Banning e-cigarettes may deprive Indian smokers of a substantially less harmful alternative, which can be against public health and can result in adverse consequences, experts have warned.
Some states in India, including Jammu and Kashmir, Karnataka, Punjab, Maharashtra and Kerala, have prohibited sales of e-cigarettes, while tobacco cigarettes remain legal.
According to media reports, the Union Health Ministry has recently ruled out acceptability of e-cigarettes in the light of research findings by experts who concluded that they have cancer-causing properties, are highly addictive, and do not offer a safer alternative to tobacco-based smoking products.
However, health experts argued that such decision creates a paradox. The government is allowing the sales of lethal nicotine-containing products — tobacco cigarettes — while banning a substantially less harmful alternative.
“In my opinion, banning e-cigarettes is against public health. I think it’s going to have an impending adverse consequence, because the ban will deprive Indian smokers of a substantially less harmful alternative,” Konstantinos E. Farsalinos a research fellow at the Onassis Cardiac Surgery Centre in Athens, Greece.
“Banning is a hasty decision and can be counter-productive, because we are not aware of the extent of e-cigarette use or its harm in India,” added R.N. Sharan, Professor at North-Eastern Hill University in Shillong, Meghalaya.
An e-cigarette is a battery-operated device that uses a liquid e-liquid that may contain nicotine, as well as varying compositions of flavourings, propylene glycol, vegetable glycerin, and other ingredients.
In tobacco cigarette, there is combustion, a burning of an organic material, which generates temperature up to 900 degree Celsius, and thus produces all the harmful material. Whereas, in e-cigarettes there is neither combustion nor tobacco. There is only the burning of the liquid, made up of ingredients approved for food and contains minimal burning, which is 100-1000 times lower compared to tobacco cigarette.
A study published in the journal The Lancet showed that India has 11·2 per cent of the world’s total smokers. Over 11 per cent of 6.4 million deaths worldwide was caused by smoking in 2015 and 52.2 per cent of them took place in China, India, Russia, and the US, the report said.
Further, the experts contented that banning e-cigarettes is contrary to worldwide trends. Various studies conducted in the US, UK and other countries in the European Union, have shown that e-cigarettes have resulted in a significant decline in smoking rates. Several countries like Switzerland, Belgium, New Zealand, Canada and the US, which were formerly advocating for bans, are now moving towards lifting the bans on e-cigarettes, Farsalinos said.
“Earlier in July, the US FDA cancelled the intended regulation saying that e-cigarettes may probably help a substantial proportion of smokers to quit smoking and switch to less harmful alternative,” Farsalinos said. “The UK’s Royal College of Physicians recently advised the UK Government to promote the use of e-cigarettes (along with conventional nicotine replacement methods) as widely as possible as a substitute for smoking,” Farsalinos stated.
A survey of over 27,000 participants all over Europe, published in Eurobarometer in 2016, showed that more than one-third of e-cigarette users polled reported smoking cessation and reduction. “With India being devoid of good monitoring systems and rich data of research, it should take cue from these countries. Ignoring the evidence from other countries, while the country doesn’t have much of its own, and deciding on bans, can be a bad idea,” Farsalinos said.
Importantly, e-cigarettes appear to be effective when used by smokers as an aid to quitting smoking. The hazard to health arising from long-term vapour inhalation from the e-cigarettes is unlikely to exceed five per cent of the harm from smoking tobacco, the experts said.
“While, its not absolutely safe, it is 95 per cent less harmful than tobacco cigarette,” Farsalinos said, adding: “We don’t recommend it to a non-smoker. We always say it’s a product for smokers, and should be used as a smoking substitute.”
However, it is best to quit smoking without use of any alternative. Farsalinos said that although marketing for e-cigarettes is essential, it needs to be done with strict regulation. There is also an urgent need to create a competitive environment between a less harmful product and tobacco cigarette, which includes accessibility and price, the experts said.