In a little over a decade, e-cigarettes have risen from relative obscurity to become devices used by 41 million people globally. Juul alone – the most popular e-cigarette brand in the US – was valued at $38 billion (£30bn) when the tobacco firm Altria snapped up 35 per cent of the company in December 2018.
Now vaping’s stratospheric rise appears to be stalling. After a rash of vaping-related lung diseases in the US, states are starting to clamp down on the devices. On September 24, the governor of Massachusetts announced a four-month ban on the sale of all vaping products. In California, the Department of Public Health urged citizens to stop vaping until investigations into the mysterious disease are complete. New York, Michigan and Rhode Island all responded by banning the sale of flavoured e-cigarettes, pre-empting similar regulations being considered at a federal level by the Food and Drug Administration (FDA).
Globally, the vaping backlash is also gaining traction. In September, the Indian cabinet announced a ban on the production, import and sale of vapes, joining Singapore and Thailand where vaping is also banned. After banning the sale of flavoured oil cartridges, Israel is also considering a total ban on e-cigarettes.
But the vaping ban might end up causing more harm than good. Critics of the recent vaping backlash say that it may squander the opportunity for more useful long term anti-tobacco regulation or make smokers less likely to quit cigarettes altogether.
"The US has a dominant position, particularly in tobacco control, which means that other countries will pick up ideas from the US and do the same,” says Deborah Arnott, chief executive of the charity Action on Smoking and Health. Most of the restrictions in the US so far have either concentrated on flavoured e-cigarette pods, or lumped all e-cigarettes together.
Neither approach seems to address the suspected cause behind the recent cases of lung illness. Of the total 805 cases of lung injury and 12 deaths reported by the US Centers for Disease Control and Prevention (CDC), it looks like the majority occurred in people who vaped e-cigarettes containing tetrahydrocannabinol (THC) – the principal psychoactive ingredient in cannabis.
Out of those 805 patients, the CDC has data on vaping use from 514. Some 77 per cent of those patients reported using THC-containing products in the month before the onset of their symptoms, with 36 per cent of them saying they only vaped THC-containing before they got ill.
And these percentages might be underestimates says Eric Lindblom, a former FDA tobacco control official now at Georgetown Law’s O’Neill Institute. Of the four states with the highest number of reported cases – California, Texas, Wisconsin and Illinois – only one (California) has currently legalised recreational cannabis use. Patients in states where cannabis is illegal might be less willing to admit that they had been vaping THC.
Despite the evidence strongly hinting that vapes containing THC are at least partly responsible for this outbreak of lung illness, no state has brought out specific regulation targeting THC vapes. “It seems kind of backwards given that the problem is clearly much more closely linked to vaping cannabis THC products,” says Lindblom. “It totally doesn’t address the mystery illness in any way.”
So what are lawmakers responding to? It could be that the recent spate of lung illnesses has provided a flashpoint for frustrations over another big problem with vaping: the number of young e-cigarette users in the US. In 2018 an FDA survey found that over 20 per cent of US high school students – just over three million young people – were e-cigarette users. The same survey identified flavoured e-cigarettes as a factor that attracted young vapers to e-cigarettes.
That might explain why so much of the vaping backlash has centred on flavoured e-cigarette products. But Arnott warns that banning flavoured pods altogether might put people off quitting smoking. "What we don't want it for people to be scared back to smoking or for smokers – who are often looking for a reason not to quit – to think 'oh well, I might as well carry on with smoking',” she says.
In the US, cigarette smoking is still responsible for more than 480,000 deaths every year, but Arnott is worried that the backlash against vaping might make people misunderstand the difference in risk between cigarettes and vapes.
"The relative risk compared to smoking is the initial thing to be concerned about, but if people are going to carry on vaping for the long term then you need to worry about what the long term impacts might be and whether it would be better for them to quit vaping as well,” she says. Public Health England has backed e-cigarettes as a way of getting people to quit smoking, saying that vaping is 95 per cent less harmful than smoking cigarettes, although e-cigarettes are not prescribed by the NHS as stop-smoking tool.
Europe appears to have avoided the outbreak of vaping-related lung illness, which might be thanks to tighter EU regulations that restrict the makeup and marketing of vapes. In the US, e-cigarettes have been largely escaped regulation, although after May 2020 vaping firms will have to be approved by the FDA in order to be sold within the country.
But if it’s approached in the right way, the rash of vaping illness could be an opportunity for useful regulation to be passed, says Lindblom. “The only time that it really happens is when there’s an emergency,” he says. As well as only allowing e-cigarettes that had been proven to have a net benefit to public health, the backlash could provide an opportunity to re-examine regulation of menthol cigarettes, which are often a gateway into smoking for young people. Menthol cigarettes are already illegal in Canada and in the EU they will be banned from May 2020.
Whatever happens, Lindblom and Arnott agree that regulators should be looking for ways to reduce the total number of smokers. That might mean encouraging people to switch to e-cigarettes, but it also shouldn’t preclude tighter regulation of conventional cigarettes, Lindblom says. “You want a system where people are thinking about this thing in a smart way instead of just throwing out the baby with the bathwater.”
This article was originally published by WIRED UK
