Introduction
The prohibition of electronic cigarettes (production, manufacture, import, export, transport, sale, distribution, storage, and advertisement) Act, 2019, received the assent of the President on December 5, 2019.
This Act safeguards public health and protects people from the harmful effects of e-cigarettes. According to this act, if a person violates the mentioned provisions, they will be imprisoned up to one year or will be fined up to one lakh rupees, or both. The Act also makes provisions that for any subsequent offence, the person will be punishable with up to three years imprisonment along with a fine of up to five lakh rupees. The US and other 27 countries have already banned e-cigarettes, considering its serious health impacts on adults, youths and most importantly on children.
India’s response comes as it is a signatory to WHO’s Framework Convention on Tobacco Control (FCTC), which encourages countries to regulate or ban the use of e-cigarettes altogether.
Expert opinion about the product is divided as there are studies that have found high nicotine levels in some brands. On the other hand, some experts claim vaping to be safer than normal cigarettes. However, the decision of the Indian government is welcome as it will keep Indians, especially children, away from smoking.
First Ban on E-cigarettes
The controversy started when six deaths were reported in the United States in which vaping was held as the major reason. Therefore, Michigan put a ban, followed by New York. New York’s governor called for emergency action in response to concerns about the rising use of e-cigarettes among teens and a nationwide spate of lung illnesses.
Understanding E-cigarettes
E-cigarettes are battery-powered devices that produced aerosol by heating a solution containing nicotine which is then inhaled. These devices belong to a category of vapour-based nicotine products, called ENDS (electronic nicotine delivery systems). They may look like their traditional counterparts or maybe in different shapes and sizes like pens or USB drives.
India’s vapour products market was nascent but was expected to experience rapid growth. It was valued at over US$ 15 million in 2017 and was projected to grow nearly 60 per cent a year up to 2022. A recent study by Prescient and Strategic (P&S) Intelligence showed that India’s cigarette market was expected to reach $ 45.3 m by 2024, growing at a compound annual growth rate (AGR) of 26.4 per cent. However, e-cigarettes are brought from China and other countries and are not manufactured in India. E-cigarettes are easily available online.
As per different reports, the global market size of e-cigarette is estimated to be worth $ 19.3 billion, which is three times the market size five years ago. About 40 million adults used vapour products in 2018. This surge also gave an uptick in the revenue of traditional cigarette makers because most tobacco majors now own or have a stake in big e-cigarette brands.
Major E-cigarette Brands
With over 460 different brands and more than 7,700 flavours marketed in India, sales of vaping devices have accelerated since 2017. Imports of e-cigarettes, their accessories, and other ENDS products grew around 119 per cent from 2016–17 to 2018–19.
The first phase started in 2012 with a number of brands. The second phase started in 2013 led by Blue, owned by Imperial Tobacco and Njoy brands. The third phase started in 2014, driven by Vuse brand, owned by British American Tobacco and Altria Group, while the parent company for Philip Morris owned 35 per cent stake in Juul. The last phase, which was the fastest, started in the second quarter of 2017, driven exclusively by Juul.
E-cigarette in Indian Market
In India, vaping surged in popularity in the past two years. It started gaining popularity in the US in the late 2000s. Initially, it was sold without undertaking a review of its health impact. The initial deadline to submit applications to the US Food and Drug Administration (FDA) was 2018, which was extended to 2022 but has been brought to 2020.
Justifying the Indian Act
The Act was necessitated by the fact that an earlier order by the Centre asking the states to crack down against e-cigarettes could not stand judicial scrutiny. The health ministry has proposed to classify such alternative smoking devices as ‘drugs’ under Section 3(b) of the Drugs and Cosmetics Act, 1940 as ENDS and related products are used as a tobacco cessation product and function for nicotine delivery.
Similarly, the manufacture, sale, and distribution of ENDS are prohibited under Section 26A of the Drugs and Cosmetics Act, 1940. Some have also added the Poisons Act, 1919.
The act is rational and a strong measure on the grounds of public health. It was necessary as the use of e-cigarettes has increased massively and acquired epidemic proportions in many countries, particularly among youth and children. It is also established that apart from nicotine, e-cigarette may also be used for delivery of other psychoactive substances. There is fear that the widespread use and unchewed escalation of e-cigarettes and similar devices might have seriously affected government efforts to reduce tobacco use.
Ban on E-cigarettes
Before the Act, the government faced hurdles in the form of court cases against the ban on e-cigarettes because electronic nicotine delivery systems (ENDS) were not declared as ‘drugs’ in the country’s drug regulations. In May 2019, the Indian Council of Medical Research (ICMR) released a white paper stating that the uses of ENDS or e-cigarettes have documented adverse effects, including DNA damage, carcinogenesis (initiation of cancer formation), cellular, molecular, and immunological toxicity, and respiratory, cardiovascular, and neurological disorders. It also affects foetal development and pregnancy. Thus, the enforcement of the ordinance will complement its efforts to reduce tobacco use and, therefore, help in reducing the economic and disease burden associated with it.
