AVI has written the following letter to all Members of Parliament

on eve of 1-year completion of vape ban in India

---

Dear Sir/Madam,

RE: Status of ENDS ban after one year of completion on September 18 – failures and lessons

---

We are a registered consumer rights organisation that advocates for harm reduction as a public health strategy to combat the alarmingly high tobacco health burden of our country. 

We are a grassroots body that works with tobacco users from across the nation to disseminate information on risk reduction and to help them make an informed choice of quitting altogether or transitioning to less harmful alternatives if they are unable to or don’t want to quit nicotine use. 

AVI is globally recognised for its work and is part of international consumer advocacy efforts to cut tobacco death and disease. Our work has been rewarded and recognised globally, and our members are invited to speak at forums in various parts of the world.

As you are aware, long before the Covid-19 pandemic hit our shores, India has been reeling under a tobacco epidemic – 26.7 crore Indians (42.4% of men, 14.2% of women and 28.6% of all adults) use tobacco in some form, of whom 10.6 crore smoke, according to GATS-2 survey. In 2016-17, 0.02%, or 2.6 lakh, had switched to e-cigarettes, and according to Euromonitor, the number of vapers in India had reached 6.25 lakh in 2019 when the government banned their sale.

Meanwhile, 13.5 lakh Indians continue to die every year from tobacco-related illnesses, with the annual economic loss rising to nearly Rs 2 lakh crore according to the latest 2020 figures. Tobacco-related cancers are also increasing, and are projected to increase further, as recorded by our cancer registries. The tobacco crisis is becoming more severe, which calls for urgent measures.

On the eve of the first-year completion of the vape ban, we would like to highlight 10 critical flaws in the decision and request your intervention as this issue impacts crores of Indian lives.

1) The haste has not been justified

The urgency shown in promulgating the ban through an executive order even before it could be considered by Parliament has not been validated as there have been no major hauls or busts which would signal the problem was so acute that it had to be dealt with such a blunt instrument as an ordinance. 

A policy impacting the lives of 11 crore people should have merited more careful consideration and enacted with the full wisdom of legislators, including through a Parliament-appointed committee to delve into its positive and negative (even if untended) outcomes.

This undue and unjustified haste points to the presence of factors other than protection of public health. The share prices of tobacco companies, in which the government is a significant stakeholder, shot up on the news of the ban. This was also an admission that safer alternatives are indeed a threat to smoking and an effective replacement, which should have been welcomed from the public health perspective instead of a ban.

2) The ban has been ineffective

A few other comparable LMICs such as Thailand, Mexico and Brazil have similarly banned the sale of e-cigarettes since many years. In each of these countries, the ban has been wholly ineffective and has created a black market which further imperils the health of citizens and especially minors as there are now no safeguards preventing access for them. 

Further, our neighbouring Bhutan recently ended its tobacco sale ban, which again had been ineffective in curbing consistent increase in prevalence while giving rise to large scale smuggling. 

As is evident from news reports, the e-cigarette industry has been pushed underground, with little impact on availability but major negative consequences for the stated goals of prohibition – to prevent access for minors and nonsmokers – while the safety of those using these products to wean off deadly smoking has been endangered.  

India now lies in the outlier group of nations that have, unsuccessfully, banned e-cigarettes.    

3) Regulation would have better served goals

According to the PRS report, almost 100 nations have decided against banning e-cigarettes, preferring instead to sensibly regulate them which ensures they are kept out of the hands of minors while allowing smokers to avail of a less harmful alternative to smoking. 

Sensible regulation and accurately communicating risks preserves and encourages individual choice in making safer decisions, earns the country revenue and creates jobs and economic activity, leads to sharp declines in smoking prevalence as can be seen in many nations such as the UK, US, Canada, France, New Zealand etc., promotes self-regulation in an organised industry and limits uncontrolled black markets, while allowing for targeted awareness campaigns to discourage use among the unintended population.

An outright ban on the other hand brushes the issue under the carpet, forcing it to fester into an unmanageable problem. Proportionate and adequate regulation allows the state to engage with it, find solutions that work and pre-empt and address potential negative outcomes.  

4) More nations have since moved towards regulation

The small group of nations that have imposed prohibition is shrinking further as more countries regulate smoking alternatives. Since India’s ban, Hong Kong, New Zealand, Philippines, South Africa and Russia have either reversed bans, regulated e-cigarettes or are considering bills for regulation.     

In nations that have allowed low-risk tobacco alternatives, we are witnessing accelerated declines in smoking rates and some like the UK are now well on track to bring smoking rates to negligible levels in a decade. India’s ban has robbed us of this potential progress in addressing our enormous tobacco-related mortality and morbidity.

5) Smokers are struggling, need more quit options

While negating the opportunity to mitigate the tobacco epidemic, the vape ban is also contributing to perpetuating smoking. Smoking is a complex habit which users find difficult to wean off. 

Cold turkey attempts have a small 5% chance of success, while use of nicotine gums/patches (NRTs) increases it to 7% and simultaneous counselling further betters it to about 15% quit rate. In India, NRTs are out of reach for most tobacco users, they are not given free or even subsidised, and counselling centres are very few. This leaves 11 crore current smokers in India with few options than the meagrely successful cold turkey method. Vaping has been shown to be twice as effective as NRTs, and can be made at price points bidi smokers can also afford. There is a need to expand the options smokers have to quit or reduce harm, not limit them further.

