London meet urges governments to regulate, but not ban, e-cigarettes to fight smoking

Public health experts, scientists and anti-tobacco campaigners from the United States, Europe, and Asia have called on the authorities to regulate e-cigarettes instead of banning them outright amid a vaping backlash.

Taking the abrupt path in banning vaping will take away a “much less harmful” alternative to smoking tobacco and a critical tool in the fight against smoking, they said at a high-level gathering in London in November.

Worse, they warned, it may encourage a booming black market of poor-quality products to emerge putting the health of a far greater number of people in danger.

The experts pushed for legislative measures that would regulate the use, sale and distribution of electronic nicotine delivery system (ENDS) products, which are being promoted to reduce harm caused by tobacco products and for smoking cessation.

They pointed to the absence of regulation in the US which means there is no cap on nicotine levels in e-cigarette liquids, making stronger doses more addictive. The UK, thanks to the EU directive, has a strict limit - 20 milligrams per millilitre. That is lower than some products sold by Juul in the US and Canada, which contain as much as 50 milligrams per millilitre.

The experts presented their cor­roborating findings that e-cigarettes and vapes are an effective method to reduce tobacco harm and make smokers quit during the recent 7th annual E-Cigarette Summit: Science, Regulation & Public Health held at the Royal Society in London on Nov 14.

The e-cigarette industry has been on fire as it has been wildly popular with the young people. The global market for e-cigarette is now estimated to be worth $19.3 billion or £15.5 billion, which was only $ 6.9 billion or £5.5 billion only five years ago.

INDUSTRY UNDER FIRE

It was pointed out in the conference that New Zealand reversed a ban on these devices in 2017 and a year later, Canada also legalised e-cigarettes based on the research evidence.

In starkly contrasting moves in Asia, India has banned e-cigarettes warning of an “epidemic” of vaping among young people, while China is taking steps to regulate its blossoming vaping market.

Bangladesh plans to prohibit the sale and use of electronic cigarettes and vaporisers, Reuters news agency has quoted the health secretary as saying on Sunday.

The potential of e-cigarettes as a way to wean people off traditional cigarette smoking habits has been touted for long but their popularity has exploded in recent years, marking an increase in teen vape users.

An outbreak of vaping illness has swept across the US where as many as 40 people have died and over 2,000 Americans affected by lung injuries until November attributed to vaping, according to the US Centers for Disease Control or CDC. The cases appear to involve illicit e-cigarettes containing cannabis and vitamin E acetate, which is used to thicken the vaping liquid.

More than half of those affected are aged between 13 and 24 years. Some researchers support the use of vaping to help adults quit smoking while others have shown that e-cigarettes are just as addictive as traditional ones.

There are concerns that e-cigarette use is surging among teenagers, with millions of them flirting with nicotine addiction, encouraged by flavoured vaping products.

But Public Health England or PHE’s lead on tobacco control, Martin Dockrell, says there is no evidence that flavours are leading kids who don't smoke into vaping, but there is evidence that they are part of what helps smokers to switch.

Government policymakers tend to respond to the public cry to “Do something!” but that something can have unintended consequences—especially if it’s not an evidence-based response, the London conference heard.

While a flavour ban might cut down on some of the teen appeal of e-cigarettes, experts warned, it will not do anything to make the black market safer. What’s worse, it might even drive customers there.

UP IN SMOKE

Smoking is the biggest single cause of avoidable death in the developed world with almost 1 billion users worldwide. The devastating effect of long-term smoking sees approximately half of all lifetime smokers dying from smoking related diseases and many more suffering a compromised quality of life.

Despite decades of tobacco control efforts and public health education on the harms of smoking, the decline in smoking rates has been frustratingly slow.

The growth of e-cigarette over the last seven years has been an unfolding phenomenon. The public health response has ranged from enthusiastic support to vigorous opposition as scientists and regulators grapple to find the most appropriate response.  Their verdicts will probably feature among the key public health decisions for ages.

The E-Cigarette Summit included high-level briefings from experts and encouraged interaction through panel debates and open floor discussions. Questions were explored in a balanced and objective environment allowing attendees to build their knowledge and share their viewpoints.

Banning e-cigarettes and vapes would reverse the positive results of the global tobacco harm reduction efforts, said Martin Jarvis, a health psychology professor at the Univer­sity College London, during a press conference.

Jarvis did not believe ENDS products are as harmful as combustible cigarettes and should be regulated. He said the ban would send some people back to smoking or introduce them to tobacco if they had not smoked before.

He said the pulmonary diseases have nothing to do with nicotine delivery.

