Much to an observer’s nightmare, policy actions in India seem to be progressively guided by temporary gusts of disconnected causes and events. Government actions, more often than not, tend to oscillate from inaction to a knee-jerk reaction. The recent advisory from the Ministry of Health and Family Welfare, asking state governments to stop sales of E-Cigarettes or Electronic Nicotine Delivery Systems (ENDS) is a stark example to showcase the current state of affairs.
The advisory quotes several reasons before coming to the final advice on ENDS. The reality remains though, that none of the stated reasons seems to be backed by any study or otherwise consideration of available scientific evidence that have emerged over the years around ENDS and their health risk profile. It seems after all, that a single meeting of selectively invited experts in 2014 was just enough to take an overnight decision to call for prohibition on ENDS, albeit, after four years of complete inaction on the issue. The reason for this haste does not seem to be too difficult to fathom. A PIL was filed before the Delhi High Court seeking proper regulation of ENDS, and the court had rightly asked the government to present an account of actions taken by it on the issue. The fact of the matter was that the government hadn’t taken any actions and calling for prohibition seemed to be an easy quick fix solution. On the other hand, creating a well devised Regulatory pathway would have been a little more of a tedious task. But isn’t that exactly what the government is supposed to do?
Ministry Is Groping In The Dark
The knowledge base about E-Cigarettes, or ENDS, and their associated health risks compared with cigarettes have moved forward to considerable extent from an initial apprehension of the unknown to established scientific evidence about their lower risk potential. Such evidence and studies have come up in great amounts since 2014. However the health ministry seems to be unaware of all this.
Many experts and health authorities around the world, such as the UK’s Royal College of Physicians and Public Health England, have recognised that e-cigarettes and other alternatives to cigarettes represent a revolutionary opportunity to reduce the harm caused by cigarette smoking. Over the last few years, many countries such as the UK, the US, Iceland etc have seen unprecedented decline in cigarette smoking rates as the these Governments have allowed e-cigarettes and ENDS as alternatives to cigarettes.
As the Royal College of Physicians, Tobacco Advisory Group, explained in its landmark April 2016 report titled “Nicotine without smoke: tobacco harm reduction”:
“This report makes the case for harm reduction strategies to protect smokers. It demonstrates that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved…..”. This is what E-Cigarettes or ENDs offer to smokers, i.e., an option, that although delivers nicotine, is devoid of the smoke from combustion of tobacco, and thus devoid of many such carcinogens that are present in tobacco smoke. ̛Hear What The Experts Say As recent as in 2018, Public Health England, too has concluded in their report titled “E-Cigarettes: An evidence update” that “ E-cigarettes are 95 percent less harmful than normal cigarettes” and “there is a need to publicize the current best estimate that using E-Cigarettes is around 95% safer than smoking……” Logically bizarre as it may seem, the Health Ministry has called for a ban on E-Cigarettes whereas at the same time sale and use of cigarettes are considered perfectly legal.
Even a WHO expert group report on electronic cigarettes concluded
that “If the great majority of tobacco smokers who are unable or unwilling to quit would switch without delay to using an alternative source of nicotine with lower health risks, and eventually stop using it, this would represent a significant contemporary public health achievement.”
Unfortunately, policy on ENDS in India appears to be driven more by dogmas and prejudices rather than science and evidence. A number of Indian states have acted to prohibit e-cigarettes, the Union government has followed suit, all sans evidence and analyses.
Given the above, it would be imperative that the government adopts a more open, pragmatic, science-based approach to decisions on issues that affect the lives of millions of smokers. It is nobody’s case that E-Cigarettes, or ENDS, that deliver nicotine are not harmful at all. The case however is that they are substantially less harmful than normal cigarettes and thus provide an alternative option to smokers who are not able to quit. It is high time the Health Ministry takes into account global scientific evidence and research on E-cigarettes and ENDS and grabs the opportunity to positively impact the health of more than 100 million smokers rather than condemning them to cigarette smoke!
Deepak Mukarji is an advocate of harm reduction to people and the planet under the banner The Alternatives.