record, and half what they were a decade prior.
But there has been a surge in vaping, with 15 per cent of those aged 18-24 vaping daily.
Kiwi model controversial
New Zealand's approach is not without its critics.
Janet Hoek is a professor of public health at the University of Otago, and argues making vapes easier to access simply leads to more people vaping, who would not have done so otherwise.
"I think the wide availability of vaping products is one of the reasons why we've seen rising levels of youth vaping," she said.
"And I think if we want to bring down youth vaping, then we really need to think much more carefully about the accessibility of vaping products."
Professor Hoek cites figures from surveys of high school students, finding around one in ten 14 and 15-year-olds is vaping daily, and up to one in four Maori girls in that age group.
She said New Zealand's model is not one she would recommend to Australian lawmakers.
"I think we need to treat vaping products as though they are therapeutic aids, that doesn't necessarily mean that they are a prescription-only product," she said.
"But it certainly means that they shouldn't be an everyday consumer product, the way that they have been treated here."
New Zealand's approach has its Australian advocates, however.
There are some in federal parliament who want to see Australia adopt an identical approach, arguing the current tight restrictions are clearly failing.
Nationals Senator Matt Canavan raised the New Zealand model in a recent Senate estimates, and questioned officials on if and when they were working with their New Zealand counterparts.
Some Australian retailers say it is a strange situation where cigarettes are widely available, but less-dangerous vape alternatives are not.
Theo Foukkare from the Australian Association of Convenience Stores, who has also previously worked in the tobacco industry, said the New Zealand model has some clear advantages.
"New Zealand has a licensed retail framework with really tight standards that manufacturers and suppliers need to adhere to before vapes can even be sold in the market," he said.
"They have done that successfully. They don't have a black market."
Vapes not healthy
Health experts push back on suggestions vaping should be made much more accessible in an effort to drive down smoking rates.
The World Health Organization argues the best option, by far, is none of the above.
"Both tobacco products and [e-cigarettes] pose risks to health. The safest approach is not to use either," it states.
Professor Emily Banks from the Australian National University has led a review of the global evidence on the harms of vaping, and concluded they are quite real.
"Addiction is a significant health harm and nicotine is one of the most addictive substances known," she said.
"People who have issues with addiction are caught in a cycle of withdrawal and craving and then satisfying that craving.
"And because nicotine is metabolised really quickly, people are going through that multiple times over the course of a day."
She said vaping is different in a lot of ways to smoking, and needs to be recognised for its own unique risks.
A single disposable vape can contain as much nicotine as a dozen packets of cigarettes, and Professor Banks said people often consume them much faster.
Professor Banks also said while there is no doubt that vaping is preferable to smoking, the primary concern should be for those taking up vaping without a history of smoking.
"The issue is that most smokers who use e-cigarettes continue to smoke," she said.
"But also a lot of the e-cigarette use that we're seeing is not in smokers, it's actually non-smokers and for them the comparison with smoking is irrelevant. We need to compare how e-cigarettes compare to breathing."
Calls to crack down harder
The TGA's consultation indicates it is looking at tightening, rather than loosening, Australia's vaping regime.
Changes to the prescription-only approach are not on the table.
Instead, it is looking at options like banning personal imports of vapes for those with a prescription, introducing plain packaging for nicotine vapes, and banning flavours other than tobacco.
Two major producers of nicotine vapes, British American Tobacco and Phillip Morris, chose not to make a submission to the TGA's consultation process.
But a spokesperson for British American Tobacco said Australia needs to alter its approach and it would support "strong regulatory action" to make sure vapes are only sold to adults by responsible retailers.
Independent MP Kate Chaney, who represents the Perth seat of Curtin, said the best thing the regulator could do is target vapes claiming to be nicotine-free, as she argues they are doing the most harm.
"I think we need to end the black market in vapes by banning all importation and supplies of e-cigarette products, regardless of their labelled nicotine content, unless they're actually going to a pharmacy for smokers with a prescription," she said.
"If we just ban the lot, there isn't really any compelling reason to have them, even if they don't have nicotine in them.
"That means we can actually then have stronger border controls and enforce that, so that border force can actually intercept any e-cigarette products that aren't bound for the pharmacy."
Labor MP Dr Mike Freelander, who represents Macarthur in south-western Sydney, said the current prescription-only model is a good one, but simply isn't being policed.
"It's a matter of spending money enforcing the rules," he said.
"We have vape shops opening up all over the place, there are several in my electorate.
"One of them has a sign on the outside showing 'why smoke when you can vape'."
He said the rules will work, if the government is willing to properly police illegal imports.
"We need to enforce importation laws around vaping," he said.
"And that can be done but it requires a commitment from government to do so."
