New Delhi: The American Journal of Public Health (AJPH) has recently published a paper that could be a trendsetter across the world for governments grappling with nicotine and tobacco issues.
The paper is significant for countries like India, identified as one of the world’s biggest consumers of tobacco.
Titled, Balancing Consideration of the Risks and Benefits of E-Cigarettes, the paper has been written by 15 past presidents of the Society for Research on Tobacco and Nicotine (srnt.org), the world’s leading professional scientific organizations.
The authors have assessed the health risks of vaping, the likelihood that vaping increases smoking cessation, the principal concerns about youth vaping, and balancing concerns about risks to youths with potential benefits for adults who smoke. The findings were indeed interesting.
The paper, a copy of which is with this reporter, says the following: “While the nation focuses on the risks of e-cigarettes for youth, ignoring the potential of e-cigarettes to aid adults in quitting smoking may come at a high cost to public health.”
“Most U.S. health organizations, media coverage, and policymakers have focused primarily on risks to youths. Because of their messaging, much of the public—including most smokers—now consider e-cigarette use as dangerous as or more dangerous than smoking. By contrast, the National Academies of Science, Engineering, and Medicine concluded that e-cigarette use is likely far less hazardous than smoking. Policies intended to reduce adolescent vaping may also reduce adult smokers’ use of e-cigarettes in quit attempts.”
Scientists are unanimous that e-cigarettes use can increase the odds of quitting smoking. Many scientists, including this essay’s authors, encourage the health community, media, and policymakers to more carefully weigh vaping’s potential to reduce adult smoking-attributable mortality.
“Research comparing vaping’s risks for youths with potential benefits for adult smokers has found the latter to dominate, potentially avoiding the smoking-produced loss of tens of millions of life-years. We believe the potential lifesaving benefits of e-cigarettes for adult smokers deserve attention equal to the risks to youths,” says the paper.
The totality of the evidence indicates that frequent vaping increases adult smoking cessation, claim experts. Smokers unable to quit smoking with evidence-based cessation methods should be well informed about the relative risks of vaping and smoking and vaping’s potential to help them quit smoking, the experts claim.
While the long-term health consequences are unknown, completely substituting vaping for smoking likely reduces health risks, possibly substantially.
“While flavor bans could reduce youth interest in e-cigarettes, they could also reduce adult smokers’ vaping to quit smoking. Like youths, adults prefer non-tobacco flavours, both groups favoring fruit and sweet flavors. Policies regarding flavors reflect the more general issue considered in this article: the need to create a balance between the sometimes-conflicting goals of preventing youth vaping and supporting adults’ smoking cessation attempts, particularly for smokers unable or unwilling to quit otherwise.”
In India, e-cigarettes remain under a government ban though there are reports that the government could take a renewed look at the tobacco market if the FDA of the US takes a call on tobacco and e-cigarettes.
In other parts of the world, governments are already making their own changes.
The New Zealand government recently approved a new regulatory framework for e-cigarettes and heated tobacco products: the Smokefree Environments and Regulated Products Act. One of its official purposes is to “support smokers to switch to regulated products” that are “significantly less harmful than smoking.”
The move, claim tobacco experts, is significant. The new law embraces two principles to help reach the target of a smoke-free country by 2025— defined as when 5 percent or less of the adult population smoke. It continues to set strict regulation for combustible tobacco products while setting a differentiated treatment for regulated vaping products, in recognition of their potential harm reduction benefits compared to cigarettes.
The intention of the legislation—to move smokers away from combustible products—is succinctly summed up in notices that can be displayed by retailers, instore or online.
Significantly, the New Zealand government has decided that heated tobacco, as a smokeless product, will now go out of standardized packaging with cigarette health warnings into branded packaging with a text warning differentiated from conventional cigarettes.
It is worth mentioning here that New Zealand is not a perfect regulatory model, and its precise policy mix may not be an appropriate model for every market. However, the intent of the legislation makes it global best practice.
What is important is that New Zealand has clearly and explicitly rejected the WHO’s position that devices should be considered as a tobacco product and regulated equally to cigarettes.
The WHO predicts that there will continue to be over 1 billion smokers into 2025 and beyond. That means many smokers will not benefit from tobacco control measures to curb adoption and increase quitting.
All eyes on big tobacco debate
A growing number of governments are now complementing traditional tobacco control measures with a harm reduction approach, i.e., providing adults who would otherwise continue to smoke with scientifically substantiated less harmful products.
Since its policy announcement in July 2017, the FDA has been outspoken about its support for alternatives to cigarettes for adults who want access to nicotine through smoke-free products. It recognizes that the primary cause of harm from smoking is burning, not nicotine. “Nicotine, while not an entirely benign substance, is not directly responsible for the cancer, lung disease, and heart disease that kill hundreds of thousands of Americans each year,” says the FDA.
The agency has been clear that measures intended to more drastically reduce smoking should be complemented by providing adult smokers who would otherwise continue with better, innovative, science-backed alternatives.
In July 2017, the UK Department of Health released its five-year tobacco plan for England, in which it aimed for a 12 percent smoking rate by 2022.
The government acknowledged the role that science-backed innovations can play in helping to achieve that objective, by helping adult smokers switch away completely from cigarettes.
Since 2017, the U.K. government has actively encouraged smokers to consider using e-cigarettes as a way out of smoking, including through its annual Stoptober campaign, a month-long national stop smoking challenge. Subsequent annual evidence reviews by Public Health England have continued to validate the important role that e-cigarettes can play in moving adults away from cigarettes.
Countries like Italy, Norway, Greece, Portugal and Uruguay are evaluating data and scientific studies with a view to establishing the reduction of toxic components, the potential risk reduction of novel tobacco products compared to combustible tobacco products, as well as the associated labelling methods.
More importantly, the European Union is also supporting special rules for electronic cigarettes. Before 2016, electronic cigarettes were banned or effectively banned across nearly half of the EU. The revised EU Tobacco Products Directive adopted that year lifted those bans and recognized that e-cigarettes and novel tobacco products were different from cigarettes by creating separate regulatory categories with customized rules, for example regarding health warnings.
All eyes are now on India, one of the world’s biggest markets for tobacco.
