The government’s ban proposal needs to be welcomed

The Narendra Modi government’s proposal to ban e-cigarettes and other electronic nicotine delivery systems (ENDS) needs to be welcomed as such a move will ensure that Indians, especially, children, are kept away from these pernicious products. Such a ban has also been recommended by the Indian Council of Medical Research (ICMR), which called for a “complete prohibition on ENDS and e-cigarettes in India in the greater interest of protecting public health, in accordance with the precautionary principle preventing public harm from a noxious agent.”

The Health Ministry last year issued an advisory asking the States to ensure that products like e-cigarettes and e-nicotine-flavoured hookahs are not manufactured, distributed advertised or sold. Following this, 15 States, including Karnataka, Kerala, Tamil Nadu, Jammu and Kashmir and Mizoram, banned them. Several of the bans were under the Drugs and Cosmetics Act or the Poisons Act, under which nicotine was included as a ‘poison’. Further, the Central Board of Indirect Taxes and Customs (Anti-Smuggling Unit) and the Drug Controller General of India directed all their officials to ensure compliance with the advisory.

Popularity among youth

Introduced about 10 years ago in India, e-cigarettes rapidly gained popularity, especially among the youth. A misconception among students, parents and teachers that these cigarettes are free of nicotine also contributed to their appeal. The reality is that the tobacco industry, hit by the success of the state’s efforts to reduce tobacco use, had developed such products to hold on to customers who would have otherwise quit. Research suggests that many youngsters, who would otherwise have never started using nicotine, took up conventional smoking after being introduced to e-cigarettes.

While the tobacco companies promote e-cigarettes as a ‘less risky’ smoking option, some industry documents show that their real goal is to introduce ENDS products as an alternative to quitting. One company started selling its e-cigarette brand in 2014, promising that it will give the consumers the ‘pleasure of smoking any time anywhere’ (suggesting that they could use the product even at public places, where smoking is banned).

Further, even though warnings on many ENDS products clearly indicate that they are not a ‘smoking cessation product’, e-cigarettes are often promoted that way. Dozens of studies show that smokers who use e-cigarettes are less, not more, likely to quit smoking. In fact, most of them become ‘dual users’, continuing to smoke cigarettes while also taking to e-cigarettes. This makes them vulnerable to added health risks.

The tobacco industry plans to expand by achieving these twin objectives — attracting more youngsters and reducing quitting by adults. After all, the industry’s end goal is profit and not improvement in health indicators. The fact that the industry continues to produce and sell conventional cigarettes, its flagship product that brings it the greatest amount of profit, despite marketing e-cigarettes as an alternative is evidence enough of its sinister design.

Myths and reality

A recent white paper by the ICMR and several other research studies have contradicted several claims of the industry. First, the industry says that ENDS products provide a safer alternative to conventional cigarettes. However, the reality is that ENDS users are almost at the same risk of contracting lung diseases and cancer as conventional cigarette users. In fact, ‘dual users’ are at greater risk of heart attacks.

Further, the industry claims that the sale of ENDS products does not violate any regulations despite the fact that the companies are in clear violation of WHO’s Framework Convention on Tobacco Control, which prohibits the sale of any product that appeals to minors. The marketing of ENDS products, targeted at youth, also impacts minors and schoolchildren. The industry’s assertion that e-cigarettes are safe is contradicted by the many fires and explosions caused by devices, resulting in injuries, loss of lives and property. Further, their accidental ingestion by children has also caused some deaths.

All these points make it clear that the Central government has shown great foresight in bringing out the ban proposal, a move that is likely to avoid causing another epidemic of nicotine addiction in the country. The ban needs to apply to all forms of ENDS products, including all ‘heat-not-burn’ devices that profess to be an alternative to the existing tobacco products.

Amit Yadav is a postdoctoral scholar at the Center for Tobacco Control Research and Education, University of California, San Francisco