The World Health Organisation (WHO) stirred up controversy by granting Indian health minister Harsh Vardhan a prestigious award for World No Tobacco Day, held on May 31st. Stunningly, WHO chief Tedros Adhanom Ghebreyesus explicitly tied the award to Vardhan’s successful effort to ban e-cigarettes in India, a controversial move which has been described as an “own goal” by harm reduction advocates.
One journalist compared the WHO’s choice to reward Vardhan’s anti-vaping advocacy to awarding the Nobel Peace Prize for banning peace talks, warning that the WHO’s short-sighted stance on vaping could cost countless lives, in India and beyond.
The blame game
The WHO’s misstep is just the latest example of public health officials and policymakers ceding to panic rather than examining the scientific evidence. India banned the sale of e-cigarettes two years ago as a knee-jerk reaction to panicked reports of a rise in teen use in the United States.
The reports of a teen vaping craze turned out to be overblown, but India has stubbornly stuck with the ban— even as elsewhere, countries are adopting sensible regulatory approaches to e-cigarettes and even incorporating the devices into their strategies to curb smoking. Moreover, evidence has mounted that e-cigarettes do not act as a gateway to smoking, but rather as an effective tool to quit tobacco—in the US and the UK, for example, smoking (across all age groups) has fallen to historic lows as many smokers have switched to vaping.
Following the science
With an estimated 15 percent of deaths worldwide attributable to tobacco smoking, any strategy that leads to a reduction in combustible tobacco use is critical. A recent review of clinical studies found e-cigarettes to be highly effective at helping smokers to quit, returning better success rates than either using nicotine patches or simply attempting to give up the habit cold turkey.
The review also found no ‘clear evidence of harm’, an observation supported by Public Health England’s findings that e-cigarettes are roughly 95 percent less harmful than smoking, and only 0.5 percent as likely to present a risk of cancer.
According to Cancer Research UK, e-cigarettes are ‘less harmful than tobacco smoking’, while anti-smoking charity ASH agrees that they can be a helpful quitting tool. While most of the studies acknowledge that we do not yet have data on any potential long-term effects from vaping, the benefits of having smokers switch to e-cigarettes seem overwhelming. In a recent BMJ modelling exercise, the impact of replacing smoking entirely with vaping in the US suggested that millions of lives (as many as 6.6 million) could be saved.
A question of public image
The Public Health England evidence review underlines the importance of unambiguously communicating the benefits of switching from smoking to vaping. That this hasn’t happened on a large enough scale speaks to the lack of clarity in public messaging – not least from the WHO, whose spokespeople consistently peddle the accurate, yet unrealistic, message that the safest approach is not to consume either combustible tobacco products or e-cigarettes.
In a 2020 Q&A, meanwhile, the WHO implied that vaping wasn’t necessarily safer than smoking – a claim divorced from scientific evidence that drew swift condemnation from experts, including one researcher into tobacco addiction who accused the WHO of ‘blatant misinformation’. While the WHO might prefer that people abstain entirely from nicotine products, many people aren’t able to give up their habit, or simply don’t wish to. Given that reality, policymakers and public health experts should consider that not only is vaping many times safer than using combustible tobacco products, it may be crucial to some who are trying to break a dangerous addiction.
Regulation rather than prohibition
Across the world, tens of millions of smokers are moving to e-cigarettes, with governments in countries such as New Zealand and the UK recognising the long-term potential for harm reduction and incorporating the devices in their plans to curb smoking. Other policymakers – including in the EU – are still equivocating, a position which could have a devastating impact on their attempts to reduce deadly tobacco smoking. European policymakers have failed to adequately distinguish between combustible tobacco products and e-cigarettes, let alone craft innovative policies to encourage European smokers to switch to the devices in order to reduce their risk of deleterious health effects.
This impasse is perpetuating falsehoods among the populations of countries in the European bloc. According to a Eurobarometer survey, more than 70 percent of respondents think e-cigarettes should be regulated as strictly as combustible tobacco—a startling finding that is likely rooted in their lack of understanding about the relative risk profiles of the two products. A study published last year found that almost two-thirds of Europeans erroneously believe that vaping is at least as dangerous as smoking. While over 20% of EU adults smoke, just two percent are regular vapers, with most European smokers never having even tried an e-cigarette—a missed opportunity which could threaten Europe’s strategy to stamp out smoking.
Facing up to the challenges
The EU approach risks prioritising policies that restrict access to the very products that are most likely to help people embrace healthier habits. In the bloc’s Beating Cancer Plan (BCP), tobacco is rated as the top avoidable risk factor, responsible for 15 to 20 percent of all European cancer cases; its goal is to create a ‘tobacco-free generation’ (<5 percent tobacco users) by 2024.
As the scientific evidence in favour of harm reduction grows, many believe that reduced risk products have an important role to play in helping Europeans to quit smoking. If it wants to meet its objectives, Brussels needs to re-examine the anti-scientific approach to smoking cessation which it shares with the WHO.
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