To smoke or vape?
Tobacco advocates accuse world health body of ignoring their voices and studies showing the lower risk of vaping products and rushing to regulate them
With the debate still raging on just how safe e-cigarettes are, tobacco advocates have accused the World Health Organization (WHO) of a lack of transparency for moving too quickly to regulate e-cigarettes, or vaping, without giving them a voice.
The issue came to the fore recently at the WHO’s seventh Conference of the Parties (COP7), which closed in New Delhi on Nov. 12.
Advocates of the vaping industry – the makers of e-cigarettes – accused the WHO of a lack of transparency by preventing any representatives from attending the conference to present their evidence.
And Indian tobacco farmers protested on Nov. 7 outside the conference venue in Greater Noida, New Delhi, against the “nondemocratic” way of framing “one-sided” policies on tobacco, the Press Trust of India reported.
The conference, which is held every two years, is of critical importance to the industry and public health since its advisory notices guide government policy across the world.
This year’s conference was marked by a tussle over ENDS (electronic nicotine delivery systems) or e-cigarettes, as they are more commonly known and are products of the vaping industry.
The WHO released an advisory notice at the end of the conference that acknowledged both sides of the issue. On the one hand, it said that, “some parties expressed concern at the use of health claims as a marketing claim for ENDS.”
It also said that, “there was consideration that different devices should be regulated under national legislation in the same way as drugs or tobacco products.”
But the WHO also concluded that, “parties called for unbiased, commercially independent and scientifically based research to ascertain the overall health impact and long-term public health risks of ENDS.”
The WHO estimates there will be one billion smokers by 2025 and the majority of them (about 60%) will live in Asia.
According to the WHO Tobacco Atlas, China had 1.5 million hectares dedicated to growing tobacco and is the world’s biggest producer, with 3.2 million metric tons of tobacco leaf grown in 2012.
E-cigarette users inhale a vapor made by heating the nicotine-containing liquid and flavoring. Nicotine is a highly addictive substance, but e-cigarette users get their fix without the deadly carcinogenic tar that comes with combustible cigarettes. There are more than 7,700 flavors in e-cigarette products, which is one of the reasons why it is banned in some markets such as Singapore as they appeal to the youth market.
Vaping groups, excluded from the conference, accused the WHO of rushing headlong toward a ban under its Framework Convention on Tobacco Control (FCTC) without consulting widely, or analyzing evidence, which suggests e-cigarettes are less risk than conventional cigarettes and have helped smokers to quit in countries where they are widely available.
Individual governments were prohibited from including representatives in their delegations with any links to the tobacco industry. Officials from state-controlled tobacco companies, or tobacco growers and theoretically anyone who deals with cigarette makers on taxation or illicit trade such as customs officials.
This is believed to have enraged a number of governments including China, who are upset about the WHO infringing on its sovereignty.
The public gallery was also permanently closed after just a few hours on Nov. 7 and journalists banned from attending meetings. Some were even frog-marched out. By contrast, the whole of the COP21 covering climate change in Paris last year was live-streamed to all.
“If the FCTC is genuinely open to debating the issue about e-cigarettes, then why should its officials fear journalists?” said Julian Morris from the non-profit think tank Reason Foundation.
“I strongly believe the WHO should make evidenced-based decisions,” Morris added. “ The problem is that it set its mind on a ban some years ago and has been very slow to respond to gathering evidence, which shows that e-cigarettes are far less harmful than conventional cigarettes.”
One of the most influential studies has been by Public Health England, which concluded in 2015 that e-cigarettes are 95% less harmful than conventional cigarettes. However, other recent studies such as one by the University of Athens have concluded that a 30-minute vaping session is equivalent to five minutes smoking a conventional cigarette.
Unable to press their case at the COP7, Morris and a group of tobacco harm reduction experts held their own meetings outside the conference venue. One attendee was Dr Konstantinos Farsalinos from the Onassis Cardiac Surgery Centre and University of Patras in Greece.
He believes consumers should be offered a third option beyond the “quit or die” mantra of the WHO.
“Study after study shows that eight out of 10 smokers are unable to quit on their own, or after using pharmaceutical products such as patches or pills,” Farsalinos said. “And if they don’t quit, those studies also show that 50% of them will die prematurely from tobacco-related diseases.”
Vaping advocates are particularly vexed about the situation in Asia where country after country has banned e-cigarettes.
Singapore does not permit the sale of nicotine-based e-cigarettes, while Thailand can impose a five-year jail sentence on anyone caught smoking one. Hong Kong plans to ban the import, manufacture, sale, distribution and advertising of e-cigarettes. An amendment bill will be introduced in the Legislative Council in 2016-17.
A Baptist University of Hong Kong study found that e-cigarettes contain one million times more cancer-causing substances than outdoor air.
Harm reduction experts believe the WHO has been deliberately trying to suppress any acknowledgment or references to the increasing body of science, which shows that e-cigarette vapor poses considerably lower risk than cigarette smoke.
They also claim that delegations from Thailand, Uganda and Kenya were the main driving force pressing for an advisory notice advocating an outright ban. On the other side of the debate was an informal grouping led by Canada, which advocated for an advisory notice maintaining the status quo until more evidence has been gathered.
“I just cannot understand why Asian governments won’t allow these smokers to use e-cigarettes to help them quit,” said Heneage Mitchell from Hong Kong-based consumer advocacy group Factasia. “At the moment we have a crazy situation where the most lethal form of tobacco is legally on sale in Asia, but the least lethal form is banned.”
Morris and Farsalinos both dismiss arguments that e-cigarettes might encourage young people to take up smoking.
Farsalinos quotes a study he conducted in Malaysia earlier this year, which covered more than 7,000 people who use e-cigarettes or vapor products. This showed that 98.3% were current or former smokers rather than nonsmokers who just started using e-cigarettes.
The figures are similar in Europe where vaping is rapidly entering the mainstream. European Union figures show that only 0.08% of nonsmokers are daily users of nicotine-based e-cigarettes.
“The EU’s own figures highlight that 6.1 million Europeans have quit smoking and a further 9.2 million reduced tobacco consumption with the help of e-cigarettes,” Farsalinos said.
Vaping promoters believe the WHO is not only out of touch, but also in danger of promoting policies, which have a detrimental impact on public health; the very opposite of what it was set up to do. In Asia, they conclude the issue is of critical importance since the region’s governments tend to import the WHO’s recommendations wholesale.
Brunei, Cambodia, Indonesia, Singapore, Thailand, and Vietnam have imposed almost all-encompassing bans on e-smoking, according to Tobacco Asia. This makes Southeast Asia the one region in the world with the highest number of countries hostile to e-smoking, it said.
They refer back to the individual choice embedded in the WHO’s seminal Ottawa Declaration of 1986. This states that, “health promotion is the process of enabling people to increase control over and improve their health.”