The jury is still out on whether the likely ban on e-cigarettes in India is a good idea; while a committee of experts had asked for this a few years ago,a Group of Ministers (GoM) has reportedly endorsed this, and a Cabinet nod is now required. Adding colour, but little else, to the debate over the pros and cons of vaping is the fact that some of those making the case for it are former WHO officials, who, for decades, swore that Big Tobacco was evil incarnate; their argument now is that technology has changed everything, and that vaping offers tobacco’s kick with a lot less risk.
The pro-vaping lobby, interestingly, is under attack in the US for a 38% rise in the number of kids vaping (bloom.bg/2md3zI0), but argues that, since e-cigarettes extract the nicotine from tobacco, they are a safer alternative to smoking cigarettes in much the same way that tobacco patches and nicotine gums are; it is the other carcinogens, and the tar from burning the tobacco, they argue, that is the killer. Interestingly, both FDA and CDC are investigating 450 possible lung illnesses—and six deaths—resulting from vaping.
Those opposing vaping, however, argue this is a partial view since nicotine is also carcinogenic; so, while many of the other 28 carcinogens in tobacco don’t find their way into e-cigarettes, even a few are enough for them to be a health hazard. As for the argument that US studies show those who vape are twice as likely to quit smoking, some oncologists point out that the tests give just 2mg/day of nicotine to users, and with behavioural intervention; while the proportion of those quitting smoking doubled to 20%, e-cigarettes present a new kind of threat. For one, each cartridge has 10mg of nicotine, which is around a third of the minimum lethal dosage; presumably CDC-FDA will also shed more light on this aspect of vaping.
Also, with vaping marketed as a cool, and less-carcinogenic solution, as the US example shows, it can attract millions of non-smokers; and vaping hasn’t been around long enough to get definitive studies on whether it is less carcinogenic. If a large number of new users get addicted to it, even if it is ‘less’ carcinogenic than smoking, this could be an even greater health hazard. Nor is it clear what ‘less’ really means; if one unit of a substance A (which is a carcinogen) is enough to cause damage, how is this safer than a formulation that has five units of A?
While it is presumed the GoM looked at both sides of the argument, since vaping is relatively new, it is unlikely there will be enough evidence—relative to that on conventional smoking—on either its pros or cons. Nor is it immediately clear that banning is going to help; more so, since the more harmful product, the conventional cigarette, can be sold freely. A better step would be to treat it—till there is clinching evidence to the contrary—like conventional cigarettes, and put restrictions on its sales near schools, ban ads, put statutory warnings on labels, ban its use in public places, etc.
The more serious problem, though, is that the government continues to get distracted by non-issues. Given what e-cigarettes cost, is this really the biggest health issue connected with tobacco usage in India? While only a very small proportion of smokers in India are likely to switch to e-cigarettes—unless there is a sharp cut in their prices—even now, India’s anti-tobacco policy is solely focused on raising taxes on cigarettes to discourage their use. So, 80-85% of tobacco taxes are got from cigarettes—from Rs 7,651 crore in FY06, cigarette taxes rose to Rs 28,489 crore in FY17—whereas just 8-9% of all tobacco consumption is made via the cigarette route; this was around 21% in 1981-82. Indeed, according to the Tobacco Institute of India—a body of farmers, manufacturers, exporters, and ancillaries of the cigarettes’ segment of the tobacco industry—cigarette duties are roughly 55 times those on other tobacco products, like bidis and gutka—Rs 5,478 per kg versus Rs 99 per kg.
While it can be argued that bidis and gutka are used, primarily, by poor people, if the government thinks higher taxes on cigarettes will dissuade usage, surely the same strategy should be used for these products also? After all, while disease and death due to tobacco usage will hit all families equally, the economic impact will certainly be the highest for the poor. Interestingly, just around a fifth of the tobacco-related disease/death can be attributed to cigarettes, the rest is due to bidis and gutka. So, if the Cabinet does ban vaping, it will be celebrated as a big victory by the anti-tobacco groups, but it is really a distraction for a country like India, where the problem lies elsewhere. This ineffective policy is the reason why, despite continuous hiking of cigarette taxes, both the acreage as well as output of tobacco continue to rise instead of falling over time.