Zoltán Massay-Kosubek

Electronic cigarettes will be regulated by the recently negotiated Tobacco Products Directive (TPD). E-cigarettes (nicotine inhalators) are both helpful to quit smoking and source of new dangers: long term adverse effects and re-normalisation of smoking. In my opinion, the regulation of e-cigarettes should be linked to have much stronger European tobacco control measures.

What are e-cigarettes?
According to the Commission conception note from 2008, “electronic cigarettes” (e-cigarettes) or electronic nicotine delivery systems (ENDS) look like cigarette, but they are actually nicotine inhalators. An e-cigarette contains pure nicotine to be inhaled.

(source of the photo © How much do we know about electronic cigarettes?)

The Controversial Nature of e-cigarettes
E-cigarettes have different dimensions. Smoked tobacco is the most dangerous form and that smokeless tobacco products are significantly less harmful. On the one hand, e-cigarettes have the full potential of a cessation aid, an alternative to regular tobacco cigarettes. On the other hand, electronic cigarettes can also be flavoured, and this could develop e-cigarettes into a gateway product, especially for the youth.

Why did e-cigarettes become so popular?
E-cigarettes have the potential to replace cigarettes in the XXIst century and would became the “tobacco of the new century”. In 1976 Professor Michael Russell wrote: “People smoke for nicotine but they die from the tar.” Indeed, the harm from smoking is caused almost exclusively by toxins present in tobacco released through combustion. What does it mean in practice? According to the available knowledge, e-cigarettes are far less harmful than conventional cigarettes. Thus, electronic cigarettes represent a safer alternative to conventional tobacco and putting a large number of smokers to a less dangerous product would be a definitive public health gain.

Why can not e-cigarettes be accepted, as the “wonder weapon” against smoking?
Because they are far from being harmless and there is little or no evidence on their long term effects. Nicotine is a toxic and addictive substance and there are also reports of other hazardous substances being used in electronic cigarettes. A study on indoor air quality said that e-cigarettes are putting detectable levels of several significant carcinogens and toxins in the air: averaging around 20% of what the conventional cigarette put into the air. The World Health Organization WHO stressed that the potential risks they pose for the health of users remain undetermined. It stressed also that their efficacy for helping people to quit smoking has not been scientifically demonstrated, yet.

The E-cigarette market as a public health minefield
Some people of the public health field became standard-bearer of the e-cigarette movement but the vast majority of well-known and recognised public health and tobacco community members remained cautious. Why? Despite the very impressive promise of having public health benefits, in light of the above presented dangers there are considerable dangers which would make public health advocates extremely careful before becoming fully convinced about their use.

Here are three of them.

1. The potential ‘gateway effect’: putting non-smoker on the vaping track and re-normalisation of smoking
There is well founded danger among the public health & tobacco control community members that e-cigarettes have the potential to make ‘smoking’ and ‘vaping’ ‘cool’ ‘fancy’ which could lead to the re-normalisation of smoking, as an accepted social norm. E-cigarette use can also promote indirectly smoking, forbidden by the way by the first international legally binding public health treaty on tobacco control: the Framework Convention on Tobacco Control (FCTC). Extremely effective marketing tactics can make e-cigarettes appealing by young adults which could undermine public health policies.Although flavours are essential to make e-cigarettes palatable, some flavours can be attractive for the youth and putting non-smoker young adults on the vaping field is an existing public health danger.

2. The lost European leadership in tobacco control policy
The Tobacco Products Directive (TPD) will be adopted hopefully before the end of the 2009-2014 political cycle (You can see here a concise summary on the TPD negotiation process as well as some questions and answers on the European regulation of e-cigarettes). Although the presumed adoption of the Tobacco Products Directive (TPD) would be a considerable win for the public health & tobacco control community despite the delaying tactic of the tobacco industry, the proposal is a result of a usual European compromise and far less ambitious than it should be. The TPD will have more strict regulation on e-cigarettes than the previous legal situation of Nicotine Containing Products (NCPs) . However, not being ambitious enough in tobacco control makes me somehow cautious as regards allowing e-cigarettes to flourish in the EU.

The most visible example of the issue of plain packaging. Strong evidence show that cigarette package is the last weapon in the hand of the tobacco industry. Figures in Canada show that the smoking rate amongst 15-19 year-olds was 12% in 2011, half the rate of the same age group in 2000. In Uruguay, since the introduction of pictorial warnings in 2005, smoking among 15-17 year-olds has decreased by 8% annually. However, the original Commission proposal contained only 75% and the final compromise is only 65% coverage of the tobacco packet.

3. The growing involvement of the tobacco industry in the electronic cigarette market
This is not a new phenomenon: traditional cigarette companies are taking notice of the emerging products. One prominent tobacco manufacturer in the United States purchased an electronic cigarette company, making it the first major tobacco firm to buy or invest in electronic cigarettes. According to a report prepared by the WHO Framework Convention on Tobacco Control (FCTC) secretariat, in 2009, a European company that produces a range of products that it describes as being for nicotine replacement therapy, and a producer of nicotine delivery systems has agreed a marketing and distribution agreement with a company within the corporate group of yet another major tobacco manufacturer.
Most recently, the spokesperson of a well known tobacco company declared that e-cigarettes are ‘substantially safer’ than conventional cigarette which made me thinking about the hidden messages behind these words.

(source of the photo © E-cigarette. Un vendeur attaqué en justice par un buraliste, illustration, AFP)

In my opinion, before answering the question of e-cigarettes, tobacco control should be the first priority of the European legislation. Not having an ambitious enough tobacco legislation is alarming and although the appropriate use and regulation of e-cigarettes can be part of the solution of the tobacco problem, e-cigarettes alone cannot be the only solution and can not put an end to the tobacco-epidemic: we need stronger tobacco control measures hands in hand with a European e-cigarette policy.

I remain at your disposal.

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