To vapor or to e-cigarette the debate rages on

To vapor or to e-cigarette -the debate rages on?

But, as more reputable organisations publish findings confirming the significantly lower risk of vaping products in comparison with cigarette smoking, so the regulatory tide is beginning to turn, says Africa Harm Reduction Alliance (AHRA).

This will be accelerated as more evidence emerges to confirm the role of e-cigarettes in reducing tobacco-related harm and how it can complement tobacco cessation.

It is ironic and inaccurate to categorise e-cigarettes as tobacco products. These products do not contain tobacco at all.

“In fact,” says Dr Delon Human, co-founder of the Africa Harm Reduction Alliance (AHRA) and President of Health Diplomats, “the two smoking processes are different.

Tobacco cigarette smoking relies on burning of tobacco, at temperatures between 800-900 degrees Celsius, which releases at least 4000 toxicants into the smoker’s body. No wonder one out of two cigarette smokers will develop a tobacco-related disease and premature death.

In contrast, vaping of e-cigarettes relies on a heating process of between 200-250 degrees Celsius to vaporise and deliver its nicotine. It is probably the word ‘cigarette’ used for both products that are causing legislative confusion,” Dr Human says.

Whilst e-cigarettes and vaping presently fall into the gap between smoking and medicinal legislation in South Africa, there have been calls locally for it to be classified under both sets of legislation. Protagonists for this viewpoint feel that it should be regarded as a medical treatment, with ‘other’ consumption falling under the Tobacco Act because it ‘should be regarded as a health risk, like all tobacco products’.

In many countries, the legislation places e-cigarettes in the same category as tobacco.

In South Africa, Health Minister, Dr Aaron Motsoaledi, has stated his attention to regulating e-cigarettes under the Tobacco Products Control Act.

The government wants to treat e-cigarettes just like tobacco products. In fact, there have been calls for an outright ban on vaping, falsely conflating it with smoking tobacco, and equally falsely attributing its rise to tobacco companies.

For example, in the United Kingdom, with its 10 million cigarette smokers, some 4 million have switched to vaping e-cigarettes and this has truly been a consumer-driven, grassroots movement, far removed from cigarette manufacturers.

“What needs to be assessed, or addressed,” says Dr Human “is the relative harm of vaping versus smoking, and the potential for vaping to provide a far safer alternative to smoking, or even a means to help people to quit smoking.”

In 2016, the UK’s Royal College of Physicians issued a 200-page report on tobacco harm reduction, which found that e-cigarettes are not a gateway to smoking, do not result in normalisation of smoking and that it’s useful in assisting to quit smoking.

It also stated that the long-term harm of e-cigarettes is most probably less than 5% compared to that of tobacco products. It’s important that risks are looked at in perspective.

“The notion that vaping eliminates 95% of potential harm, compared to smoking, does not mean that there is no risk or no harm. It should therefore not be surprising that some studies do find some harm associated with vaping, but the focus needs to be on the harm reduction it provides,” emphasises Dr Human.

Increasingly, international research studies confirm that vaping is reducing cigarette smoking for active tobacco smokers.

Vaping is a means of weaning people off tobacco smoking by still offering the hit experienced by nicotine – medically regarded as the least dangerous of the all the substances found in tobacco cigarettes, according to 2017 May report entitled ‘Where there’s no smoke, is there still fire?

Ethical aspects of tobacco harm reduction’ – published by the Africa Harm Reduction Alliance (AHRA).

A new report also recently emerged which is based on more than 800 peer-reviewed scientific studies on the health effects of e-cigarettes by the US National Academies of Sciences, Engineering and Medicine.

The report found conclusive evidence that by substituting conventional cigarettes with e-cigarettes reduces the user’s exposure to most of the toxins and carcinogens that are in conventional cigarettes. It also saw it resulting in reduced short-term adverse health outcomes in several organs.

“In South Africa, the vaping Industry needs to be recognized as a stakeholder in the prevention and control of chronic diseases linked to combustible tobacco.  If tomorrow, all cigarette smokers in South Africa were to switch to harm reduced vaping products, the impact is bound to be extremely positive from a non-communicable diseases point of view. It is our duty to ensure that we provide a safer alternative to the millions of smokers in the country,” says Dr Human.

There is a danger to medicalise vaping. As e-cigarettes have now become the most popular and effective way to quit smoking, in countries such as the United Kingdom, the pharmaceutical industry would like to secure a monopoly on its distribution. The way to do this is for vaping to be regulated exclusively under the Medicinal Act. Unfortunately, this type of regulation would make vaping less affordable and accessible to the normal smoker in South Africa.

In South Africa, members of the Vapour Product Association(VPA) have responded to the legislative situation by adhering to their own code of conduct, the development of product standards and voluntarily committing to not selling the product to and by people under the age of 18.

Despite being considered safe or low-risk, especially when divorced from burning tobacco, nicotine has been classified as a schedule 2 or 3 drugs locally, depending on the concentration.

It remains unclear to what extent that applies to sellers of vaping liquid containing nicotine, or whether it applies at all to sellers of the devices themselves and the very many nicotine-free liquids on the market. Tobacco control leaders have unfortunately attributed the rise of e-cigarettes to tobacco companies, despite never having adequately assessed or addressed its relative harm in comparison with smoking or how it can help smokers quit.

In the US, the FDA, under the leadership of Dr Scott Gottlieb, appears to be moving towards regulatory changes that are designed to move smokers towards non-combustible, harm reduced products, such as e-cigarettes.

The Reuters news agency (July 17, 2017) said the government proposed cutting nicotine in cigarettes to ‘non-addictive’ levels.

The FDA cannot reduce nicotine levels to zero, nor can it ban cigarettes. But Gottlieb said the agency would study regulating nicotine levels with a view towards the ‘FDA’s potential to render cigarettes minimally addictive or non-addictive.’

“Nicotine itself is not responsible for cancer, lung disease and heart disease that kill hundreds of thousands of Americans each year,” he said.

“It’s the other chemical compounds in tobacco and in the smoke, created by setting tobacco on fire, that directly causes illness and death.”

Analysts said they expect regulators in Europe to study similar actions on nicotine products. The action shakes up a debate among public health advocates as to whether e-cigarettes represent a health risk or potential benefit.

“While there’s still much research to be done on these products and the risks that they may pose, they may also present benefits that we must consider,” Gottlieb said.

During an April hearing on whether to advance his nomination for the FDA position, he said some e-cigarettes may have the potential to wean smokers off combustible cigarettes and be less harmful.

As the debate on legislation continues, so more medical research is being released on the potential benefits of e-cigarettes and vaping.

Public health bodies, such as Public Health England (PHE) and medical organizations, such as the Royal College of Physicians, have entered the debate with positive findings on vaping and the role it plays in reducing risk within the smoking community.

“It may take time, but it is inevitable that as the body of evidence increases, on the role of vaping in tobacco harm reduction, so legislators will have to review their stance on vaping.

Organisations like the AHRA are committed to providing evidence-based information on harm reduction, while ethically serving individual and population health,” concludes Dr Human.


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