Konstantinos Farsalinos, a pharmacology professor from the University of Patras in Greece, said it was hard to determine what caused pulmonary diseases of e-cigarette users since most of these sick people were also tobacco or cigarette users for an extended period.

He said arterial stiffness, which in studies is called the acute effect of vaping use, could also be acquired through the intake of caffeine.

This was also the belief of Professor Tikki Elka Pang­estu from Lee Kuan Yew Public Policy School of the National University of Singapore.

Pangestu said the cause of the illness and death in the United States is not vaping, but the contaminated cannabis oils purchased in the black market which were not subjected to quality control.

A study by PHE, which is supported by similar studies in other countries cited by Pangestu, showed that vaping is 95 percent less harmful than burning cigarettes.

THE GREAT DEBATE

For the uninitiated, e-cigarettes or vapes are battery-powered devices that contain a liquid, which is often flavoured and usually contains nicotine.

They give smokers the nicotine they crave but without the cancer-causing substances that come from burning tobacco. They do not use tobacco leaves, unlike regular cigarettes.

More than 3.6 million people in the UK now use e-cigarettes, according to Action on Smoking and Health, or ASH, a public health charity in the UK that works to eliminate the harm caused by tobacco.

Professor John Newton, director for health improvement at PHE, said at the gathering: “PHE has always been clear that vaping is not without risks. If you don’t smoke don’t vape.

“But if you smoke there is no situation where it would be better for your health to continue smoking rather than switching completely to vaping. The sooner you stop smoking completely the better.”

“UK regulated e-cigarettes carry a fraction of the risk of smoked tobacco. This view is held by many across the world, including the Royal College of Physicians, Cancer Research UK, the British Medical Association and the National Academy of Sciences in the US.”

“What we risk right now is the potential for inadvertently sending some people back to smoking, or to smoking if they haven’t smoked before, because of the effort to stringently crack down on e-cigarettes,” Cliff Douglas, the director of the centre for tobacco at the American Cancer Society, told the conference.

“Right now, we’re at risk of actually interfering with our efforts to reduce smoking and stalling what has been the most successful public-health campaign in modern time, which is to reduce the tobacco epidemic.”

Many health experts believe it is too early to assess the long-term impact of vaping, and some studies have linked e-cigarettes to heart and lung problems.

Despite the concerns about vaping, researchers such as Ron Borland, a professor of health behaviour at the University of Melbourne in Australia, told the London conference that nothing compares with the dangers of tobacco.

Smoking kills about 100,000 people every year in Britain, he said. Vaping products “are not going to kill anywhere near as many people as cigarettes. Smoking is like no other problem”.

VARYING VIEWS

Deborah Arnott, chief executive of Britain’s largest anti-smoking organisation, ASH, said: “E-cigarettes are legal for people 18 years old and over to purchase, and they are also the most popular aid to quitting smoking in the UK.

A leading figure in the UK's tobacco control movement, she added: “The latest evidence is that between 50,000 and 70,000 people quit smoking due to their use of e-cigarettes in 2017 alone. Nicotine Replacement Therapy is available on the shelves and over the counter, and e-cigarettes should be too.” 

Officials in the UK worry that the outcry in the US will ruin efforts to reduce smoking. “What we’re seeing in the US is an acute outbreak of what looks like some adulterated product. It’s not a result of mainstream vaping,” continued Arnott.

She added that there are 3.6 million people in Britain who use e-cigarettes, and 80 percent of them have been vaping for more than a year.

“Vapers should not be scared back to smoking by the news of vaping illness in the U.S. Nor should smokers stick to smoking rather than switch to vaping.”

In Bangladesh, tobacco claims 161,253 lives annually, accounting for 19 percent of all deaths, according to a WHO estimate of 2018 -- the latest figures available.

Dr Mithun Alamgir is convinced about the benefits of e-cigarettes. He also happens to be the head of community medicine at Enam Medical College, Savar and he says smoking them helps save people from the ravages of tobacco smoking.

"I would say vaping helps one 100 percent in quitting smoking. I can say from my personal experience that it does. I am an example of that. But it's not just me. There are many people in Bangladesh who have quit smoking completely by taking up vaping.

"The government has the right to ban anything it deems necessary. But there has to be a legal framework for that and there must be justification as to why something is being banned."

Continues Prof Mithun: "If the government has the scientific evidence that shows it is more harmful than the regular cigarettes then it should be banned.

"But if there is no scientific evidence to that effect, then it is meaningless to simply follow another country blindly and ban something for which there is no scientific justification,” he argues.

"If the government says vaping is as harmful as regular cigarettes then why not ban both? It makes no sense to have two different standards.”