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October 12th, 2016:

The debate on regulation of e-cigarettes in China

China manufactures 80% of the world’s e-cigarettes.1

The domestic Chinese e-cigarette market has expanded since 2014, with a 33% increase in sales in 2015 alone.2 The 2014 China Global Youth Tobacco Survey, which studied 155 117 students aged 13–15 years, showed that 45·0% of them had heard about—and 1·2% had used—e-cigarettes.3 Some members of the global public health community are calling for regulation of e-cigarettes, but, owing to inconclusive evidence on their impact,4 no simple and unified guidelines exist to assist countries in such regulation. In China, a regulatory framework has been debated between the public health community and government agencies since 2005. We aim to analyse the development of a regulatory system for e-cigarettes and the interests and strategies of policy makers in China, and hope that this Comment might assist other countries undergoing similar debates on the regulation of e-cigarettes.

There have been dramatic changes in the way that e-cigarettes are marketed in China since they first emerged in 2005. Back then, e-cigarette companies promoted their products as a cigarette-like but healthier alternative to tobacco, as a tool to help quit smoking, and as gifts,5 which attracted attention from tobacco control advocates and government agencies.

However, with little evidence on the health effects of e-cigarettes, and little international experience in their regulation, government agencies were initially hesitant to take over regulatory responsibility. The ensuing debate centred on whether to categorise e-cigarettes as tobacco, medicinal, general, or harmful products—each coming under different agencies with different regulatory mechanisms.

Over a decade later, this issue is still unresolved.

The China Food and Drug Administration expressed its position in 2006 that “Electronic Nicotine Delivery Systems (ENDS) should not be managed as medical equipment.”6 The State Tobacco Monopoly Administration (STMA) refused to classify e-cigarettes as tobacco products but rather as potentially harmful chemical products, recommending regulation under State Administration of Work Safety.

Nonetheless, the e-cigarette industry was challenged by the media and public health advocates for its marketing ploys. The industry then changed its strategy to promote e-cigarettes as fashionable, innovative, leisure consumer goods, and built a fan base, both online and offline. Many e-cigarette centres, clubs, and bars were established in major cities to help disseminate and portray the culture of vaping, and to increase sales of e-cigarettes.

As the e-cigarette industry developed, the Chinese tobacco monopoly decided to include e-cigarette development in its own strategy. It established a task force led by the STMA’s leaders to coordinate issues related to all new tobacco products. Its local branches, an affiliated research centre, and two e-cigarette companies agreed to cooperate in development of e-cigarettes co-branded with the key existing cigarette brands.7

The trajectory of e-cigarette regulatory development has also been affected by the changing policy context in China. First, many tobacco control measures have been implemented, such as increases in tobacco tax, revision of advertising laws, non-smoking directives to government officials, and a national smoke-free law under process.

Second, as China’s economy has begun to slow down since 2009, a core strategy of the Chinese administration to stimulate economic vitality is through deregulation of industries. The government also encourages industries to form associations for improved self-regulation. With more than 1000 brands, 6000 products, and over 1800 companies in the industry, leading e-cigarette companies echoed this central policy by establishing the first National Association of Electronic Cigarettes in 2015.8

The Ministry of Industry and Information Technology (MIIT)—the supervising ministry for STMA—seems to support the self-regulation of the e-cigarette industry. By encouraging small and medium e-cigarette companies to form into associations, MIIT might be able to manage the industry more easily.

However, MIIT suggested that the STMA should seriously consider and push forward the regulation of e-cigarettes and other tobacco products.9 At the time of writing, the central government has yet to make a decision on how to regulate e-cigarettes.

Whether e-cigarettes end up being regulated by the STMA or through self-regulation by the e-cigarette industry, we call upon the central government to include e-cigarettes in all future tobacco surveys, and establish a regulatory system as soon as possible to at least ban sales to children, prevent e-cigarette marketing towards youth and non-smokers, and require disclosure of ingredients and labelling—as a first step until the science is clear.

Xiaoxin Xu, *Xinsong Wang, Xiulan Zhang, Yanli Liu, Huan He, Judith Mackay

School of Social Development and Public Policy, Beijing Normal University, Beijing 100875, China (XX, XW, XZ, YL); School of Public Administration, Southwestern University of Finance and Economics, Chengdu, Sichuan, China (HH); and Vital Strategies, Kowloon, Hong Kong Special Administrative Region, China (JM)
We declare no competing interests.

1 Shan J. E-cigarette controls considered for safety. China Daily, Jan 7, 2015. htm (accessed May 31, 2016).
2 Beijing Hua Yan Zhong Shang Yanjiu Yuan. Analysis of e-cigarettes market status in China and trend forecasting, 2015–2020. Beijing: Beijing Hua Yan Zhong Shang Yanjiu Yuan, 2015 (in Chinese).
3 Global Youth Tobacco Survey. Fact sheet: China 2014. Chinese Center for Disease Control and Prevention, WHO, and Centers for Disease Control and Prevention. (accessed May 24, 2016).
4 Levy DT, Cummings KM, Villanti AC, et al. A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Addiction 2016; published online April 25. DOI:10.1111/ add.13394.
5 Tobacco China Online. Healthy “cigarettes” appearing at Canton Fair, customers mostly from overseas. 2005. (in Chinese) (accessed May 24, 2016).
6 China State Food and Drug Administration. Notice on classifi cation of products including the system of re-leveling of leukocyte (2006, No 268, State Food and Drug Administration), Article 41. In: China State Food and Drug Administration, ed. Beijing: China State Food and Drug Administration, 2006.
7 Jiang Z, Gu M. Shanghai Lvxin and CNTC cooperate on e-cig, taking the high ground. 2014. http://fi (in Chinese) (accessed May 4, 2016).
8 Cecmol. National Association of Electronic Cigarettes established. 2015. (in Chinese) (accessed May 4, 2016).
9 Dongfang Yancao Wang. The speech by Miao Yu at the 2016 Tobacco Work Meeting (excerpt). 2016. (in Chinese) (accessed May 4, 2016).


China: the tipping point in tobacco control

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