The battle over flavoured vapes in the US has intensified after the head of the Food and Drug Administration (FDA) resigned following reported clashes with Donald Trump over whether fruit-flavoured products should be approved.
Marty Makary stepped down as FDA commissioner after 13 months in the role, with Kyle Diamantas named as acting replacement. According to reports, Trump had signed off on a plan to fire Makary after criticising him for not approving fruit-flavoured vapes.
Makary initially overrode agency scientists to halt approval of the first fruit-flavoured vapes on the market, before the FDA later said approval would move forward.
Trump told reporters at the White House that Makary was “a great guy” but “was having some difficulty”. In a Truth Social post, Trump thanked Makary “for having done a great job at the FDA”.
Smoking falls as vaping rises
The leadership change comes as new figures from the National Center for Health Statistics show 9.9 per cent of US adults smoked cigarettes in 2024, while seven per cent used vapes.
The report, based on the 2024 National Health Interview Survey, said cigarette use among adults has decreased, while vape use has increased.
It states that cigarette smoking is the “leading preventable contributor to disease and death” in the US and causes various cancers and diseases, along with exposure to secondhand smoke.
The report also said vape use has been linked to respiratory, neurological and cardiovascular effects, citing a 2023 review, but it did not examine the strength of that evidence in detail or compare those risks with smoking.
Rural adults more likely to smoke and vape
The data also shows smoking and vaping are both more common among adults living outside large cities.
Cigarette use was eight per cent in large central metropolitan counties and large fringe metropolitan counties, rising to 11 per cent in medium and small metropolitan counties and 15.4 per cent in nonmetropolitan counties.
Vape use followed a similar pattern. It was 6.1 per cent in large central metropolitan counties, 6.7 per cent in large fringe metropolitan counties, 7.3 per cent in medium and small metropolitan counties and 9.2 per cent in nonmetropolitan counties.
Among adults aged 18 to 24, vape use was highest in nonmetropolitan counties at 20.6 per cent. It was 11.5 per cent in large central metropolitan counties, 16 per cent in large fringe metropolitan counties and 14.9 per cent in medium and small metropolitan counties.
Political reaction divided
Makary’s departure drew sharply different reactions from politicians.
Democratic senator Dick Durbin said Makary had resisted Trump’s plan to “expose millions of children to the dangers of vaping”.
Republican senator Josh Hawley called the resignation “welcome news”, although his criticism focused mainly on Makary’s handling of abortion-related issues at the FDA.
Makary’s resignation leaves another senior health role in flux at a time when the Trump administration is also waiting to fill other key public health posts.
FDA direction now uncertain
The FDA has been under pressure over a range of decisions, including drug reviews, vaccines and nicotine products.
The dispute over fruit-flavoured vapes has put renewed attention on how the agency weighs adult smoking, youth vaping and the legal market for nicotine alternatives.
