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Will ENDS justify the means?

The global anti-tobacco conference’s move to allow member nations to prohibit or restrict sale of Electronic Nicotine Delivery Systems provokes an outcry from harm reduction experts

The global anti-tobacco conference winded down on Saturday toeing a hard line towards e-cigarettes and other vaping devices. The seventh session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control (FCTC) ended with Southeast Asian countries voting for complete prohibition of Electronic Nicotine Delivery Systems (ENDS) and Electronic Non-Nicotine Delivery Systems (ENNDS) in the region.

The clampdown rationale

The World Health Organisation’s concern stems from the fact that while public health policy has been slow to catch up, ‘vaping’ — a ‘tobacco-free’ version of the cigarette where smokers inhale the vapour through liquid in a vaporiser — has become extremely popular among smokers as a ‘healthier’ option to smoking.

All vaping devices heat a solution called ‘e-liquid’ to create an aerosol; the e-liquid comes in flavours that are dissolved into propylene glycol or/and glycerine. Health organisations maintain that the toxicants generated by e-liquids can vary enormously — even within brands — due to the increased thermal decomposition of e-liquid ingredients with rising applied temperatures in open system devices.

Arguing that new nicotine replacement devices were not a valid substitute for people trying to stop smoking, the FCTC has voted in favour of a regulation that allows member nations to prohibit or restrict sale of ENDS/ENNDS devices. “It now depends on national laws but India is likely to opt for complete prohibition. Other countries might choose to restrict access. India has taken a unified stand against ENDS as there are enough tobacco products in the market already. It will take us years to understand the full effects of ENDS products. There is not enough research and a complete prohibition will help prevent more tobacco-related illnesses,” says a member of the Indian delegation. According to WHO, the global market for ENDS/ENNDS in 2015 was estimated at almost $10 billion.

Sidestepping wider consultations

International harm reduction experts, however, warn that measures to limit access to e-cigarettes will result in nearly a million smokers dying. A recently released documentary film about vaping, ‘A Billion Lives’, has argued that e-cigarettes, whose health risks are far lower, could be useful in saving lives.

Some experts claim the lack of transparent discussions on ENDS could cost lives. “These are closed-door meetings and WHO officials have drafted proposals to ban less harmful alternatives to cigarettes without consultation with many member countries. Instead of an open and transparent discussion exploring the evidence and science of better, safer, non-combustible nicotine delivery products, countries that do not agree with a ban are being excluded from the process and the FCTC is even withholding documents from delegations,” charges Julian Morris, vice-president of The Reason Foundation think tank and harm reduction expert.

Alleging that WHO is giving up its responsibility to save lives by recommending prohibition and restriction on ENDS/ENNDS, Riccardo Polosa, another harm reduction expert, says, “If this is true, it is simply outrageous. If the WHO extinguishes e-cigarettes (ENDS), it will have passed up what is clearly one of the biggest public health innovations of the past quarter century — one that could potentially prevent hundreds of millions of premature deaths. It will also have abrogated its responsibility under its own charter to empower consumers to take control of their own health, something that millions are already doing.”

The government is likely to opt for a complete prohibition of ENDS/ENNDS devices, says a member of the Indian delegation to the WHO FCTC conference

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