E-cigarettes and e-hookah could become unattainable in India as long-standing efforts by the Centre to ban them amidst the war on tobacco products seem on the cusp of bearing fruit.
The Drug and Technical Advisory Board (DTAB) has cleared the way for the prohibition of electronic nicotine delivery systems (ENDS). This has been a pet project of sorts for the Union Health Ministry since August last year when it directed state governments to ban ENDS. The Delhi High Court had this year ruled against the directive, offering the ENDS industry and users of the devices a temporary reprieve. This reprieve may soon be over.
The DTAB has approved a proposal to regulate ENDS as drugs according to anonymous insiders. This decision would lead them to fall under the purview of the Drugs and Cosmetics Act, 1940. As per the Union Health Ministry’s proposal
“After revisiting its earlier deliberations, the Drugs Consultative Committee has recommended that since ENDS and related products are used as a tobacco cessation product and function for nicotine delivery, these devices fall under the definition of ‘drug’ as defined under Section 3(b) of the Drugs and Cosmetics Act, 1940.”
This was accepted by the DTAB. One anonymous official told the Times of India that “DTAB has evaluated the evidence, studied the recommendations in detail and have arrived at a decision that ENDS should be banned immediately as they can pose serious risk to public health as well as a threat [to] government’s anti-tobacco measures.”
“With the Health Ministry now cleared to move against them, it is likely to mark the end of the legal sale and use of all electronic nicotine devices including e-cigarettes, e-hookah, and e-Shisha devices in India.”
The lack of such regulation hitherto formed the crux of the Delhi High Court’s argument against the ENDS ban as they said the devices are not promoted as therapeutic or medical devices. Now that the DTAB has asserted otherwise, all that stands in the way of an outright ban at the national level is the approval of the Union Health Minister and subsequent notification by the ministry. This would enable the Central Drug Standards and Control Organisation to order the ban of ENDS.
States including Bihar, Himachal Pradesh, Jharkhand, Karnataka, Kerala, Jammu and Kashmir, Mizoram, Puducherry, Punjab, Rajasthan, Tamil Nadu, and Uttar Pradesh have banned the devices already. With the Health Ministry now cleared to move against them, it is likely to mark the end of the legal sale and use of all electronic nicotine devices including e-cigarettes, e-hookah, and e-Shisha devices in India.
The grounds upon which the ban of e-cigarettes is being pursued is that they contain nicotine. Given the addictive qualities of nicotine, fears have been expressed that they could hook young people on nicotine and provide a gateway to begin using tobacco. Concerns have also been expressed about potential adverse health effects.
“ENDS including e-cigarettes are promoted by the industry body as a smoking cessation aid,” one anonymous official told The Indian Express. “Their efficacy and safety as a quitting aid has not yet been firmly established. Though some smokers claim to have cut down smoking while using ENDS, the total nicotine consumption seems to remain unchanged.”
“The vigour of the Centre’s action against ENDS cannot be disputed, but one can query as to whether or not it is misplaced. Tobacco products are responsible for one death every eight seconds, ranking as the fourth leading cause of death in India. Fourteen percent of Indian adults use smoking tobacco and 25.9 percent of adults use smokeless tobacco.”
The ICMR, meanwhile, is also worried that these devices would attract non-smokers. It said on World Tobacco Day this year
“Use of ENDS or e-cigarettes has documented adverse effects on humans, which include DNA damage; carcinogenic, cellular, molecular and immunological toxicity; respiratory, cardiovascular and neurological disorders; and adverse impact on fetal development and pregnancy
“While such benefits have not been firmly established, there is also evidence that there is risk of people continuing to use both them as well as tobacco products. In addition, these devices could encourage non-smokers to get addicted to tobacco.”
Health Issues India recently reported that 34 percent of Indian youngsters are unaware of side effects of smoking and 5000 children start consuming tobacco every year.
The vigour of the Centre’s action against ENDS cannot be disputed, but one can query as to whether or not it is misplaced. Tobacco products are responsible for one death every eight seconds, ranking as the fourth leading cause of death in India. Fourteen percent of Indian adults use smoking tobacco and 25.9 percent of adults use smokeless tobacco.
It cannot be denied that the Centre has moved against tobacco in recent years: graphic pictorial warnings on tobacco product packaging stand as perhaps its biggest achievement in this regard. 8.1 million fewer Indians used tobacco in the 2016-17 period compared to 2010. Yet there is still more that can, and must, be done. Strengthening efforts to enforce the Cigarettes and Other Tobacco Products Act is one means, given the low rate of compliance with the law’s stringent provisions banning the advertising and promotion of tobacco products. Another could be upscaling taxation levels on tobacco products to meet World Health Organziation (WHO) recommendations.
“The scientific body of evidence as to the adverse effects of ENDS is still emerging and, therefore, limited. Subsequently, it would be wrongful for the Union Health Ministry to not be vigilant when examining the devices. However, a blanket ban may only drive ENDS underground and outside of the purview of government regulation.”
Yet efforts against conventional tobacco products seem to have slowed amidst the Centre’s push to ban ENDS. Evidence as to the exact nature of the harmful effects of ENDS is mixed. One British report disputed claims such as ENDS having a gateway effect encouraging young people to use tobacco. A Harvard University investigation acknowledged that ENDS are associated with a number of adverse health effects and that evidence is mixed as to their effectiveness as a smoking cessation device. Nonetheless, the report concluded that “e-cigarettes are almost certainly less lethal than conventional cigarettes.”
It is important to note that the scientific body of evidence as to the adverse effects of ENDS is still emerging and, therefore, limited. Subsequently, it would be wrongful for the Union Health Ministry to not be vigilant when examining the devices. However, a blanket ban may only drive ENDS underground and outside of the purview of government regulation. Citing that they contain nicotine as the reason for their ban begs the question as to why similar steps have not been taken against conventional tobacco products. These not only include nicotine but a plethora of other harmful chemicals.
In many ways, the focus on prohibiting ENDS could detract from the anti-tobacco push underway in the country for the past several years. ENDS should not be outside of the eye-line of the Union Health Ministry, but they should not fill it disproportionately. Ensuring that combating tobacco products does not play second fiddle to the fight against ENDS remains to be seen going forward.