Monday, October 18, 2021
HomeFocusConfusing science, disparate international responses to e-cigarettes

Confusing science, disparate international responses to e-cigarettes

While America clamps down on vaping, India bans e-cigarettes and Juul vanishes from online Chinese stores, Europehas been more positive about vaping and Britain has embraced it in the fight against cigarette smoking. The responses to scientific findings – and the lack thereof – could really not be more disparate or unhelpful to health professionals..

China, India turn against vaping. Europe sees it as safer than cigarettes

E-cigarette makers were counting on Asia as a growth market. But the region may not be a refuge from an escalating crackdown in America, reports Bloomberg. India banned e-cigarettes recently – days after Juul Labs Inc’s products vanished from online Chinese marketplaces. But authorities in Europe are more sanguine about vaping.

India’s government announcement banning the sale and production of all e-cigarettes echoed growing concerns worldwide over health risks associated with the smokeless nicotine devices popular with teenagers.

“Why are we debating if it’s more harmful or less? It is harmful. It is addictive,” said Preeti Sudan, India’s health secretary. “The entire next generation will be going down the drain if we don’t control it now.”

Originally touted as a safer alternative to wean people off cigarettes, e-cigarettes have come under widespread attack in the US, especially for their appeal among youth, Bloomberg writes in an article published by the Los Angeles Times. Authorities have reported 530 suspected cases of vaping-related lung illnesses nationwide, including 70 in California.

India’s decision follows similar prohibitions in about 27 other countries including Australia, Singapore and Brazil.

But some nations still view e-cigarettes as viable alternatives to smoking, a leading cause of preventable death. Public health officials in Britain, the biggest market in Europe for the products, endorse vaping as a way to wean people off smoking. 

It’s the prevailing view across Europe, where authorities are more sanguine because the ailments popping up in the US have largely been linked to vaping liquids laced with THC, the psychoactive compound in cannabis, which is off-limits in much of Europe, Bloomberg reports.

Use among European teenagers is also much lower than in the US, as is the nicotine content in popular vaping products. Public Health England has repeatedly said vaping is 95% less harmful than cigarettes.

Vaping companies had been setting their sights on Asia, where 65% of the world’s cigarettes are sold, according to Bloomberg. India alone has 266.8 million tobacco users, according to a World Health Organisation fact sheet.

Juul only started selling its nicotine vaporisers online in China a couple of weeks ago. Its official online stores quickly disappeared on Alibaba Group Holding Ltd’s Tmall and Inc, prompting speculation that official action may be on the way. Juul wasn’t given a reason for why its products were pulled, but said it wanted to make them available again.

It isn’t clear whether China plans to ban or enforce stricter scrutiny of e-cigarettes or vaping devices. The country’s National Health Commission announced in July that it was devising legislation for such products.

European authorities have combined their embrace of e-cigarettes with tougher regulations – restricting marketing to children, for example, and imposing lower limits on nicotine content – that have made the new devices more acceptable to health officials, reports Bloomberg.

The European Union also has lower limits on nicotine levels in e-cigarette fluid, permitting a maximum of 20 milligrams per millilitre, compared with 59 milligrams per millilitre in Juul Labs Inc’s vape hits.

Keep calm and vape on: UK embraces e-cigarettes, US cautious

While America scrambles to crack down on vaping, Britain has embraced e-cigarettes as a powerful tool to help smokers kick the habit, reports AP. The Royal College of Physicians explicitly tells doctors to promote e-cigarettes “as widely as possible” to people trying to quit. Public Health England’s advice is that vaping carries a small fraction of the risk of smoking.

US public health officials have taken a more wary approach, and have been slow to regulate e-cigarettes. That caution turned to alarm, though, with an explosion in teen vaping, prompting the federal government and some states to take steps to ban fruit and minty flavours that appeal to youths.

And now, with hundreds of US cases of a mysterious lung illness among vapers, the US Centers for Disease Control and Prevention is recommending that people consider not using e-cigarettes, especially those with THC, the compound that gives pot its high, writes AP’s Maria Cheng in a 28 September article.

The US reaction is “complete madness,” said Dr John Britton, director of the UK Center for Tobacco and Alcohol Studies at the University of Nottingham. “The reality with smoking is, if you tell people to stop vaping, they will go back to tobacco and tobacco kills.”

International patchwork of policies

Regulations about e-cigarettes vary by country, making for a patchwork of policies. More than 30 countries ban e-cigarettes outright; India halted sales this month. Many European countries including Austria, Belgium, Germany and Italy classify e-cigarettes as tobacco products, subjecting them to strict controls. They are mostly sold as consumer products in Britain and France, under more lax rules, the AP article continues.

Since arriving in the US in 2007, e-cigarettes have been largely unregulated. The US Food and Drug Administration didn’t get the power to do that until three years ago and is still working out the details. Black market versions, meanwhile, have flourished.

In Britain, a review by Public Health England, an agency similar to the CDC, concluded that vaping is about 95% less dangerous than smoking. A leading British anti-tobacco charity, Ash, even called for e-cigarettes to be licensed as medicines and provided free to smokers trying to quit by Britain’s government-funded health system.

“We need radical solutions to stop smoking and one option is providing smokers with e-cigarettes so they can get the nicotine they need without the tobacco smoke. “We have a much more relaxed attitude to people being addicted to nicotine on the basis that nicotine itself isn’t particularly hazardous,” Britton told AP.

In the US, the rapid rise in e-cigarettes’ popularity among teenagers, a thriving black market for vapes containing marijuana extracts and the illness outbreak have muddied the public health message recently, said Ryan Kennedy of the Institute for Global Tobacco Control at Johns Hopkins Bloomberg School of Public Health.

On 27 September, the CDC said many of the 800 people who got sick reported vaping THC. More information was needed on whether a single product, substance or brand is responsible. 

Full report on the LA Times site

[link url=""]China and India turn against vaping. But Europe sees it as safer than cigarettes[/link]

Full report on the AP site

[link url=""]Keep calm and vape on: UK embraces e-cigarettes, US cautious[/link]

Subscribe to our Newsletter

Receive Medical Brief's free weekly e-newsletter.

* indicates required