The world has embraced electronic cigarettes, commonly known as vapes, and other electronic nicotine delivery systems (ENDS) as harm-reduction alternatives to combustible tobacco used in cigarettes. Globally, several tobacco control researchers have concluded that e-cigarettes are at least 95% less hazardous than combustible cigarettes. Studies by Public Health England show that the risk of passive smoking associated with them is also extremely low, as they do not produce tobacco fumes. But India, it would seem, is just not convinced.

That is surprising given that the country bears 12% of the global burden of tobacco users, has 40% of its adults exposed to passive smoking, and also has the dubious distinction of showing the lowest quit rate among all countries surveyed in the Global Adult Tobacco Survey 2. Despite the figures, our government appears keen to deny the Indian populace access to a tobacco harm-reduction alternative by taking a hard stand against the use of electronic cigarettes. It is no wonder that the government’s decision to ban ENDS across the country has sparked a debate. However, since there is empirical evidence to suggest that countries, which have regulated ENDS, have witnessed a decline in smoking rates, India needs to take note and reconsider its stance on the matter.

According to a study conducted by The British Medical Journal, as many as 68 countries, including the UK, US, Canada, France and Japan, are using a range of regulatory mechanisms aimed at enhancing the discretionary power of their adult citizens. These include laws that prohibit sales of ENDS to minors, regulate advertising and promotion, impose limits on nicotine concentration, and place checks on product quality and battery standards. India has instead opted to ban these products completely and deprive people from harm-reduction solutions that the world is adopting. Shouldn’t India allow smokers the right to choose?

Globally, the most successful regulations for ENDS are those with strong evidentiary underpinning. The UK and France, for example, have witnessed a decline in their smoking rates, with the UK marking the lowest at 14.9% in 2017, in comparison to 19.8% in 2011, and a record 1.6 million people in France having moved away from combustible cigarettes over the past two years. Sweden has achieved the lowest rates of smoking-caused illnesses in Europe, thanks in part to a low-risk form of smokeless tobacco called snus. In Asia, Japan has reduced cigarette sales by a third in just three years through product substitution. This underscores the viability of ENDS as a long-term alternative to smoking.

Why ban when you can regulate? Country-wise e-cigarette policies differ and the outcomes of their experience so far could inform a regulatory system in India.

Even as New Zealand is promoting ENDS by launching a website called Vaping Facts to clarify myths and make the country smoking-free by 2025, Canada, the UAE and Seychelles have reversed their bans to regulate the product and allow access to adult smokers. These countries now have regulatory mechanisms to monitor the manufacture, sale, labelling and promotion of ENDS products to enable people to switch and deter unintended consequences. Canada has created a separate provision for vaping products under its existing tobacco control regulations. Its objective is to ensure that the category of modern products is regulated but these are more accessible than old tobacco products, which are significantly more harmful.

The World Health Organization and the EU have acted in favour of a regulatory framework instead of a blanket ban. They have provided detailed policy suggestions for countries to restrict producing, marketing, selling and using e-cigarettes. This grants consumers who are unable to quit smoking the right to choose a less harmful alternative.

With a smoking population estimated at over 100 million, India is not only a lucrative market for e-cigarette players, but also has more to gain from a public health standpoint if ENDS are permitted. A large chunk of India’s healthcare expenditure goes into the treatment and management of preventable diseases, including tobacco-related illnesses, and by changing its mindset and accepting the opportunity that electronic cigarettes and similar tools present, India will not only gain economically but also find better solutions to combat the voluntary inhalation of harmful substances.

India needs to think of vaping as part of a solution and learn from the empirical evidence being provided by various countries. In the interest of people’s health, the government must not ignore scientific innovations, which allow us to combat a crisis of addiction that has not been satisfactorily responsive to various measures adopted over the decades. India is currently the second-largest tobacco consumer in the world, a position that should encourage us to intervene in ways that are likely to yield results.

A ban on a widely accepted alternative to smoking regular cigarettes not only prevents consumers from making a less harmful choice, it may also result in an illicit trade turning rampant. We need to check the entry of dangerous counterfeits, and deny vulnerable groups access to these products via the black market. It is important for the government to examine the data from other countries and formulate a holistic strategy to reduce India’s tobacco disease burden.

Amir Ullah Khan is economist and director of research at Aequitas, and was formerly with the Bill and Melinda Gates Foundation

Close