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Can Banning E-Cigarettes Do More Harm Than Good?

It has been a year since the Indian government banned electronic cigarettes, enough time to gauge its impact, whether it has served the intended purpose of preventing teen access and strengthened tobacco policy, and if there are any negative outcomes.

Long before India prohibited e-cigarettes last September, some other low- and middle-income countries – Mexico, Brazil and Thailand – had enacted a similar sale ban. In each of these nations, e-cigarettes are now widely available, smuggled and sold illegally as demand continues to rise. Neighbouring Bhutan recently lifted its 2010 tobacco ban as it did little to prevent rise in use but seeded a major smuggling operation. South Africa too rescinded its tobacco ban during the pandemic over fears that the resultant black market would become too entrenched to shake off.

Prohibition, therefore, has rarely worked as a measure against preventing use, and comes with unintended consequences, which in the case of India’s e-cigarette ban is also the removal of safeguards to inhibit access for minors who are now being served by a black market and in the absence of self-regulation from a legal industry. Crucially, a ban has stymied public awareness efforts to discourage uptake among nonsmokers and underage, brushing the issue under the carpet. Targeted awareness has yielded positive results in the US where teen use of e-cigarettes has fallen sharply this year, even as the Food and Drug Administration (FDA) has begun the regularisation process for vaping products. Meanwhile, use of combustible cigarettes among teens, and the general population, continues to fall to record lows in the US. This is what good tobacco policy outcomes should look like.

In India, where we face a much larger tobacco burden, our policies are galloping in the opposite direction. Bidis, the most used smoking product and by far the deadliest, which cause nearly a million deaths annually, are hardly taxed and were recently exempt even from pictorial warnings, while flavoured tobacco which is being weeded out across the world is being launched in new variants to attract more to take up smoking.

In the absence of meaningful or adequate quit support as nicotine gums or patches are out of reach for most Indians and there are minuscule counselling centres for 270 million tobacco users, we have also lost the golden opportunity of capitalising on increased desire to quit during the pandemic lockdown. Prohibition of e-cigarettes, which have proven to be twice as effective than gums in helping smokers quit and can be made at price points even bidi smokers can afford, has further dented efforts to assist Indians in mitigating risks from tobacco use.

Since the e-cigarette ban was announced by finance minister Nirmala Sitharaman, which led to a spike in tobacco shares and accrued a notional gain of Rs over 1,000 crore to the government, any discussion about it cannot be complete without also assessing its economic impact. The tobacco trade may seem highly profitable, but it isn’t – for the Rs 50,000 crore in taxes, four times more is lost in tobacco-related mortality and morbidity costs each year. It is therefore in the long-term interest of the state to put a lid on the increasing burden from tobacco use, as indicated by the rise in both tobacco-related costs and cancers. In this scenario, disrupting risk reduction measures perpetuates the problem, with escalating losses for the economy.

While the government stated the ban was necessary to block the entry of Juul, a US-based e-cigarette maker, which could be seen as a protectionist move to shield the domestic tobacco industry, it overlooks the ground reality that the main component of Indian e-cigarette trade were entrepreneurs who were creating jobs and economic activity, while also helping India quit deadly smoking. Now, as the Chinese e-cigarette industry grows into a $5 billion enterprise, in India we have decimated a green sector, given rise to corruption and black market, and narrowed means for smokers to proactively reduce harm.

Given the negative health and economic impact of the e-cigarette ban, and the growing tobacco epidemic in India, a course-correction is much needed. In this the government should take heed from Hong Kong, New Zealand, Philippines, South Africa and Russia who have either reversed bans, regulated e-cigarettes or are considering bills for regulation since India took its decision to prohibit safer tobacco alternatives.

The author is India’s leading tobacco harm reduction advocate and president of International Network of Nicotine Consumer Organisations.

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