Countries should consider curbing the use of e-cigarettes because there is not enough evidence to show they help people stop smoking, according to a World Health Organisation report.

Vaping will be on the agenda of a major meeting starting in India on Monday of the 180 countries that have signed the Framework Convention on Tobacco Control, aimed at combatting Big Tobacco and preventing the millions of deaths every year around the world caused by smoking.



But the public health community is split over whether e-cigarettes are friend or foe and some are outraged by the WHO’s advice to the meeting. It suggests countries that have not already banned e-cigarettes and other forms of nicotine delivery might want to consider imposing severe restrictions, including banning the flavouring of e-cigarettes as well as sales, advertising and possession by young people.

Countries might also want to ban nicotine delivery devices from all public places where smoking is not allowed, require health warnings about the chemicals in them, include information on the addictive potential of nicotine and ban any claims that they can help people give up tobacco smoking, the report says.



Countries that have banned e-cigarettes As well as bans on tobacco advertising and restrictions on where people can smoke cigarettes, many countries have put in place restrictions on the sale and use of e-cigarettes. A handful of countries have banned e-cigarettes entirely, including Argentina, Brazil, Cambodia, Singapore, the United Arab Emirates, Uruguay, Venezuela, and the Seychelles and many more have instituted restrictions on them, especially on their sale to minors.



The WHO suggests these are reasonable measures to control the use of products with effects that are still unknown – and which are increasingly being manufactured by the multinational tobacco corporations the signatories to the convention are pledged to defeat.

But for some in the public health community, WHO’s report is a backward step that will hamper the fight to cut tobacco-related deaths.

Professor John Britton, director of the UK Centre for Tobacco and Alcohol Studies based at Nottingham University, said the WHO report was unbalanced. “There is nothing saying e-cigarettes are allowing hundreds of thousands of people to stop smoking,” he said.

The convention exists to combat tobacco use, not nicotine use, he said. “It is perfectly reasonable to be concerned that young people might use e-cigarettes and become addicted. All those arguments apply to licensed nicotine products that anybody can walk into Tesco and buy.” But nicotine regulation is for other agencies, he said.

Britton is concerned about the “flavour” of the WHO document “which is that these products are out there, they are being produced by tobacco companies and we should probably ban them – or if not, here are some regulations that you might want to introduce.”

The meeting in Delhi will be a conference of the parties (COP) that have signed the treaty, which includes national governments and the European Union. It takes place every two years to decide the future direction of tobacco control. The WHO report was written at the request of the parties who wanted to know about the scientific evidence for or against nicotine-delivery devices, said Dr Vera Luiza da Costa e Silva, head of the convention secretariat.

“So far there is a clear understanding that e-cigarettes should be regulated,” she said. “They should not be promoted among young people and pregnant women and other specific groups. They should not be promoted widely – there should be restrictions and regulations.” More monitoring of the effects and possible health benefits is needed, she said.

“While I don’t think COP will close the door [to e-cigarettes], I don’t think COP will open the door to them at this time,” she said.

The issue splits the public health community. Critics of e-cigarettes are concerned that they may be a “stalking horse” for Big Tobacco, which the Framework Convention has made a pariah.

Countries that have signed the treaty agree under Article 5.3 that the tobacco industry is beyond the pale and must never be allowed into negotiations. If e-cigarettes can help people stop smoking, the tobacco companies can argue for their rehabilitation and a presence at the table.

“While e-cigarettes offer a significant opportunity to public health, there are also risks. One is the way the tobacco industry uses harm reduction to secure reputational and access possibilities and to split the public health camp,” said Anna Gilmore, professor of public health at the University of Bath and the UK Centre for Tobacco Control Studies.



“The tobacco industry uses e-cigarettes to claim it is committed to harm reduction, but meanwhile it continues to engage in harm maximisation by spending millions to promote tobacco and oppose any policy that would reduce its use.”

Ahead of the Delhi meeting, rightwing thinktanks and libertarian groups have been on the attack, arguing that the COP is secretive and not transparent, because members of the public may be excluded from the proceedings. But, says Gilmore, that is because the industry and its representatives have to be kept out of the COP discussion, under Article 5.3, “yet we know the industry infiltrates these meetings often using third parties as a disguise,” said Gilmore.

It is impossible to screen every individual and group who wants to attend. “They are caught between a rock and a hard place, because of the industry’s underhand tactics,” she said.