What should be top of the agenda at next week’s 9th Conference of the Parties of the Framework Convention on Tobacco Control won’t be on the agenda at all: regulating vaping like coffee.
South Africa’s stalled Control of Tobacco Products and Electronic Delivery Systems Bill, which has yet to land on Cabinet desks, treats vapes, a.k.a. vapourisers, a.k.a. vaping devices, a.k.a. e-cigarettes, a.k.a. electronic nicotine (or non-nicotine) delivery systems (ENDS or ENNDS, respectively), as if they were tobacco products.
Under the Bill, they will largely be burdened with the same extreme restrictions regarding packaging, retail, and public use. The Bill will prohibit online sales of vaping products. It also opens the door to prohibiting flavoured vapes, although ironically, tobacco-flavoured vape liquids will probably be permitted.
The goal is to discourage people from using vapes at all, as if they were just as harmful as cigarettes.
This is patently absurd. There is no justifiable basis for regulating non-nicotine vapes at all, and even nicotine-containing vapes should be regulated like coffee. That is, they shouldn’t be regulated either, beyond basic rules to protect consumers from contaminants and similar hazards.
Neither ought to fall within the remit of the Framework Convention on Tobacco Control (FCTC), since neither are tobacco products.
Vaping does not pose a threat to public health. On the contrary: the threat to public health is the dogmatic opposition of health authorities and anti-tobacco lobbyists to vaping, and seeking to restrict them either as equivalent to tobacco products, or to regulate them as pharmaceutical products instead.
By doing so, they are violating the principle of harm reduction on which the original FCTC was based, and which is nominally the purpose of tobacco legislation in many countries.
This opposition to vaping is not based on science. In fact, all the research to date supports a highly liberal approach to vaping.
The UK’s lead
The leading country with a well-considered, evidence-based approach to vaping is the United Kingdom. It has integrated vaping into its strategy for smoking harm reduction and smoking cessation, with considerable success, and is even considering making vapes available via the National Health Service as an aid to quit smoking.
This approach is quite the reverse of the condemnatory, regressive, knee-jerk objections to vaping by other countries, the FCTC and the World Health Organisation itself. These have led to highly restrictive regulations that are openly hostile to vaping.
Their consensus view, no doubt informed by the anti-tobacco lobbyists that occupy the FCTC echo chambers, seems to be that smokers ought to be ostracised, demeaned and punished, and that any easy and pleasant means of harm reduction or smoking cessation is just too good for them.
Medicalising vaping has its own drawbacks, of course. The low success rate and unpleasantness of historical nicotine-replacement therapies (NRT) have not predisposed smokers to view the medical industry as an ally.
The image of vaping as smart, sensible and sophisticated stands in stark contrast to the tackiness and desperation of nicotine chewing gum and patches.
The proposed prohibition of online sales of vaping products in South Africa significantly prejudices smokers in rural areas, where the population might not be able to support specialist, brick-and-mortar vape shops.
More generally, the proposed over-regulation of vaping products will significantly reduce their attractiveness, and will discourage smokers from switching. That, frankly, would be a crime.
Mixed messages
In some countries, like New Zealand, people are getting mixed messages. On the one hand the government is actively encouraging smokers to switch to vaping, while on the other, NGO campaigns emphasise the unknown risks of vaping in the hope of discouraging non-smokers and teens from taking up vaping.
Alarmist articles like these also do immense harm. Its reference to the misnamed EVALI (which stands for E-cigaretted and Vaping Associated Lung Injury) involves an additive, vitamin E acetate that is only present in some black-market tetrahydrocannabinol (THC, or cannabis) liquids, designed to get you high.
It also references a single case of so-called ‘popcorn lung’ (bronciolitis obliterans), but that was also associated with a THC vape. Many other potential harms of vaping are entirely speculative, and have never actually been observed in the wild.
While it would be astonishing if vaping never led to any negative health outcomes, there is no evidence of anyone, ever, being harmed by ordinary vapes to date, whether or not the liquid contained nicotine.
The general consensus, drawn from the fact that ENDS vapour contains only a handful of the chemicals that tobacco smoke does, and in far smaller quantities, is that vaping is at least 95% safer than smoking tobacco.
As the Royal College of Physicians wrote: ‘Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure.’
That probably puts it in the same health safety bracket as your average Danish pastry, or a cup of coffee. Coffee, after all, also contains an addictive stimulant, as well as a rich assortment of minor toxins, some of which may well be carcinogenic to a few unfortunate addicts.
The mixed messages and alarmist misinformation about the safety of vaping, however, are causing widespread confusion, which is discouraging smokers from quitting in favour of vaping products. Given that smoking, unlike vaping, really is very harmful, that ought to be a grave concern for public health authorities.
