E-cigarettes ban in India: ICMR recommends complete ban to prevent nicotine addiction among non-smokers

Apex research body - Indian Council of Medical Research (ICMR) has recommended a "complete" ban on Electronic Nicotine Delivery Systems (ENDS), including e-cigarettes, saying their use can initiate nicotine addiction among non-smokers.

ENDS are devices that heat a solution to create an aerosol, which also frequently contains flavours, usually dissolved into propylene glycol and glycerin. 

There are various types of ENDS devices like e-cigarettes, heat-not-burn devices, vape, e-sheesha, e-nicotine flavoured hookah among others. 

The most common type is an e-cigarette that produces an aerosolised mixture of the flavoured liquids and nicotine, which is inhaled by the user. 

In a white paper released on Friday on World No Tobacco Day, the ICMR said e-cigarettes adversely affects the cardiovascular system, impairs respiratory immune cell function and airways in a way similar to cigarette smoking and is responsible for severe respiratory disease.

It also poses risk to foetal, infant and child brain development, the white paper claimed.

The release of the white paper comes amid a raging debate over the harm reduction aspects of ENDS with some organisations claiming that they help in smoking cessation and are less harmful alternatives to traditional cigarettes. 

The Indian government is, however, seeking to ban them stating that they pose health risks to users, that are similar to those of traditional cigarettes.

ICMR officials and scientists, who have studied over 250 research papers on nicotine delivery devices to create an official stance for India, stated that e-cigarettes are also harmful to non-users and have adverse health impacts even when people are exposed to second-hand vapours. 

"Passive exposure to vapours during pregnancy can severely affect the health of both the mother and the foetus. There are reports of poisoning due to accidental swallowing by children. These devices also can cause fire and explosion.

"Use of ENDS or e-cigarettes by non-smokers can lead to nicotine addiction and regular smoking," the white paper stated.

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Referring to studies, the white paper stated that youths using ENDS or e-cigarettes are more likely to use regular cigarettes later as it increases the likelihood to experiment with regular tobacco products and increases intention to indulge in cigarette smoking.

They also increase the risk of dual-use due to lack of awareness about the harmful effects of ENDS, it said.

The white paper highlighted that there is very limited evidence regarding the impact of ENDS on tobacco smoking cessation, reduction in cigarette use or adverse health effects.

ENDS are advertised through various forms of media with youth being the target group and are being marketed as safer alternatives to conventional cigarettes or harm reduction products, in a glamorous manner, so as to make them attractive under the guise of being less harmful.

These techniques are aimed at targeting the youth and children," it said.

"It is also noteworthy that major tobacco companies have purchased or developed ENDS products, with the dual commercial intent of expanding their range of tobacco products while touting their ability to offer a product that they claim reduces harm from the cigarettes.

"Cigarette smokers who may have otherwise given up the habit are thereby retained as nicotine-addicted customers, while those who may have never attempted to experiment with cigarettes are drawn into the nicotine addiction web. This duality of product marketing is a business strategy adopted by tobacco companies who see conventional cigarette smoking diminishing in many countries," the white paper claimed.

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The sale of e-cigarettes is completely banned in 25 countries, including Brazil, Norway and Singapore, while market authorization is required in 17 other countries. 

In the United States, ENDS, that are marketed for therapeutic purposes are currently regulated by the US-FDA and Center for Drug Evaluation and Research, the white paper stated.

Professor K Srinath Reddy, President, Public Health Foundation of India and a renowned cardiologist who chaired the ICMR expert group for this white paper said that the tobacco consumption, especially cigarette smoking, has shown a decline in India in recent years, in response to several tobacco control measures that have already been initiated. 

"Thus, at this juncture, marketing of a product like ENDS or e-cigarettes, with unproven benefit and high potential harm from addiction and health risks, is unwarranted as a tobacco control measure,"

Professor Balram Bhargava, Director General of ICMR said, "Given the extent of harmful health effects of e-cigarettes to the users as well as passive exposure and multiple faces of the ENDS use epidemic around the world where it was introduced, if no appropriate interventions are taken at the right time by bringing together all stakeholders under one umbrella to prevent these impending epidemics of e-cigarettes use, it can lead to a public health disaster in India."

In August last year, the Union Health Ministry issued an advisory to all states and UTs to stop manufacture, sale and import of ENDS.

The advisory was subsequently challenged in Delhi High Court which ruled it to be non-binding on states and government bodies.

However, some states in India including Punjab, Karnataka, Kerala, Bihar, Uttar Pradesh, Himachal Pradesh, Tamil Nadu, Maharashtra, Jharkhand, Rajasthan and Mizoram have already banned use and sale of e-cigarettes, Vape and E-Hookah.