Pressure is growing on Ontario to follow other jurisdictions taking strong measures against vaping, but a public health expert warns a prohibition on sales could fuel a dangerous black market.

“I don’t think a straight-up ban is necessarily desirable or feasible and it may just increase the likelihood of contaminated products,” Prof. David Hammond, chair of the University of Waterloo’s applied public health program, said Thursday.

“That’s why I think there’s got to be a more effective regulated approach to this and governments need to get on with that.”

Despite a “frightening” spate of vaping deaths and illnesses in the United States, bans such as one in India last week are difficult to explain when a more deadly product in the long-term — tobacco — remains widely available, Hammond said.

“Politicians will not want to be asked or answer that question.”

Critics said an easy interim move is to curb promotional displays and advertising, with other suggestions including more testing of vape products for safety, curbing fruit flavours and limiting sales to adult-only stores where proof of age is required to keep underage teens from picking up an increasingly popular and potentially harmful habit.

Health Minister Christine Elliott’s office said it is “considering all options to protect our youth from the potential dangers of vaping” after directing hospitals to begin reporting cases of vape illnesses last week following the rise in U.S. cases.

“As a first step, we are requiring hospitals to share information about incidences of vaping-related severe pulmonary disease so we can better understand the potential scope of this emerging issue. As we do, we will continue to engage experts to identify evidence-based solutions,” said spokeswoman Hayley Chazan.

No statistics were immediately available from the government, with St. Michael’s Hospital saying it has not had any cases and University Health Network, which includes Toronto General and Toronto Western hospitals, declining to provide any information.

The public health physician who sounded the alarm in London, Ont., last week on Canada’s first known case of vape-related illness said he has not heard of any others across the province.

But Dr. Chris Mackie, chief medical officer of health at the London Middlesex Health Unit, joined Hammond, former health minister George Smitherman, the NDP and the Ontario Campaign for Action on Tobacco in calls for the Ontario government to stop the promotion of vape products in convenience stores and gas stations.

“It is time we get a hold on this advertising,” Mackie told the Star, noting he was alarmed to hear his 10-year-old daughter name a specific brand of vaping product in a conversation about his job.

“Young people are becoming addicted to nicotine in droves right now,” he added, saying the chemical is no less harmful delivered in a vaping device because it can still cause high blood pressure and increase the risk of heart attacks and strokes.

Smitherman, who brought in the landmark Smoke-Free Ontario Act a decade ago, said the province has abandoned its leadership in the field by allowing promotional displays of vaping in stores and not putting vape products behind closed doors away from public view as is the case with cigarettes.

“To me, it’s immoral,” said Smitherman, who is now involved in the legalized cannabis industry and has two young children.

New Democrat MPP France Gelinas (Nickel Belt) said Premier Doug Ford’s Progressive Conservative government should reverse its July 2018 decision to allow the in-store promotional displays and flavoured vape juices she maintained are aimed at teens.

“She could change this in two minutes,” Gelinas said of Elliott.

The Canadian Vaping Association, representing about 300 retailers, has asked the province to limit sales of vaping products to specialty vape stores registered by law with their local health units, because the shops are in a position to restrict entry to customers who are at least 19.

“If you go into grocery stores and convenience stores these places are lit up with promotions like Christmas trees and it’s right beside the candy bars,” said executive director Darryl Tempest.

Vape industry leader Juul Labs of San Francisco — which announced Wednesday it will stop advertising in the United States only — is pushing back against that idea.

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“It’s important that vaping products are available to current adult smokers at the most important time — when they are about to purchase cigarettes,” said Juul Canada spokeswoman Lisa Hutniak. “That’s why vaping products should be available wherever cigarettes are sold.”

In Waterloo, Hammond maintained restrictions on sales and promotion of vaping products are “reasonable” as a public health measure, even if vaping is less harmful than smoking.

“I have three kids and when you go to the corner store for a slurpee you can’t get out of there without seeing an ad for an addictive drug.”