Electronic Cigarettes

GOVERNMENTS MUST ACT QUICKLY TO REGULATE E-CIGARETTES

The introduction of electronic cigarettes (or e-cigarettes) in countries around the world poses new challenges to governments and advocates dedicated to protecting youth and reducing tobacco use. E-cigarette use by youth presents serious concerns as the use of nicotine in any form is unsafe, causes addiction and can harm adolescent brain development. E-cigarettes can also expose youth to harmful and carcinogenic chemicals.

While e-cigarettes may have public health benefits if they help smokers switch entirely to e-cigarettes, there is concern that e-cigarettes may create a new generation of young nicotine and tobacco users. There is limited evidence that e-cigarettes help people quit smoking, and some studies have found that young people who use e-cigarettes are more likely to become smokers.¹ Evidence from the United States shows that the majority of e-cigarette users also smoke conventional cigarettes.¹ E-cigarettes risk slowing decades of progress in reducing tobacco use and nicotine addiction.

In the United States, e-cigarette use among youth has exploded into what the Surgeon General and the Food & Drug Administration have called "epidemic" levels – with Juul and its imitators being the primary cause. With all of the major multinational tobacco companies launching their own e-cigarettes or buying established brands, and e-cigarette brands setting up shop in new countries, there is concern that the youth e-cigarette epidemic in the United States will soon spread to other countries.

Alarmingly, e-cigarette marketing uses many of the same strategies effectively used by the tobacco industry to reach kids. The tobacco industry’s flavored products that taste like fruit, mint and candy have long been known to be appealing to kids, and now e-cigarettes are available in these flavors. Tobacco and e-cigarette companies are also using social media marketing – including the use of hugely popular influencers – to advertise e-cigarettes in ways that appeal to kids.

Government policy makers and regulatory agencies around the world must take e-cigarettes seriously due to their potential impacts on youth and their ability to reverse or hinder national health goals. The goals of effective e-cigarette regulation include:

• Preventing e-cigarette use by non-smokers, particularly youth;
• Minimizing potential health risks to e-cigarette users and non-users;
• Preventing e-cigarettes from undermining progress in reducing tobacco consumption and nicotine addiction;
• Protecting public health policy from the commercial interests of the tobacco and e-cigarette industries; and
• Assisting smokers to quit and avoiding dual use.

International Regulation of E-cigarettes

Three primary approaches are available to governments acting to regulate e-cigarettes:

• Completely banning e-cigarettes;
• Regulating e-cigarettes as medicinal or therapeutic products; and
• Regulating e-cigarettes using tobacco control measures.

There are no clear global trends on how countries are approaching the regulation of e-cigarettes. Some countries or territories have recently introduced bans on e-cigarettes (such as India), and others are considering new bans (including Hong Kong and Mauritius). Other countries that had previously banned e-cigarettes have decided to allow them on to their market (such as Canada, Bahrain, Kuwait, and the United Arab Emirates). Still other countries have legislative proposals to regulate e-cigarettes under their tobacco control regimes (including South Africa).

• At least 24 countries or territories ban all sales of e-cigarettes.² (These are detailed in the country profiles in the www.tobaccocontrollaws.org database)
• At least 7 countries only permit the sale of e-cigarettes as licensed medicinal products.³ In these countries, this amounts to a de facto ban on sales because there are currently no e-cigarettes being sold that have been medicinally licensed as a smoking cessation aid.
• At least 47 countries regulate e-cigarettes under a tobacco products regime.⁴ Among these countries, there are significant variations as to the restrictions on public use, advertising, health warnings, content regulation and the taxation levels.
• Nearly half of all countries report that they do not regulate e-cigarettes in any way.⁵

International Organizations

The World Health Organization (WHO) Report on the Global Tobacco Epidemic 2019 found, after an extensive review, that "[e-cigarettes] are a diverse group of products, containing a wide variety of nicotine dosages, flavours, and emissions” but that “[e-cigarettes] are not harmless and must be regulated” and they “pose risks to users and non-users. There is insufficient evidence to quantify this risk and the long-term effects of exposure to [e-cigarettes’] toxic emissions are unknown.”⁶

The report recommends that “Member States that have not banned [e-cigarettes] should consider regulating them as harmful products”⁷ including prohibiting their use indoors especially where smoking is already banned, and an outright ban on advertising, promotion and sponsorship.

¹ National Academies of Sciences, Engineering, and Medicine. 2018. Public health consequences of e-cigarettes. Washington, DC: The National Academies Press. Available at: http://nation-alacademies.org/hmd/Reports/2018/public-health-conse-quences-of-e-cigarettes.aspx.
² Argentina, Brazil, Brunei, Cambodia, Ethiopia, Gambia, India, Iran, Lebanon, Macau, Mauritius, Mexico, Oman, Panama, Qatar, Singapore, Sri Lanka, Suriname, Syria, Thailand, Timor-Leste, Turkmenistan, Uganda, and Uruguay.
³ Australia, Chile, Hong Kong, Japan, Malaysia, Taiwan and Venezuela.
⁴ 28 European Union countries, Albania, Azerbaijan, Belarus, Canada, Cote d’Ivoire, Georgia, Guyana, Iceland, Israel, Moldova, Montenegro, New Zealand, Norway, Rep. of Korea, Saudi Arabia, Tajikistan, Tunisia, United Arab Emirates, and United States.
⁵ WHO FCTC COP8 FCTC/COP/8/10 Progress report on regulatory and market developments on electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS). Paragraph 25. https://www.who.int/fctc/cop/sessions/cop8/FCTC_COP_8_10-EN.pdf?ua=1
6 WHO Report on the Global Tobacco Epidemic, 2019. Geneva: World Health Organization; 2019. License: CC BY-NC-SA 3.0 IGO.
⁷ Ibid