NEW DELHI
A seasoned lawmaker has said India needs to seriously take a relook at its tobacco laws, and those relating to e-cigarettes and heated tobacco because the health ministry’s ban on e-cigarettes is a missed public health opportunity.
MV Rajeev Gowda, vice-chairperson, State Institute for Transformation of Karnataka and former Rajya Sabha member strongly feels e-cigarettes could have been an option to help smokers wean themselves off tobacco in India, the world’s second largest consumer of tobacco.
Gowda says tobacco is India’s largest threat to public health, reducing life expectancy among both men and women by more than a decade. Hence, the government must make efforts to curb tobacco consumption. But the Health Ministry missed the trees for the woods when it banned the Electronic Nicotine Delivery Systems (ENDS). Gowda says the government probably wanted to prevent the emergence of a large user base particularly among the youth but when it banned ENDS, it did not consider the different types of ENDS and Heat Not Burn (HNBs) devices, their differential health impacts, and the use of HNBs as a tobacco harm reduction product.
Gowda feels the term “e-cigarettes” is used as a catch-all term but in reality, there are actually a range of devices with distinct technologies and characteristics. “Policymakers should have evaluated and regulated each kind of device based on their individual features and implications rather than clubbing them together under a blanket ban,” he said in an interview.
Gowda says it is strange that anyone and everyone can buy ENDS and e-cigarettes at local shops, online, and even through WhatsApp. All these point to the ban’s failure to meet its objectives. It’s a similar story to alcohol prohibitions, which have resulted in huge black markets as well as unintended health risks from the consumption of spurious liquor.
“The government must study the balance of risk and reward in regulating e-cigarettes, an approach it has already applied to alcohol and tobacco — products that have impacts on health, but which are difficult to ban and which also generate income for the government,” said Gowda.
He said India’s India’s tobacco cessation strategy is largely focused on nicotine replacement therapies (NRT), but products like ENDS which do not contain tobacco and HNBs which do not entail combustion of tobacco, offer alternative and innovative tobacco harm reduction strategies.
“India has an opportunity to adopt a risk-proportionate regulatory framework for such devices, based on scientific evidence, which would allow the government to simultaneously protect non-smokers, discourage smoking tobacco, and protect tobacco smokers by providing regulated access to lower-risk products.”
But is that happening?
Gowda says public policy should be based on scientific evidence and not assumptions or biases. The Health Ministry did constitute an Expert Committee which supported a ban. But a lot of analysis has emerged since then. There are very interesting lessons for India to learn from how other jurisdictions have regulated ENDs and HNBs.
“Scientific and academic consensus on the regulation of e-cigarettes has been growing. India can and should learn from all this evidence to design its own scientific framework for tobacco harm reduction,” said Gowda.
So what is the alternative?
“The government can commission a thorough scientific investigation into the regulation of e-cigarettes and their impact on key parameters of concern. Whether this is conducted by a parliamentary committee, expert committee, ICMR or other relevant body, it is essential that all available evidence, both for and against the regulation of e-cigarettes, be objectively evaluated on its merits before arriving at any conclusions.
“Given the scale of tobacco harm in India, be it in terms of lives damaged and lost, or costs to public health expenditure and the economy, all avenues for innovative tobacco harm reduction must be scientifically explored.”
Gowda said it is important to understand the distinction between ENDS and HNBs or HTPs. “ENDS do not contain tobacco and instead vaporise a liquid nicotine solution for inhalation.
HNBs do contain tobacco which is heated just enough to release an aerosol, rather than being burned. HNBs have been proven to reduce tobacco-related harms compared to combustible cigarettes, and to aid the transition away from combustible cigarettes.
“By clubbing HNBs with ENDs under a blanket ban, tobacco consumers have been deprived of a possibly safer, lower-risk alternative to combustible cigarettes and their right to make informed decisions.”
Gowda said the G20 Summit is an ideal platform to exchange knowledge and perspectives on complex issues. India should showcase its ability to be a pioneer in policy design that is proactive, flexible, and scientific. At the G20 Summit, India can raise the issue of e-cigarette policy and learn from the experiences of different nations.
And where does this entire issue leave the tobacco farmers, and tobacco products like cigarettes and bidis?
“On the demand side, tobacco-related harms remain one of India’s most serious public health concerns. Beedis produce five times more tar compared to manufactured combustible cigarettes, yet they remain the most popular combustible tobacco product. Smokeless tobacco remains hugely popular especially among users from rural areas and from economically and socially disadvantaged groups.
The regulation of beedi production alone is a complex and standalone issue since it is a largely informal sector. Given the scale of tobacco production, it is vital to consider how any changes to regulation would impact the livelihoods of the millions of people involved.
This is part of the reason why farmers’
associations have spoken out against the WHO’s recommendation that tobacco crops be replaced with alternative food crops to help combat the global
food crisis.”