Electronic-cigarettes are battery-operated devices that produce aerosol by heating a solution containing nicotine, which is the addictive substance in combustible cigarettes. These include all forms of Electronic Nicotine Delivery Systems (ENDS), Heat Not Burn Products, e-Hookah and the like devices.
India currently has the second largest number of tobacco users (268 million or 28.6% of all adults in India) in the world – of these at least 12 lakh die every year from tobacco-related diseases according to government data. The data also states that total direct and indirect cost of diseases attributable to tobacco is ₹1.04 lakh crore ($17 billion) in 2011 or 1.16% of India’s GDP.
“India is already the second largest consumer of tobacco. With e- cigarettes, it was being seen that this new industry was picking up fast here. Currently there are barely 10-15% of consumers and it has a potential to increase further. As e- cigarettes are equally harmful, the vaping industry is promoting a new addiction when the country is already struggling with all forms of tobacco addiction," said Ravi Mehrotra, Chief Executive Officer at Indian Cancer Research Consortium, Indian Council of Medical Research (ICMR).
"Even if the government wanted it, couldn’t have regulated e- cigarettes in a scenario when tobacco control is difficult. Despite efforts such as spreading awareness and big pictorial warning, tobacco is causing harm to users. It was a better idea to stop it before it becomes another problem," he said.
e-Cigarette, with its design and flavours was already getting extremely popular in schoolgoing children globally, in India government surveys, through school authorities, found that it was in schoolbags of children and looked innocuous like a pen drive. Also children were pooling in money to buy these and indulge in group smoking.
“We were concerned about its rising prevalence and with challenges faced in enforcement of tobacco laws this product which was odourless, smokeless and left no residue would be too difficult to control. The Government thought it appropriate to nip it in bud before it becomes too big to control as presently number of users is less, there is no domestic manufacturing therefore the Industry favourite arguments of loss of livelihood would hold no ground," said a senior union health ministry official.
About 18 states and two Union Territories in India i.e. Gujarat, Punjab, Karnataka, Haryana, Mizoram, Kerala, Jammu & Kashmir, Uttar Pradesh, Bihar, Maharashtra, Tamil Nadu, Jharkhand, Himachal Pradesh, Puducherry, Rajasthan, Meghalaya, Nagaland and Odisha already banned the use and sale of e-cigarettes, vape pens and d-Hookah due to health harms.
The ICMR also recommended a complete ban on e-cigarettes and other electronic nicotine delivery systems (ENDS), based on currently available scientific evidence. As per the ICMR recent paper, it was noted that e-cigarettes and other such devices contained not only nicotine solution, which was highly addictive, but also harmful ingredients such as flavoring agents and vaporisers.
Use of ENDS or e-cigarettes has documented adverse effects on humans, which include DNA damage; carcinogenic, cellular, molecular and immunological toxicity, respiratory, cardiovascular and neurological disorders, and adverse impact on fetal development and pregnancy, according to ICMR.
“The Health Ministry Ordinance does not refer to cultivation, manufacturing of tobacco or nicotine or its export. Presently India does not manufacture or export e-cigarettes. It is being imported and therefore the Ordinance does not impact the livelihood of tobacco and nicotine, farmers, manufacturers, traders etc," Bhavna B Mukhopadhyay, Chief Executive, Voluntary Health Association of India.
Doctors have also negated the idea of harm reduction through ENDS claiming there are no authentic studies to show that it helps. “To counter withdrawal symptoms of smoking, nicotine (2mg) has been approved to be used under medical supervision for a short period of time. There are very few reports of long term addiction to nicotine tablets or gums. Over- the - counter sale of E cigarette will promote easy and unregulated access to very high dosage of nicotine for recreational use rather than medicinal use," said Pankaj Chaturvedi, Professor and Surgeon, Department of Head Neck Surgery, Tata Memorial Center.
“Nearly 80% of those who start e-cigarette to quit cigarettes can’t quit the e-cigarette. It deprives a quitter of nicotine free life despite quitting cigarettes successfully. Contrary to claims of e-Cigarette lobby, e-cigarette has not been approved as a cessation drug or tool. There is no conclusive study to support the claims of e-cigarette lobby regarding its medical benefits," he said.
Acording to a new study by researchers in the Perelman School of Medicine at the University of Pennsylvania, published in Science Daily journal in August 2019, smoking e-cigarettes, also called vaping, has been marketed as a safe alternative to tobacco cigarettes and is rising in popularity among non-smoking adolescents. However, a single e-cigarette can be harmful to the body’s blood vessels -- even when the vapour is entirely nicotine-free.
The Union Cabinet, chaired by the Prime Minister Narendra Modi, has on Wednesday approved the Promulgation of the Prohibition of Electronic Cigarettes (production, manufacture, import, export, transport, sale, distribution, storage and advertisement) Ordinance, 2019.