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Public Health News South Africa

Proponents challenge WHO findings on vaping dangers

The recently released United Kingdom Centre for Tobaccos and Alcohol Studies' (UKCTAS) independent report, criticising many of the health and safety findings of a World Health Organisation (WHO) report on vaping - or the smoking of electronic cigarettes - is likely to focus attention on the need to separate vaping from smoking in both the minds of health officials and the global general public.

Global treaty

The global health industry is currently focused on the seventh session of the Conference of the Parties (COP7) taking place in Delhi, India. Importantly, this year’s gathering brings together the 180 signatories of the World Health Organisation’s (WHO) Framework Convention on Tobacco Control (FCTC).

The FCTC which entered into force in 2005 was the WHO’s first international treaty and has been effective in coordinating and supporting the global struggle against tobacco.

The WHO, in preparation for COP7 commissioned an assessment of electronic cigarettes and vaping – which the WHO report refers to as electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS).

Risk smaller than tobacco

While people smoke for the nicotine, they are dying from the tar. Nicotine, while addictive, does not cause cancer. Repeated quantification of the risks of e-cigarettes concludes that vaping remains 95% less harmful than tobacco cigarettes.

Despite a large body of existing research demonstrating the clear role of vaping in saving smokers’ lives and the WHO report’s own acceptance that, “vaping presents a magnitude of risk likely to be much smaller than tobacco smoke, the WHO report then, somewhat controversially, goes on to suggest that electronic cigarettes should be regulated along with tobacco,” said Philip Bartholomew of the Electronic Cigarette Association of South African (ENDS).

WHO study at odds with other research

The UKCTAS released its critique of the WHO findings to express their main concerns.

The widely differing views expressed by both studies are likely to fuel the debate on correctly understanding, and separating, both public and official views on vaping and tobacco smoking.

State-sponsored scientific studies of the health and safety aspects of vaping have, to date, been limited to the United Kingdom, Australia, New Zealand, Europe and the United States. Amongst these the United Kingdom has, by far, invested the most intellectual capital in understanding the clear advantages of vaping.

Despite these generally accepted views of pure nicotine, the fact that the recently published WHO research is at such variance with independent United Kingdom research and policy prescriptions, “provides the vaping industry a powerful opportunity to position itself globally – with COP7 the ideal platform from which to articulate this positioning,” says Bartholomew.

A review of UKCTAS’s critique of the WHO findings neatly encapsulates the key issues of the current vaping versus smoking debate.

In this critique UKCTAS argues that:

  • Despite medical consensus currently agreeing that vaping is less harmful than smoking, the WHO paper provides a poor assessment of ENDS risks – in effect, failing to correctly quantify the risk of vaping.
  • The section of the WHO report on risks of second-hand exposure to electronic cigarette ‘vapour’ provides no evidence that such exposures pose any material risks to bystanders. The claim in the WHO report that that ENDS have the “potential to lead to adverse health effects” in bystanders does not reflect the science behind the cited source.
  • The four supporting papers upon which the WHO report is based are, themselves, still undergoing peer review and will likely be extensively revised.
  • Policy options discussed in the WHO report begin from a position of prohibition. It is unethical to deny smokers access to much lower risk options than cigarettes.
  • Policy proposals in the WHO report are made without supporting evidence for their effectiveness or cost-effectiveness.
  • The WHO paper systematically fails to compare the negligible exposure arising from vaping, with the substantial exposure resulting from inhaling tobacco smoke. As such, the WHO paper presents inadequate comparisons between vaping and smoking.
  • The WHO paper does not properly assess the role that ENDS play in quitting smoking and uncritically repeats several errors found in the literature. The result is that the WHO paper dismisses the evidence that vaping helps smokers quit.
  • The WHO report’s section on ‘product characteristics’ incorrectly promotes a connection between flavours and teenage addiction. The reality is that flavours aid the appeal of vaping to people seeking an alternative to smoking. Flavours do not encourage first time users.
  • The WHO report fails to acknowledge the potential of disruptive technology like electronic cigarettes to challenge the global tobacco industry. As such, the WHO recommendations potentially provide the traditional tobacco industry an opportunity to slow down the disruption of the tobacco cigarette market.

  • The WHO report does not recognise the likelihood of ‘unintended consequences’ arising from the policies proposed in the WHO paper, especially since many of the proposed policies would in fact increase smoking. Almost every policy listed in the WHO paper could serve to protect the tobacco industry by promoting smoking - rather than vaping - increasing the burden of non-communicable diseases on global health systems.

Understanding the science

Correctly understanding the very clear scientific, health and safety differences between vaping and tobacco smoking, is critical to the formulation of vaping legislation.

Bartholomew believes that South Africa should be guided by independent United Kingdom research and policy, “classifying vaping and e-cigarettes in a category of their own – critically distinct from tobacco cigarettes, as science has shown that e-cigarettes can - and are - saving lives.”

Balanced approach to regulation

EASA strongly believes that the vaping industry should be regulated but any regulatory strategy developed for e-cigarettes must take a balanced approach by seeking to ensure product safety, enable and encourage smokers to use electronic cigarette products instead of tobacco, and prevent effects that counter the overall goals of tobacco control policy.

As award-winning director Aaron Biebert’s recent documentary A Billion Lives so graphically demonstrates, the world is standing at a crossroads. Vaping, for the first time in history, holds out the real possibility to end smoking globally, saving a billion lives – and halving global health budgets.

How COP7 receives and interprets the current data on vaping, and how legislators globally and in South Africa use this information to craft policy is critical to saving lives.

“It is imperative that we all work together to reduce the tobacco smoking pandemic. Vaping today, through scientific evidence provides a chance for smokers.” concludes Bartholomew.

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