Vaping myths
The UK’s public health agency, creatively named Public Health UK, maintains a regularly updated review of the scientific evidence about vaping. Its most recent publication is dated February 2021, and reaches a number of conclusions that debunk common anti-vaping talking points.
First, despite the arguments about attractive marketing and flavours, young people are not taking up vaping in large numbers, and vaping is not acting as a ‘gateway drug’ to smoking. Only about one in 100 teenagers who had never smoked are current vapers. That means the vast majority of teenagers who do vape are also, or once were, smokers.
Even then, the numbers are not alarmingly high. Among 11 to 18 year olds, 6.7% smoke, while 4.8% vape, and among 16 to 19 year olds, 6.2% smoke and 7.7% vape.
What is alarming, however, is that the proportion of 11 to 18 year olds who thought that vaping was less harmful than smoking had declined to 43.3% in 2020, from 66.7% in 2015. That is dangerous misinformation, for which the WHO, the FCTC, many public health authorities, and the anti-tobacco lobby are directly responsible.
The bogeyman of a youth vaping epidemic is just that: a bogeyman. It isn’t real. Besides, the vaping industry worldwide entirely agrees with a prohibition on sales to under-18s. The first principle to which members of the Vaping Products Association of South Africa are expected to adhere is: ‘VPASA members sell only to adults and not minors.’
Among adults, too, vaping prevalence was found to be between 17.5% and 20.1% among current smokers, around 11% among former smokers and between 0.3% and 0.6% among never smokers.
The notion of vaping as a gateway to smoking is entirely false. Never-smokers very rarely take up vaping.
Like with the youth, harmful misinformation also seemed to be common among adults: ‘Perceptions of the harm caused by vaping compared with smoking are increasingly out of line with the evidence. [One of the surveys] found that: 29% of current smokers believed vaping was less harmful than smoking, 38% believed vaping was as harmful as smoking, 18% did not know whether vaping or smoking was more harmful, [and] 15% of smokers believed vaping was more harmful than smoking.’
This is not how you conduct public health. If your goal is to get people to quit smoking, you don’t scare the bejeezus out of them about an alternative that is objectively far, far safer.
The report found that about 60% of people who started vaping quit within six months. The belief that vaping is just as addictive as tobacco smoke seems to be speculative, at best.
(My own experience is anecdotal, of course, but I quit smoking twice by using a vape. Switching to the vape was fairly hard, but after the first week or two I really enjoyed it. Quitting it after a while was not hard, though. The first time it happened without my even trying after three months. The second time I vaped for six months, before giving it up. Both times, I tapered the nicotine content of my vaping liquid over time, and found quitting the vape was much, much easier than quitting cigarettes had been. Before vaping was a thing I also tried a variety of NRTs like gum, patches and mouth spray, but I hated all of them, and none worked.)
Effective for cessation
Referring again to the Public Health UK research, vaping is twice as popular as an aid to quitting smoking as NRT, and six times as popular as medication. The evidence review also found that vaping is becoming more popular, while NRT is becoming less popular, among long-term quitters.
‘Vaping is positively associated with quitting smoking successfully,’ the report summary states. ‘In 2017, over 50,000 smokers stopped smoking with a vaping product who would otherwise have carried on smoking.’
It also says that the evidence that vaping works for smoking cessation and smoking reduction is stronger in the most recent evidence review than it had been before.
The report says: ‘The extensive use of vaping products in quit attempts compared with licensed medication suggests vaping products may reach more people who smoke and so have more impact than NRT and varenicline.’
This suggests that treating ENDS in the same manner as either tobacco, or pharmaceutical NRTs, will significantly reduce their utility as smoking cessation devices, which will in turn harm the ultimate goal of the FCTC, which is to get all smokers to quit.
What should happen at COP9
So, let’s summarise.
There is no actual evidence of harm due to ENDS or ENNDS, although it seems reasonable to assume that over the long term, they won’t be entirely safe.
There is evidence to show that vaping is not a gateway product to smoking, and is not particularly appealing to young people, despite the availability of a panoply of non-tobacco flavours.
There is growing evidence that vaping is an effective and relatively safe way for people to reduce their tobacco use, or to quit tobacco altogether.
This evidence, however, is unlikely to be presented to the FCTC COP9, because only anti-tobacco lobbyists are invited, and they largely don’t care about smokers or about harm reduction.
Next week, the unelected rule-makers whose whims will become law for over a billion smokers around the world, gather in their secret conclave. They should resolve that national health authorities, instead of restricting vaping, should regulate it like coffee. They should resolve that vaping should be actively promoted to smokers as an effective and pleasant means to cut down or quit smoking.
But they probably won’t. After all, it isn’t about the science anymore, or about harm reduction. It has become an ideology, and a danger to public health.
[Image: Lindsay Fox from Pixabay]
The views of the writer are not necessarily the views of the Daily Friend or the IRR
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