Ill-effects of Tobacco
Another study, published in The Lancet found that tobacco use was the leading risk factor for cancer in India in 2016. As per ICMR estimates, India is likely to face over 17 lakh new cancer cases and over 8 lakh deaths by 2020. About 27 crore tobacco users were recorded in India in 2018. Also, a substantial number of people exposed to second-hand smoke were also found who were at an increased risk for cardiovascular diseases, as per the WHO fact sheet. Over one million people die of consuming tobacco each year, contributing to 9.5 per cent of all deaths.
India currently has 10 crore, adult smokers, making a lucrative market for e-cigarette firms. India does not have any manufacturing unit for e-cigarettes. there are about 400 brands and 150 different flavours being sold in the country.
As per the Act, the owners of existing stocks of e-cigarettes will have to suo moto declare and deposit their stocks with the nearest police station on the date of the commencement of the Act.
The sub-inspector has been designated as an authorised officer to take action against the violation of the act and for the enforcement of the same. The Union Health Secretary has written to the Commerce Secretary to block the entry of a US-based company that manufactures vaping devices.
The opposition of the ENDS Products
The use of e-cigarettes can lead to nicotine addiction among non-smokers as an e-cigarette cartridge is filled with liquid nicotine, flavouring agents, and other chemicals. A typical cartridge contains about as much nicotine as a pack of 20 regular cigarettes, as per a report published in the Indian Journal of Medical Research, May 2019.
According to a head and neck cancer surgeon at the Tata Memorial Cancer Hospital in Mumbai, nicotine is a poisonous substance that in very low dosage, for a limited period and under medical supervision, can be used for tobacco cessation. However, e-cigarettes have a high amount of nicotine which may damage human organs.
ENDS users are almost at the same risk of contracting lung diseases and cancer as conventional cigarette users. ENDS product companies are in clear violations of WHO’s Framework Convention on Tobacco Control (WHO FCTC), which prohibits the sale of products that appeal to minors. Accidental ingestion by children has also caused some deaths. Besides, fires and explosions caused by the device resulted in injuries, loss of lives, and property.
Favour for ENDS Products
Responding to ICMR white paper, the Association of Vapers India (AVI) in a statement says that the white paper does not present the true picture. As per the director of AVI, the findings of ICMR do not match with the empirical data from countries where e-cigarettes are regulated and research is conducted by some of the most credible organisations in the world. As per pulmonologists and director to the National Chest Centre, nobody says e-cigarettes are harmless, but the question is of harm reduction. What should be banned are cigarettes that kill people but nobody is concerned about it. As for e-cigarettes, they are part of the National Health Service’s (NHS) ‘quit smoking’ programme. There should at least be the option of supervised if not prescription use of e-cigarettes. NHS does endorse the use of e-cigarettes for smoking cessation, but they are not supplied by the stop-smoking services offered by NHS.
The trade body representing importers, distributors, and dealers of e-cigarettes opined that taking the decision hastily itself is evidence of the ‘unsustainability’ of government’s ‘position’. They also charged that the health ministry ran with the proposal to ban on a selective basis, refusing to address stakeholders. The US, the UK, China, France, Germany, and Japan can be cited as countries where e-cigarettes are not prohibited altogether.
Calling the decision of ban as draconian, the Association of Vapers India (AVI) alleged that the government was protecting its stake in the country’s top cigarette producer, ITC. The government holds 8 per cent stake in ITC worth over ` 23,000 crores through the specific undertaking of the Unit Trust of India (UTI). Similarly, state-run insurance companies, led by LIC, hold another nearly 21 per cent. The AVI also alleged that ITC is also selling an e-cigarette brand, namely, Eon, which is not prohibited. The Trade Representatives of ENDS in India (TRENDS) say that it is ironical that the ICMR itself acknowledges that it has proffered no research or study to support the claims made in the white paper. Similarly, it can be said that an equal number of studies are available in the medical world that argues against the decision derived by ICMR.
Bizarre Decision
There is another view regarding the government’s decision of banning e-cigarettes. As per the view, banning e-cigarettes while keeping the tobacco product is bizarre. It can be taxed heavily and there are no fiscal or health grounds. Therefore, the decision seems to be unnecessary and without any logic.
Appreciation of the Move
To conclude, the decision of ban should be appreciated unanimously. As per the chief executive of the Voluntary Health Association of India (VHAI), the government’s move should be appreciated because e-cigarettes pose health risks that are similar to those of conventional cigarettes. Marketing e-cigarettes as harm-reduction products is contrary to the truth.
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