Crucially, while safer alternatives have been banned, bidis which are the most harmful and deadly way of consuming tobacco, are hardly taxed and have recently been exempt from even pictorial warnings, while flavoured tobacco which is being banned across the world is being introduced in new variants. It is unfortunate that tobacco in India is being perceived entirely from commercial and political lens than the huge death and destruction it causes.

6) Ban is perpetuating smoking

In the seven years between GATS 1 and GATS 2, tobacco use decline was 6%, which is negligible when weighed with population increase. Globally too, the number of smokers has remained over a billion since 2000 and will continue to remain so until 2025, according to the World Health Organisation (WHO). 

Fewer quit options also mean smoking continues to perpetuate as current smokers struggle and fail to quit in the absence of effective and suitable options. This perhaps explains why shares of tobacco companies increased when e-cigarettes, which could have broken this chain, were banned.

During lockdown, the number of people trying to quit rose sharply as supply was limited. But in the absence of meaningful support through NRT subsidies or affordable vaping options, most of these users are likely to fall back into smoking.

7) Key reasons for the ban have been refuted

During the Parliament debate on the e-cigarette ban, health minister Dr Harshvardhan pointed to vaping deaths and high teen use in the US as reasons for the ban. Since then, the deaths have been attributed to illegal cannabis use, which is banned in India, and had nothing to do with nicotine vaping. 

Further, after a two-year blip, teen vaping prevalence has fallen by 34% in 2020 – 4.4% of US middle schoolers and 0.4% of high schoolers vape regularly. It’s worth noting that vaping is not banned in the US at the federal level, and the US FDA has infact started the process to regularise vaping. 

The other excuse, that India’s vape ban was in adherence to WHO/FCTC policy, does not hold true as nearly 100 nations, most of whom are signatories to the FCTC treaty, have regulated vaping. WHO’s Europe hub in fact released a report this year stating there is ‘conclusive evidence’ that e-cigarettes are less harmful than smoking and focussed on adequate regulation (PDF, page 5). 

The government counsel stated in Kolkata court that the ban was imposed to prevent entry of Juul. This stinks of protectionism, shows the influence the competitors (the tobacco industry) bear on government policy, and the willingness of the government to place industry profits before the health of people. 

8) Science has strengthened in favour of e-cigarettes since India’s ban

In the year since India’s ban, scientific evidence continues to mount in favour of e-cigarettes being less harmful than smoking, though not entirely harmless. A report published in January 2020 in the Journal of Hazardous Materials compared toxicity between regular cigarettes, heat-not-burn (HNB) tobacco products and e-cigarettes on bronchial epithelial cells. It found e-cigarettes to be the safest, while HNB products little more toxic while cigarettes to be the most toxic.

In report filed by the UK committee on Toxicity of Chemicals in Food, Consumer Products, and the Environment (COT) published in September 2020 found e-cigarettes to be significantly less harmful and confirmed the 2015 Public Health England (PHE) findings of e-cigarettes to be 95% safer than smoking. 

In a report published in the US National Library of Medicine in April 2020 which compared carbonyls and carbon monoxide emissions, it found that multiple types of e-cigarettes generated anywhere between 0 to 3618 times less carbon monoxide (CO) than conventional cigarettes; all e-cigarettes emitted 3 to 3950 times less acetaldehyde; and 3 to 120 times less formaldehyde; all when compared with regular cigarettes. 

9) Ban smacks of philanthro-colonialism

Earlier this year, a Paris-based NGO funded by Bloomberg Philanthropies, The Union, released a position statement that tobacco harm reduction through e-cigarettes and other safer alternatives should be banned in lower- and middle-income countries (LMICs) such as India because of weak mechanisms and to prevent teen use. 

This is a highly discriminatory position which seeks to widen health inequalities between the developed and developing world on the pretext that we are ill-equipped to avail of technological advances without their facing negative side-effects. The correct policy response should be strengthening frameworks rather than denying people who can least afford to deal with tobacco-related consequences a means to reduce harm.

This prohibitionist line is being perpetuated in India through Bloomberg-funded NGOs such that every single anti-vaping crusader or nonprofit in our country is linked to the same funding source. This outside pressure must be resisted so that India can develop independent, evidence-led thinking instead of our policies being driven by rich New York billionaires.

10) Ban was a bad economic decision

The e-cigarette ban, a health policy, was announced by finance minister Shrimati Nirmala Sitharaman, whose true impact is coming into sharp relief during these lean pandemic times when the economy is struggling. 

The e-cigarette industry could have been an emerging source of revenue for the government while also helping reduce tobacco-related mortality and morbidity which is draining our nation’s resources. This economic activity would also have the upstream effect of creating a revenue alternative for the country’s crores of tobacco farmers who are currently struggling. 

The sector presented a rare combination of improving the country’s health as well as wealth, and yet it was banned in haste. The $5 billion e-cigarette industry is booming in neighbouring China while in India we have increased smuggling, black market and corruption.

In light of these missteps, we request Parliament and the Indian government reconsider the ban on e-cigarettes and institute a panel to conduct an unbiased analysis. There are a number of regulatory frameworks available from which to adopt the aspects best suited to India’s needs – EU’s Tobacco Products Directive (TPD), US FDA’s deeming regulations, China’s proposed regulatory framework, as well as regulations from New Zealand, Philippines, South Africa etc.

AVI would be honoured to support, through expertise and intervention programmes, the formation of harm reduction tobacco policies which benefit the country’s 27 crore tobacco users, provides them accurate information on risks and assists them in making informed, safer choices.