When the NDA government completes 100 days of its second term on September 7, the Health Ministry will hope to have in place an ordinance banning the manufacture, sale and marketing of e-cigarettes. One of the three 100-day goals the ministry has set for itself, The Prohibition of E-cigarettes Ordinance 2019 is being sent to a Group of Ministers as directed by the Prime Minister’s Office.
What are e-cigarettes?
An e-cigarette, short for electronic cigarette, is a battery-operated device. One of a large variety of Electronic Nicotine Delivery Systems (ENDS), an e-cigarette emits vaporised nicotine, or non-nicotine solutions. The user inhales it looking for a sensation similar to inhaling tobacco smoke, but without the smoke.
The pros and cons of e-cigarettes are hotly debated, with the industry refuting scientific evidence about the product being harmful, and users urging the government to legalise it. India’s market for e-cigarettes, while nascent today, is projected to grow annually at more than 25 per cent in the next five years.
The draft ordinance
The draft ordinance was necessitated by the fact that an earlier order by the Centre asking the states to crack down against e-cigarettes could not stand judicial scrutiny. However, a recent order, in which the High Court threw out a petition asking for protection from an ordinance against e-cigarettes, has emboldened the Health Ministry, which now seeks legal backing for a ban (rather than just an advisory) in the form of an ordinance. The ordinance makes any violation of its provisions punishable by imprisonment of one to three years, and a fine of Rs 1-5 lakh.
Some states, including Punjab, Karnataka, Kerala, Bihar, Uttar Pradesh, Himachal Pradesh, Tamil Nadu, Maharashtra, Jharkhand, Rajasthan and Mizoram, have already banned use and sale of e-cigarettes, vape and e-hookah.
In August last year, the ministry had written to states asking them to stop sale (including online), manufacture, distribution, trade, import and advertisements of e-cigarettes. Under the Constitution, health is a state subject, so any move to ban manufacture and sale of a product on health grounds needs to come from the state government.
In February, the Central Drugs Standards Control Organisation had written to all state drug controllers, saying they should not allow sale, online sale, manufacture, distribution, trade, import or advertisement of ENDS. The Delhi High Court stayed the Centre’s circular banning sale and manufacture of ENDS like e-cigarettes and e-hookah with nicotine flavour, saying as the products were not a “drug”.
The scientific position
In a white paper in May, the Indian Council of Medical Research (ICMR) wrote: “The use of ENDS or e-cigarettes adversely affects almost all the human body systems with impact across the life course, from the womb to tomb. The cartridges used in ENDS or e-cigarettes are filled with liquid nicotine, flavouring agents and other chemicals. A typical cartridge contains about as much nicotine as a pack of 20 regular cigarettes and can act as a potential source for nicotine addiction.”
Published in the Indian Journal of Medical Research, the ICMR white paper added: “Studies on these nicotine solvents had shown a varied degree of release of potential carcinogens… depending on the battery output voltage. The liquid-vaporizing solutions also contain toxic chemicals and metals that have been demonstrated to be responsible for several adverse health effects, including cancers and diseases of the heart, lungs and brain.”
In the United States, the Centers for Disease Control and Prevention (CDC) said in a recent statement: “As of 5:00 pm, August 22, 193 potential cases of severe lung illness associated with e-cigarette product use had been reported by 22 states…CDC is providing consultation to state health departments about a cluster of pulmonary illnesses possibly related to e-cigarette product use, or ‘vaping’, primarily among adolescents and young adults.”
Patients have presented with symptoms such as cough, chest pain, shortness of breath, fever, fatigue, nausea and headache. These are sometimes accompanied by anorexia, diarrhoea and weight loss.
The industry’s opposition
In a reply to the Drug Controller General of India dated August 28, the Trade Representatives of ENDS in India (TRENDS), has questioned the scientific documents that the government has cited in favour of a crackdown on e-cigarettes: “…It is ironical that it has been acknowledged by the ICMR itself that it has proffered no research or study to support the claims made in the white paper and that it is merely a compendium of available reports in the international medical field. By the same token, may we humbly suggest that an equal number of studies are available in the medical world that argue against the conclusions derived by ICMR.”
Complaining that its letters to the ministry and to the minister have gone unanswered, TRENDS has sought an appointment with CDSCO officials to “place before you scientific evidence that refutes all the claims made in the ICMR report about the dangers of ENDS as a product category”.
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