There are adverse public health consequences to banning e-cigarettes or Electronic Nicotine Delivery Systems (ENDS). It is a backward step in the effort to achieve a decline in smoking
India is severely affected by an epidemic of tobacco-associated disease, especially cancers, not only due to smoking but also due to the use of a variety of other addictive tobacco products (bidis, gutka, etc) and their equally dangerous alternatives containing areca (betel) nut (zarda, khaini and the like). Currently, smoking cessation support in India is minimal with little or no efforts to develop a proper communication strategy to achieve a significant decline in smoking prevalence. Electronic Nicotine Delivery Systems (ENDS) which are more commonly known as e-cigarettes are widely used in the UK, the EU and the USA as a substitute for smoking. They work by delivering nicotine while avoiding the harmful combustion process. The ingredients in e-cigarettes are compounds approved for human consumption for ingestion. Research evidence universally and overwhelmingly supports that they are by far less harmful than smoking.Major health organization such as Public Health England and Royal College of Physicians estimate that they are at least 95 per cent less harmful than smoking. Thus, they represent the exact definition of a harm reduction product. Indeed, even the WHO states in its ENDS report from August 2016: "If the great majority of tobacco smokers who are unable or unwilling to quit would switch without delay to using an alternative source of nicotine with lower health risks, and eventually stop using it, this would represent a significant contemporary public health achievement."
E-cigarettes currently represent the most popular smoking cessation aid in several countries including the European Union and USA.While being very popular among smokers, use by non-smokers is absolutely minimal. In the European Union, an estimated 6 million smokers have managed to quit with the help of e-cigarettes, while an additional 9 million have reduced their smoking consumption. At the same time, only 0.04% of non-smokers use nicotine-containing e-cigarettes daily.In the UK alone,1.5 million smokers have quit with the use of e-cigarettes, with smoking prevalence showing an accelerated decline since e-cigarettes became popular. This situation is desirable from a public health perspective, showing that e-cigarettes attract smokers only, and help many of them reduce or entirely quit smoking. The UK has recently released a comprehensive strategic plan for tobacco control, which includes e-cigarettes as part of the solution and an important aid in eliminating smoking. Other countries, such as Belgium, Canada, New Zealand and Switzerland, which had imposed bans on nicotine-containing e-cigarettes are now in the process of lifting the bans, acknowledging that e-cigarettes help smokers quit. In July2017, Dr. Gottlieb, the US FDA Commissioner, said: "We do think there's a potential opportunity for e-cigarettes to be a lower-risk alternative to smokers who want to quit combustible cigarettes".
India, which is devastated by smoking-related diseases, urgently needs to adopt a plan which recognizes e-cigarettes as part of the solution rather than an urgent problem. India should not take decisions that will deprive Indian smokers from their fundamental right to access to lower-risk products. While regulation to ensure product quality and proper marketing to intended population groups (i.e. smokers) is needed, a decision to ban e-cigarettes is not only counterproductive but will also have adverse public health consequences, and will perpetuate tobacco cigarette sales. India needs to be open-minded towards other harm-reduction heat-not-burn products which could further enhance the reduction in smoking-related harm. The stakes are high, and decisions should be made based on evidence.
(The author is doctor at the Onassis Cardiac Surgery Center, University of Patras, Greece)