Explained | E-Cigarettes: As Safe as They Sound?

From the point of view of science and public policy, e-cigarettes have not yet been declared kosher.

“If e-cigarettes are banned, then why not cigarettes?” is a popular hot-take currently making the rounds, as the Union government today announced an ordinance banning e-cigarettes.

The situation does appear to be paradoxical, but a little bit of science and logic may help understand why there is global panic among policymakers, health practitioners, tobacco companies and e-cigarette companies.

First of all, sample these facts: the US states of New York and Michigan have just banned flavoured e-cigarettes. The US Centers for Disease Control and Prevention recently announced that it was investigating 380 cases of potential vaping related illness. It has confirmed six recent deaths, suspected to be linked to vaping and has opened emergency operations to deal with the epidemic. Recently, it had opened emergency operations during hurricanes and the Zika outbreak in 2016.

So perhaps the primary reason why the situation resembles a paradox is that cigarettes and bidis continue to flourish in India without heavy penal taxation or pricing or public health measures. We know cigarettes are linked to cancer and kill people, but on the other hand, we have six deaths alleged related to vaping.

So do e-cigarettes have it worse? Or is it that just since cigarettes don’t have as much of a hard time, e-cigarettes should get the same treatment? Falling upon ‘what about cigarettes?’ may not help untangle this situation.

‘What about cigarettes?’

E-cigarette and vape companies have claimed that their products are “less harmful,” have a “reduced risk” and can thus be seen as a “safer alternative” and a “cessation device”.

But now comes the science and the logic: None of these claims imply that e-cigarettes are safe or even safer than rolled tobacco cigarettes. It just means that e-cigarettes may have some benefits in comparison to cigarettes, but may also come with other harmful effects which are different or similar to the ones from cigarettes.

Also read: Explained: Can the Health Ministry Curtail Research on E-Cigarettes?

After all, nicotine, the primary component of vapes, is itself a known and listed pesticide in India and other countries. In very small quantities and in permissible ranges, it has some therapeutic properties and is thus used in nicotine patches to help cigarette smokers quit. But in higher amounts, nicotine intake can kill humans.

Moreover, there is no single type of e-cigarette or vaping device. A range of companies are making all kinds of products with different levels of nicotine and flavouring agents apart from a host of unknown chemicals. In the US, the Food and Drug Administration has been regulating some of these devices but the vast majority of them are not cleared by any regulator.

So while most companies claim their product is safer than cigarettes, there’s no way to really know without rigorous testing and standardisation of every product that is vying for entry.

Electronic cigarette vaporisers. Photo: Wikipedia commons

While the jury still out on this issue, the Indian government led heavily by the health ministry, has worked hard over the last year to ensure that e-cigarettes don’t enter Indian markets. The ordinance issued by the cabinet today is the culmination of this process. The ordinance will have to be introduced and passed in parliament within the next six months.

Basically, there’s a lot that we know about the harmful effects of cigarettes. But there’s a lot that we don’t know about e-cigarettes, which means, from the point of view of science and public policy, e-cigarettes have not yet been declared kosher.

What has the Indian government done so far?

Cigarettes in India are regulated under the COTPA (Cigarettes and Other Tobacco Products Act). At the time of passing this law, the text did not envision the rise of e-cigarettes.

Also read: Three Ministries Advance Regulations to Control E-Cigarettes

But do e-cigarettes need to be regulated under COTPA at all? Is e-cigarette an entirely different product with its own potential harms and benefits, not comparable with cigarettes? Since nicotine is listed as a drug in India, and e-cigarettes operate using nicotine, should e-cigarettes instead be regulated as drugs? Since e-cigarette companies claim that their devices actually help people make healthy choices by decreasing smoking, should it be regulated from the point of view of health instead?

This matter was before the Delhi high court, where a petition asked that the government not ban e-cigarettes but regulate it under COTPA. This case has been going on for a while, without any resolution so far.

In the meantime, the health ministry issued an advisory to all states in 2018 asking them to try and ensure that nicotine devices are not sold in their states.

The Wire also reported that the ministry of electronics and information technology had proposed an amendment to the information technology rules that would ban the advertising of e-cigarettes. The customs department also issued a circular asking that all consignments of e-cigarettes should be cleared by state drug controllers first.

In May 2019, the Indian Council of Medical Research issued a “white paper” and called for a ban on e-cigarettes as well.