Latching on to an emerging global trend, the Indian government on September 18 banned e-cigarettes, citing health risks to youth and children. The ban covers the manufacture, sale, import, export, and advertising of all electronic nicotine delivery systems, or Ends.
These devices were already banned in 25 countries, including Brazil and Singapore, while 17 others regulate their production, sale and use. On September 17, New York City prohibited the sale of flavoured e-cigarettes and vapes.
In India, the ban has triggered a debate about the government’s intention and whether it will actually serve the goal of safeguarding public health. The Association of Vapers India, which claims to represent e-cigarette users across the country, argued that the ban would only deprive an estimated 11 crore smokers in the country of safer options.
Dr Bharat Gopal, pulmonologist and director of the National Chest Centre, agreed, arguing that the government’s decision was rooted in misconceptions and lacked understanding of the concept of harm reduction. “Tobacco harm reduction is a public health strategy to lower the health risks associated with using nicotine. It is used in many countries to help smokers quit through the use of non-combustible products,” he explained. “The government has turned a blind eye to science-behind e-cigarettes and denied smokers a less harmful product and a chance to attempt quitting the habit.”
Dr Prakash Chandra Gupta, director of the non-profit Healis-Sekhsaria Institute of Public Health, however, questioned the scientific validity of claims that e-cigarettes are less harmful than traditional tobacco products. “There is no evidence to back the claims of e-cigarettes being less or more harmful than cigarettes,” he said. “Cigarettes have been around for decades. Various studies have been done on the harmful effects of cigarettes. But e-cigarettes have been around for only ten years or so. There are no studies on their effects, just individuals saying that e-cigarettes have helped them quit smoking.”
Gupta, though, confirmed that e-cigarettes contain fewer toxicants than regular cigarettes.
Why then did the Indian government ban e-cigarettes but not traditional tobacco products?
Part of the answer may be that the government has stakes in at least two listed tobacco companies. The stock prices of both these companies, ITC Ltd and VST Industries Ltd, shot up as the ban was announced, delivering a notional windfall of around Rs 1,000 crore to the government.
Private cigarette makers too benefited: the stock price of Godfrey Phillips India rose by 9 per cent and that of Golden Tobacco by 4.69 per cent.
Dr SK Arora, additional director of Health in the Delhi government, argued that the ban on e-cigarettes should be extended to all tobacco products. “Traditional cigarettes have been in the market for so many years, so we are restricting their use using the Cigarettes and Other Tobacco Products Act. But we have not been able to tackle the traditional cigarette menace fully,” he explained. “At this moment we don’t want any new products like e-cigarette to enter the market.”
Arora questioned the notion of e-cigarettes being a safer alternative. “How many physicians prescribe e-cigarettes or vapes to help their patients quit smoking?” he asked. “The product is argued to be 92-95 per cent safer without any scientific evidence. Why should we have any product in the market which is not 100 per cent safe? Most studies on e-cigarettes have found that rather than make people quit smoking, they make them addicts.”
His concern about the threat posed by new smoking products such as e-cigarettes is echoed in a white paper released by the Indian Council of Medical Research in May 2019. “There is an increasing trend of the use of…e-cigarettes amongst the youth and adolescents in many countries where these products were introduced,” the paper reads. “E-cigarettes are the most commonly used nicotine products in the United States, and their use is reported to be rising at an alarming rate.”
Highlighting the potential health hazards, the paper says, “E-cigarette use adversely affects the cardiovascular system, impairs respiratory, immune cell function and airways in a way similar to cigarette smoking and is responsible for severe respiratory disease. The particulate nature of vapour in e-cigarettes has been established by various studies. The number of particles delivered and the particle size distributed by these devices are similar to those of conventional cigarettes. Most of these particles are ultrafine in nature and can easily reach deep into the lungs and can cross into the systemic circulation.”
The paper notes that flavouring agents used in e-cigarettes are cytotoxic, that is toxic to living cells. Ends can also harm pregnant women who use the devices or are exposed to passive aerosol, and adversely affect foetal, infant and child brain development.
While doctors and addiction experts largely favoured the ban, the Trade Representatives of Ends, the e-cigarettes industry body, described it as “ironic and erratic”. “A safer alternative to smoking is sought to be banned while the more dangerous product will continue to be sold,” said Praveen Rikhy, convenor of the body, referring to traditional cigarettes.
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