Celebrated by many in the tobacco control field, India with much ado banned the sale of e-cigarettes two years ago. The decision was taken to protect the country’s youth following news from the US about alarming rise in teen use, with the final straw being the spate of deaths there due to e-cigarettes.
Since then, as evidence keeps mounting for the relative safety of e-cigarettes compared to combustible cigarettes, which they are replacing, the reasons provided for the ban appear to be on shaky ground, putting India in a shrinking outlier group of prohibition countries, while over 100 have opted for the regulatory route, which includes the entire developed world, and a host of developing nations from Asia, Latin America to Africa.
Teen use of e-cigarettes fell sharply last year in the US, where vaping is undergoing a formal regulatory process, indicating what was dubbed as the ‘teen epidemic’ was more likely a fad. The concern that vaping leads to smoking is not borne out either as both in the US and the UK where e-cigarette adoption is on the rise, smoking prevalence across all age groups has fallen to historic lows. E-cigarettes are now the most popular stop smoking aid in England, and should therefore be considered as cigarette substitution products rather than being classified under a new category.
The e-cigarette deaths scare in the US was also found to have no connection to nicotine vaping, the product class India banned, which is the result of illegally made cannabis cartridges. As cannabis consumption is already prohibited in India, the ban on nicotine-containing e-cigarettes is therefore a misdirected policy, which is due for course-correction in light of this new evidence.
Further, the tide is firmly shifting towards the adoption of regulatory measures instead of bans which, especially in the context of developing nations like India, lead to more negative outcomes in the absence of enforcement. When use of tobacco products was banned during the first wave of the epidemic, their illegal trade increased tenfold, according to government data. Prohibition of alcohol in Gujarat and Bihar have also yielded poor results. The vape ban has similarly weakened regulatory control by removing the safety net to prevent their sale to minors.
In our neighbourhood, while regulatory mechanisms may vary, there has been an unmistakable tilt towards regulation — China recently announced a regulatory direction for e-cigarettes, while Philippines few days ago passed the final reading of a law to promote them as a harm reduction measure to curb smoking, where lawmakers had also questioned the meddling by foreign groups in their tobacco control policies. Malaysia and Indonesia already have regulatory frameworks for e-cigarettes. Collectively, there are now estimated 19 million e-cigarette users in Asia, spread over 15 nations. Farther out, Australia recently announced regulations while New Zealand is actively promoting vaping as a less harmful alternative to its smokers. Lower-risk smoking alternatives are also legal in South Korea, Russia and Japan which witnessed a record 43 per cent decline in cigarette sales thereafter. Globally, 101 countries have decided against banning nicotine vaping products, whereas 30 currently have bans, down from 39 in 2018, as countries such as the UAE, Seychelles, Venezuela and others have overturned their prohibitions. With smoking set to disappear from many markets in the next decade or two owing to largescale switch to safer alternatives, India’s ban prevents similar public health gains even as tobacco-related cancers and economic costs continue to rise. The sole beneficiaries of this prohibition appear to be cigarette companies who have found protection from replacement products, which was reflected in the uptick in their share prices on the news of the ban.
With over 100 million smokers and 1 million annual deaths attributable to smoking, coupled with woefully inadequate cessation support facilities, India can ill-ignore the harm reduction approach which allows tobacco users to proactively reduce risk. A sensible policy that enshrines safeguards against teen uptake while encouraging smokers to switch has proven globally to be a more effective tobacco control direction than prohibition.
(The author is director of Council for Harm Reduced Alternatives, a nonprofit engaged in the adoption of harm reduction as a tobacco control strategy. Views expressed are personal and do not necessarily reflect those of Outlook Magazine.)