Following an advisory from the ministry of health and family welfare issued last year, at least 12 states in India have banned Electronic Nicotine Delivery Systems (ENDS). States of Punjab, Maharashtra, Karnataka, Kerala, Bihar, Uttar Pradesh, Jammu & Kashmir, Himachal Pradesh, Tamil Nadu, Puducherry and Jharkhand have taken steps to ban the use of ENDS, officials in the union health ministry have said.
Of late there has been an increasing popularity of ENDS, more commonly known as e-cigarettes or “vapes" in India. E-cigarettes do not fall within the scope of existing national legislation on tobacco production, distribution, and use. Yet doctors claim they pose significant health risks to users that are frighteningly similar to those of conventional cigarettes.
In August 2018, the ministry had issued an advisory to all states and union territories to ensure that ENDS, e-cigarettes, heat-not-burn devices, vape, e-sheesha, e-nicotine flavoured hookah, and similar devices that enable nicotine delivery are not sold (including online sale), manufactured, distributed, traded, imported and advertised in their jurisdictions. The move came in the wake of the Delhi High Court taking strong exception to the Centre for delay in coming up with appropriate measures to tackle the “new emerging threat" of e-cigarettes in the country. Recently, the Directorate General of Health Services (DGHS), Central Drugs Standard Control Organization (CDSCO), had also issued a similar order.
After the health ministry’s advisory, the Ministry of Electronics and Information Technology (MEITY) had also proposed an amendment to the Information Technology (Intermediary Guidelines) Rules, 2018 to ban the advertisement of e-cigarettes. Also, the Central Board of Indirect Taxes and Customs issued a circular saying that all import consignments of e-cigarettes must be cleared by the drug controller first.
“Nicotine is a highly toxic chemical and potentially carcinogenic. In fact, it will not be an exaggeration if it is considered poison. Therefore, any nicotine product should be taken under strict medical supervision for controlling withdrawal symptoms during cessation therapy," Pankaj Chaturvedi, oncologist, Tata Memorial Hospital, said.
As per a report prepared by the World Health Organization (WHO); ENDS emits nicotine, the addictive component of tobacco products. In addition to dependence, nicotine can have adverse effects on the development of the foetus during pregnancy and may contribute to cardiovascular disease.
A debate is on over ENDS. Some organizations claim that ENDS work for cessation and are less harmful than the tobacco products, however, the government argues that there is no substantial evidence to prove this. Rationale of the Public Health England (PHE) report has been seriously questioned by the most reputed medical journal Lancet, where it strongly criticized the PHE and UK House of Commons Science and Technology Committee report on ENDS/ e-cigarettes. The medical communities across the globe have also questioned the acceptance of ENDS as a harm reduction or tobacco cessation strategy.
“Naming 'e-cigarette' is a tactic used by the industry to fool public by giving it a tubular shape and putting a red LED at the tip which lights up when the tube is sucked to mimic cigarette smoking. It is as incorrect to call it a tobacco product as calling penicillin, a fungal product. It is a nicotine delivery device and ought to be regulated as such," said Prakash C. Gupta, Director, Healis Sekhsaria Institute of Public Health. Over 36 countries around the world have so far banned the ENDS.