Are ENDS really less harmful than cigarettes?

New Delhi, June 13: The future of Electronic Nicotine Delivery Systems (ENDS) in India seems bleak as the Health Ministry has proposed to classify such alternative smoking devices, including e-cigarettes, as "drugs" under the Drugs and Cosmetics Act, in a bid to ban their manufacture, sale, distribution and import.

Citing official sources, PTI has reported that the proposal has been approved by the Drug Technical Advisory Board (DTAB).

The report says that the Central Drugs Standard Control Organisation (CDSCO) has proposed that manufacture, sale, and distribution of ENDS, should be prohibited under Section 26A of the Drugs and Cosmetics Act, 1940, while their import should be outlawed under Section 10A of the legislation.

ENDS or e-cigarettes are manufactured in such a way to resemble traditional tobacco products like cigarettes, pipes, cigars, and common gadgets like flash drives, flashlights, or pens. Currently, there are more than 460 different e-cigarette brands with the varied configuration of nicotine delivery available in the market.

Around 1.3 million people in the country die every year due to tobacco-related illnesses. There are 300 million people in India that use tobacco and nearly 106 million people in India who smoke combustible cigarettes. India is currently home to approximately 11.2% of the combustible cigarette smokers in the world.

After the report was published, the Confederation of All India Traders (CAIT) has jumped in and demanded that instead of banning ENDS, the government should regulate its sale to eliminate the risks of an increase in the illicit trade of ENDS products, entry of counterfeit and spurious ENDS products, and loss of revenue to the government;

CAIT Secretary General Praveen Khandelwal on Wednesday wrote a letter to Union Health and Family Welfare Minister Dr Harsh Vardhan.

He said around 4 million paanwalas in India are already under pressure due to anti-smoking initiatives of the government and complete ban on ENDS will further augment their woes.

"It is our strong belief that allowing sale and access to less harmful alternatives as ENDS at such outlets, with appropriate regulatory measures and safeguards including age verification, will help in curbing cigarette smoking while ensuring sustained revenue for the traders and the government," says Khandelwal.

The CAIT has claimed of researching the pros and cons of ENDS and said that 98 countries like the United States, UK, and Canada have come up with robust frameworks that ensure stringent and transparent regulation that address the risks and benefits of the category adequately.

The trades' body has also questioned research by Indian Council of Medical Research (ICMR), which released its study on ENDS on May 31 this year.

"Use of e-cigarettes adversely affects almost all the human body systems with impact across the life course, from the womb to tomb. E-cigarette use adversely affects the cardiovascular system, impairs respiratory immune cell function and airways in a way similar to cigarette smoking and is responsible for severe respiratory disease. It also poses risk to foetal, infant, and child brain development. ENDS or e-cigarettes are also harmful to non-users and have adverse health impacts even when people are exposed to second-hand vapours," says the ICMR study.

The CAIT informs Dr Harsh Vardhan that the methodology adopted by ICMR has not accounted for the positive scientific evidence on ENDS and presents an incomplete assessment of the literature on the subject.

It also alleges that the ICMR study seems to have incorporated views of civil society organisations that have vested interests or receive funding from bodies which don't have the best interests of India in mind.

To drive home its point, the CAIT gives example of the UK and says guidance may be drawn from the process followed in the UK, where Public Health England conducts a yearly evidentiary review on ENDS as per the directions of the House of Commons Committee on Science and Technology.

"It must also be noted that in all these assessments the Public Health England has maintained that ENDS are at least 95% less harmful than combustible cigarettes and the Government of UK views ENDS as a potential tool to reduce their public healthcare expenditure incurred on account of tobacco related illnesses."

However, Some States - including Punjab, Haryana, Kerala, Mizoram, Karnataka, and Jammu and Kashmir - have already banned e-cigarettes as an unapproved drug.

American Academy of Paediatrics says that use of e-cigarettes among youth is a significant public health concern.

"E-Cigarettes contain a liquid solution that is usually flavored. the Tobacco Industry uses flavors to lure kids into using tobacco products. Flavors, which are appealing to children, can include fruit flavors, candy, coffee, piña colada, peppermint, bubble gum, or chocolate," says American Academy of Paediatrics.

In 2016, US Surgeon General Vivek Murthy released a report, "E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General." The report concluded that youth should not use e-cigarettes due to the health effects on users and on others exposed to secondhand e-cigarette aerosol.