Post-advisory, Govt of India appears reluctant to ban e-cigarettes, "harmful" to kids

By Rajiv Shah
Is the Government of India dilly-dallying over the issue of banning e-cigarettes, which have been declared by anti-tobacco activists across the world as providing “an entryway to nicotine addiction”, especially among the kids? It would seem so, if the latest developments are any guide.
Indeed, Four-and-a-half years after India showed some “intention” to ban e-cigarettes, considering them as risk to public health, especially among the non-smoking youths, following the World Health Organization (WHO) in August 2014 seeking “stiff regulation” on it across the world, its “booming” $3 billion global market appears all set to dangerously invade India.
The Union ministry of health and family welfare, in October 2014 had called e-cigarettes, which use battery-powered cartridges to produce a nicotine-laced vapor, a “backdoor entry” to health risk, because has nicotine, pointing out that expert panels have already recommended regulation or a ban.
The ministry view came after e-cigarettes, imported and sold by small firms, began being sold by India’s largest cigarette maker, ITC. Meanwhile, over more than four years, they are available on online stores, including on Amazon India, Electronic Cigarette India and Vapour India.
In fact, four-and-a-half years on, all that the Government of India (GoI), instead of banning the product, has done is to issue a feeble advisory on August 28, 2018 to all states to consider banning e-cigarettes, which it said, should be done “in larger public health interest” and in order to “prevent the initiation of Electronic Nicotine Delivery Systems (ENDS) by non-smokers and youth with special attention to vulnerable groups”.
The advisory insisted, the states should do this to “ensure that any ENDS, including e-cigarettes, heat-not-burn devices, vape, e-sheesha, e-nicotine flavoured hookah, and the like devices that enable nicotine delivery are not sold (including online sale), manufactured, distributed, traded, imported and advertised in their jurisdiction.”
It added, this was necessary because “there are possibilities that children, adolescents & youth (and generally non-smokers) will initiate nicotine use through ENDS at a rate greater than expected if ENDS did not exist; and that, once addicted to nicotine through ENDS, such children, adolescents & youth are likely to switch to cigarette smoking.”
Following the advisory, while several states – including Karnataka, Kerala, Punjab, Jammu and Kashmir, Mizoram and Maharashtra — have banned e-cigarettes under the Drugs and Cosmetics Act, 1940, and Food Safety & Standards (Prohibition and Restriction on Sales) Regulation, 2011, GoI appears reluctant to take things forward.
In a clear indication that it would not like pursue a blanket ban to save non-smoking youths from a new health hazard, Vikas Sheel, joint secretary, Ministry of Health and Family Welfare merely tweeted about the harms the e-cigarettes can cause on January 31, suggesting its effectiveness is still not “proven.”
He said, “Effectiveness of e-cigarettes as cessation aides as compared to other nicotine replacement therapy (NRT) tools is not proven. Such claims are marketing propaganda of the ENDS companies to use these gateway products for initiating youth on nicotine addiction.”

Industry campaign  

Meanwhile, industry campaign for introducing e-cigarettes, despite clear harm it may cause to the youth, has picked up. Among others, Dr KK Aggarwal, president of the Heart Care Foundation of India, and past national president, Indian Medical Association, has stated that the ENDS are “far less harmful than conventional cigarettes”.
He says, “Tobacco harm reduction means action taken to reduce the health risks associated with the use of tobacco or nicotine. It involves the use of non-combustible products such as vaping ones like e-cigarettes, heated tobacco products or smokeless tobacco. These products are collectively called Alternative Nicotine Deli­very Systems (ANDS) and do not involve burning of tobacco leaf or smoke inhalation.”
The senior doctor quotes a UK parliamentary inquiry into e-cigarettes reported on August 17, 2018, which stated that “e-cigarettes present an opportunity to significantly accelerate already declining smoking rates, and thereby tackle one of the largest causes of death in the UK today. They are substantially less harmful -- by around 95 percent -- than conventional cigarettes.”
This contradicts the WHO view, which has expressed skepticism about the effectiveness of ANDS as effective tools for quitting, pointing out that, “with almost 8,000 different flavours added, including fruit and candy-like flavours, there is legitimate concern that instead of reducing the number of smokers, they will actually serve as a gateway to nicotine addiction, and ultimately, smoking, particularly for young people”.
However, says Dr Aggarwal, the organization he heads, the Heart Care Found­ation of India “feels that, based on available evidence, using e-cigarettes is less harmful than smoking cigarettes though the health effects of its long-term use are not known.”
Even as GoI is failing to take any decision in the matter, new, dangerous signals have come from the US. Juul Labs Inc has reportedly revealed its plan to launch its e-cigarette products in India by late 2019. The report follows Uber India executive Rachit Ranjan joining as senior public policy strategist with Juul, and India-based Mastercard executive Rohan Mishra as head of its government relations.
The report says, Juul plans to hire at least three more executives, including an India general manager, LinkedIn job postings showed. It also plans “a new India subsidiary”, according to one posting.
Juul’s sleek vaping devices, which resemble a USB flash drive and offer flavours such as mango and creme, are a sensation in the US, especially among the teenagers. Juul devices, like most e-cigarettes, vaporize liquid containing nicotine, the addictive stimulant that gives smokers a rush.
Even as anti-tobacco activists say, Juul devices involve addictive chemicals and can be a gateway to cigarette smoking, especially for the young, the push to launch in India is said to be part of the company’s broader Asia strategy, as India has 106 million adult smokers, second only to China in the world, making it a “lucrative market”.
Juul sources have been quoted as saying that the company is exploring “potential markets”, and is already “engaged with health regulators, policymakers and other key stakeholders”. And, as part of its evaluation, it would consult with the Indian Journal of Clinical Practice (IJCP), a healthcare communications company, one of whose editors is Dr Aggarwal.