Governments of poorer countries need to regulate e-cigarettes just as much as their wealthier counterparts, and ought to opt for a pharmaceutical model – but they may find it difficult, according to a new paper by two U.S. academics.
“It is a common misconception that e-cigarettes are a problem relevant only to high-income countries,” say Andrew Chang and Michelle Barry of Stanford University in California.
“The availability of ENDS [electronic nicotine delivery systems] extends not just to wealthy nations but also to low- and middle-income countries (LMICs) because the devices can now be made more inexpensively,” they suggest, citing a 2014 World Health Organization (WHO) statement that “more than half the world’s population resides in countries where ENDS are available for purchase”.
However, “governments with high levels of corruption or poor law enforcement capabilities cannot execute control and regulation of both legal and illegal markets of tobacco and ENDS products”.
135 of 215 nations in the world are classed as LMICs, according to a categorisation used by the World Bank and the WHO.
Chang and Barry – whose paper “The global health implications of e-cigarettes” is published in JAMA, the journal of the American Medical Association – also see e-cigs posing specific problems in less wealthy nations. For example, they say, “harms unique to ENDS such as unintentional ingestion of refillable nicotine fluids are magnified in rural settings where access to emergency medical services is limited”.
To control e-cigs, developing nations should treat them as pharmaceutical products, Chang and Barry propose, and “place e-cigarettes under the purview of their medical and pharmaceutical regulatory boards”.
And they single out China as one country which may have to tackle the issue of e-cigarette regulation.
“How the Chinese government approaches this issue will be of great interest to global health authorities because if even a small fraction of the nation’s smokers were to adopt e-cigarette use, the number of users would be considerable. Access to ENDS in China is an open door, as 95% of the world’s e-cigarettes are manufactured in the country,” Chang and Barry write.
What This Means: Reading this paper, we were repeatedly disturbed by an unpleasant screeching sound: the bottom of a barrel being scraped.
To take two examples among many where the authors seem over-keen to hypothesise possible public-health harms from e-cigarettes in developing nations, Chang and Barry muse that “the health effects of ENDS can stress LMIC health systems relatively more than health systems in high-income countries”, and that “uncontrolled population growth of cities in many LMICs also introduces the variables of air pollution and crowded urban living conditions, amplifying the potential secondhand vapor exposure”.
But if there are no deleterious health effects (or at least – as the emerging “95% safer” consensus holds – very few compared with the tobacco cigarettes which nearly all e-cig users are giving up or cutting down on), and no risks in secondhand exposure (as seems highly likely), these are utter non-issues.
Other suggestions, for example concerning Big Tobacco’s strategies, smack of conspiracy theory.
Still, some interesting points are implied, not least that declining costs will bring e-cigs within the reach of the middle class in many developing nations; and that China may be an enormous market about to blossom. Indeed, as we have reported before, there are some early signs of that already.
– Barnaby Page ECigIntelligence staff
Photo: Christian Haugen