In what it describes as a “major health and wellness initiative for the country”, the union cabinet has approved the promulgation of an ordinance to ban electronic cigarettes. The move, coming amid a debate over the ways to control tobacco use, should be welcomed, and it needs to be complemented by strong and pro-active measures against other tobacco products.

Finance minister Nirmala Sitharaman Wednesday announced the decision to promulgate “The Prohibition of Electronic Cigarettes (production, manufacture, import, export, transport, sale, distribution, storage and advertisement) Ordinance, 2019”. The ordinance route was necessitated as the manufactures have filed petitions in various courts against the decision of some states to ban e-cigarettes.

An e-cigarette is a battery-operated device that produces aerosol by heating a solution containing nicotine, which is the addictive substance in regular, combustible cigarettes. The category includes all forms of ‘Electronic Nicotine Delivery Systems’ (ENDS), ‘Heat Not Burn Products’, e-Hookah and similar devices.

Though marketed as a ‘replacement therapy’, that is, an aid to combat withdrawal symptoms for those who are quitting cigarettes; studies have shown that they often hook non-smokers. “Their use has increased exponentially and has acquired epidemic proportions in developed countries, especially among youth and children,” an official statement said after the cabinet decision.

Bans in India are often on the consumption of the given product alone, leaving production, sale and other elements of the cycle open. In case of the e-cigarettes, however, the ordinance makes “any production, manufacturing, import, export, transport, sale (including online sale), distribution or advertisement (including online advertisement) of e-cigarettes a cognizable offence punishable with an imprisonment of up to one year or fine up to Rs. 1 lakh or both for the first offence; and imprisonment of up to three years and fine up to Rs. 5 lakh for a subsequent offence. Storage of e-cigarettes shall also be punishable with an imprisonment up to 6 months or fine up to Rs 50,000 or both.” 

The owners of existing stocks of e-cigarettes on the date of commencement of the ordinance will have to suo moto declare and deposit these stocks with the nearest police station. The sub-inspector of police has been designated as the authorized officer to take action under the ordinance.

The decision will help protect population, especially the youth and children, from the risk of addiction through e-cigarettes, the official release said, adding that, “Enforcement of the ordinance will complement government's efforts for tobacco control and will help in reduction of tobacco use and reduction in associated economic and disease burden.”

Complementary efforts are welcome since the tobacco industry has been quite pro-active in its campaigns in recent years – from those ‘poor tobacco farmer’ advertisements to lobbying hard against anti-tobacco NGOs. After the cabinet decision, the stock prices of the tobacco firms went up – and ironically the government through financial institutions holds substantial equity stakes in them.

Also read: The Tobacco War

The replacement therapy – offering nicotine-containing aids like chewing gums and patches for those who quit – has been in the eye of the controversy as it too is apparently found to have risk factors. Any debate remains controversial as the replacement therapy seems to be a competition for the traditional tobacco industry.

The decision to ban e-smoking comes on the back of an advisory issued by the government in 2018 to all states to consider banning e-cigarettes. As many as 16 states and one UT have already banned e-cigarettes in their jurisdictions. Notably, the Indian Council of Medical Research (ICMR), in a recent white paper on the subject, also recommended a complete ban on e-cigarettes based on currently available scientific evidence. The WHO has also urged member countries to take appropriate steps including prohibiting these products.

“These products are usually marketed as being safer alternatives for conventional cigarettes but such notions of safety are false. On the other hand, available literature suggests that these products may act as gateway products to induce non-smokers, especially youth and adolescents, to nicotine-use, leading to addiction and subsequent use of conventional tobacco products. E-cigarettes are usually promoted by the industry as smoking cessation aids but their efficacy and safety as a quitting aid has not yet been established,” the official release said.

Unlike the tried and tested nicotine and non-nicotine pharmacotherapies that are known to help people quit tobacco use, the WHO does not endorse e-cigarettes as cessation aids. The possibility of tobacco industry interference in tobacco cessation efforts through misinformation about the potential benefits of these products, which are presented as alternatives but in most cases are complementary to the use of conventional tobacco products, also is a present and real possibility. Apart from nicotine, e-cigarettes may also be used for delivery of other psychoactive substances. Scientifically proven nicotine replacement therapies, without the risks associated with e-cigarettes, exist in the form of gums, lozenges and patches for those willing to quit tobacco use. Widespread use and unchecked proliferation of e-cigarettes and the like devices would seriously undermine and derail Government's efforts to reduce the prevalence of tobacco use.