End of the road for ENDS! Why we must applaud ban on e-cigarettes
December 5, 2020 7:45 AM
The Union and state governments did well to take timely action and work towards banning Electronic Nicotine Delivery System (ENDS), or e-cigarettes, in India
Thus, indicating that they were a gateway product to conventional smoking and tobacco use, thereby, severely undermining the country's tobacco control efforts.
By Preeti Sudan
The Prohibition of Electronic Cigarettes Act, 2019, was notified on December 5 last year. After Lok Sabha passed the Bill on November 27, Rajya Sabha considered the Bill on December 2. As health secretary, I had observed the proceedings of Rajya Sabha. The health minister made a speech that went beyond the official brief. With personal commitment, he made a compelling case for the ban.
The eureka moment came as the Bill got passed by voice-vote, cutting across parties! The spontaneous hurrah that followed was an expression of a high degree of fulfilment one experiences in some instances in their career as a civil servant. Faced with a powerful lobby, industry-supported doctors, media pressure and legal battles, the process for the banning of an evidently harmful product was much more challenging than I had expected.
One wintry night, I witnessed a group of kids barely 12-13 years of age smoking cigarettes and weed in a neighbourhood park. I wondered what if they were my grandchildren? It was December 2013, and I was the additional secretary in the ministry of women and child development. I realised that kids were seen as an emerging market and targeted for easy access to facilitate habit-forming.
I realised that the Juvenile Justice (JJ) Act was being amended, and we could use the opportunity to make a legal proviso towards curbing this menace. The role played by a dedicated oncology surgeon from Tata Memorial Hospital, who relentlessly took up the cause with stakeholders, needs acknowledgement. After due diligence by the concerned joint secretary, and support of the minister, the proviso in the amended JJ Act, 2015, made the sale of tobacco to minors a criminal offence punishable by seven years of rigorous imprisonment. We are one of the few countries to have a powerful deterrent that firewalls our kids.
During my stint in the health ministry, I could contribute to the cause further. India had embarked on a multi-pronged approach to reduce tobacco consumption. Apart from ratifying international treaties on Global Tobacco control (FCTC), a legislative framework, price and tax measures to reduce demand, regulation of contents of tobacco products and disclosures, deterrent packaging and labelling norms, the prohibition of advertising, promotion and sponsorship, several awareness measures, a free helpline/Quitline were also setup.
Considering that 26.68 crore Indians use tobacco, its reduction is indeed a mammoth job. However, we achieved a 17% relative decrease in tobacco consumption between 2010 and 2016, the highest reported globally in such a short span. What was truly heart-warming was that consumption among kids witnessed a 33% decline. Our aim should be to stop its initiation itself.
While we were barely able to take measures to protect our young from tobacco, a new threat was emanating from the Western world. Promoted as a less harmful alternative to cigarettes, this was the electronic nicotine delivery system (ENDS), containing a toxic and addictive chemical nicotine available with nearly 7,000 flavours! India, with its young population, was viewed as a lucrative market. A committee of experts coordinated by a dedicated doctor was constituted to examine the matter. This committee, and later a task force of ICMR, suggested a ban. Despite our determination, lack of appropriate legal provision turned out to be our Achilles heel.
In October 2018, I represented India, presiding over the eighth session of the WHO FCTC Conference of Parties (COP8). On ENDS, there was confusion, and countries were looking for evidence-based research. Interestingly, global evidence against ENDS also started emerging.
Research by an assistant secretary under-training brought clarity on the subject bolstering our commitment. A study by Jessica et al published in late 2018, on students in the US, found that e-cigarette users have 6.17 times the odds of initiating a person to conventional cigarettes.
Thus, indicating that they were a gateway product to conventional smoking and tobacco use, thereby, severely undermining the country’s tobacco control efforts. US Surgeon General in December 2018 issued advisory that ENDS use among school students increased 900% during 2011-2015. WHO, in 2019, stated that scientific evidence on e-cigarettes as cessation aids was inconclusive.
The new government in May 2019 by including the issue in the first 100 days’ agenda exhibited the highest political will. Since ENDS was never approved in India, an advisory was issued to states to stop the illegal sale. Sixteen states prohibited e-cigarettes. The action of state governments and the central government advisory was challenged and stayed by courts. By June 2019, news emerged about deaths and mysterious lung injury from the US. At this point, one of the leading ENDS manufacturers rolled out a plan for their launch in India by 2019 end.
Legal opinion suggested an Ordinance to stop the march of ENDS in India, with a Bill to be placed in Parliament. GoM under FM recommended the ban in one sitting. An Ordinance banning e-cigarettes was approved on September 18, 2019. As expected, it was challenged in the Court. However, no stay was given.
Lung injuries caused by Covid-19 and its manifestations are similar to those caused by e-cigarettes, new studies published in SAGE Open Medical Case Reports and Lancet have revealed. Fever, cough, shortness of breath, chest pain, hypoxia along with detection of lung opacities on imaging are some common overlapping symptoms.
The launch of e-cigarettes in India, planned by the end of 2019, had been successfully stalled. As I sat watching Parliament proceedings on TV, apart from feeling a sense of fulfilment that timely action has saved our children from addiction and consequent non-communicable diseases, I also felt humbled at how at each stage, though the task seemed daunting, political will at the highest level, support and collaboration helped find solutions.