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The sixth session of the Conference of the Parties to the World Health Organisation’s Framework Convention on Tobacco Control (COP6) is due to be held from the 13th to the 18th of October 2014 in Moscow.
The FCTC is an international treaty adopted by the WHO that entered into force in 2005 with the objective “to reduce the prevalence of tobacco use and exposure to tobacco smoke.”
The FCTC and its guidelines for implementation substantially influence how governments across the globe regulate tobacco. The COP is the governing body and decision-making organ of the WHO FCTC and meets every two years. All parties to the convention are invited to attend meetings of the COP to review and potentially recommend tobacco control policy measures across a broad range of areas, including e-cigarettes. The WHO report on e-cigarettes, published ahead of this conference made the following points in relation to e-cigarettes:
- Recognition that there is a debate among scientific and public health experts around the world with respect to the role e-cigarettes play in reducing tobacco smoking.
- Acknowledgement that it is likely that e-cigarettes offer a less harmful alternative to tobacco cigarettes.
The WHO report proposes the following regulatory options for e-cigarettes:
- A ban on health claims unless substantiated by scientific evidence,
- A ban on the use of e-cigarettes in public places,
- A requirement for health warnings commensurate with proven risks,
- A ban on the sale of e-cigarettes to under 18s,
- A ban on the marketing and advertising of e-cigarettes,
- A ban on the use of flavours, and
- Requirements for product design and information requirements.
Given the primary objective of the FCTC, the question must be asked, do e-cigarettes lead to more or fewer people smoking?
Fewer. There are 2.1 million people in the UK who regularly use e-cigarettes. All of these people are now smoking significantly fewer or no tobacco cigarettes as a direct result. At the same time the proportion of adult smokers in the UK has fallen to its lowest level since records began in the 1940s.[1]
Robert West, Professor of health psychology and director of tobacco studies at University College London made clear there is a direct link between the rise in the use of e-cigarettes and a decline in the number of smokers.[2]
Furthermore, as ASH have made clear, “The drop in smoking also shows that concerns that the use of e-cigarettes would lead to a renormalisation of tobacco use appear unfounded. The rapid increase in use of these products has coincided with a consistent steady decline in smoking.”[3]
Are e-cigarettes less harmful than tobacco cigarettes?
Yes and the WHO accept that they are. Professor Peter Hajek of Queen Mary University London and the NHS have both made clear that e-cigarettes are “orders of magnitudes safer than tobacco cigarettes.”[4] The NHS made clear that they were 1,000 times safer[5].
Is it therefore better for smokers to switch to e-cigarettes?
Yes. Professor John Briton from the Royal College of Physicians said: “If all the smokers in Britain stopped smoking cigarettes and started using e-cigarettes we would save five million deaths in people who are alive today. It’s a massive potential public health prize.”[6]
Will the proposed regulatory options set out by the WHO make it easier or more difficult for a smoker to switch to e-cigarettes?
The ban on flavours, the ban on advertising, and the ban on the use of e-cigarettes in public will make it more difficult for smokers to switch to e-cigarettes. These proposals when taken as a whole will result in a reduction in the range of products and those products that are available will be less appealing to smokers.
Banning flavours – In research[7] carried out by Dr Konstantinos Farsalinos and others, vapers stated that the availability of flavours was “very important” in their effort to reduce or quit smoking. This research also found that the majority of vapers would find e-cigarettes “less enjoyable” or “boring” if flavours were restricted, while 48.5 per cent of vapers stated that it would increase their cravings for tobacco cigarettes and 39.7 per cent of vapers said that without flavours it would have been less likely for them to reduce or quit smoking.
Banning public vaping – The ban on smoking in enclosed public places was introduced to benefit the health of non-smokers whose health was put at risk as a result of being in close proximity to smokers. Therefore any proposal to include e-cigarettes within this ban must also be to protect the health of non-vapers.
Is passive vaping dangerous? No. A major scientific study undertaken by Dr Konstantinos Farsalinos and Professor Riccardo Polosa concluded that the “effects of e-cigarette use on by standers are minimal compared with conventional cigarettes.”[8]
Smoking rates also increased in New York by a staggering 2.1 per cent following the introduction of a ban on the use of e-cigarettes in public.[9] A ban on the use of e-cigarettes in public would also force vapers to vape alongside smokers thus exposing them to temptation, the dangers of second-hand smoke and cause many to go back to smoking.
With a ban on the advertising of e-cigarettes soon to be introduced, following the passing of the Tobacco Products Directive (TPD), where are smokers to find out about e-cigarettes, particularly if they are banned in public? Smokers need to see people using e-cigarettes in public, they need to be able to go up and speak to e-cigarette users so that they can find out further information and then hopefully make the switch to a less harmful alternative.
In the words of Professor Robert West: “What is the problem that requires further regulation?”[10]
In the UK the debate surrounding e-cigarettes is highly active and following the introduction of the TPD, e-cigarettes will be subjected to a stricter regulatory regime than some tobacco products. Research into the effects of e-cigarettes is being carried out on a continual basis and the findings are reported openly.
Given the WHO’s recognition that e-cigarettes are an “evolving frontier”, it would be premature for FCTC to adopt any regulatory recommendations until all the scientific evidence has been fully interrogated. We therefore propose that sensible measures such as the ban on the sale of e-cigarettes to under 18s and the ban on e-cigarette companies making health claims without the necessary scientific facts to support them are supported as a matter of priority. The WHO should then resist recommending any further regulatory measures until a need can be proven.
Final question – e-cigarettes are a consumer product; they do not contain tobacco, so why are they even included within the scope of the FCTC?
[1] http://www.theguardian.com/society/2014/oct/07/smoking-falls-lowest-level-uk-recording-started-1940s
[2] Professor Robert West speaking at the E-cigarette Summit, The Royal Society, London on the 12th of November 2013.
[3] http://www.theguardian.com/society/2014/oct/07/smoking-falls-lowest-level-uk-recording-started-1940s
[4] http://www.bbc.co.uk/news/health-27161965
[5] http://www.spectator.co.uk/features/9197731/vape-alarm/
[6] The Independent Newspaper, 29 March 2013
[7] http://www.mdpi.com/1660-4601/10/12/7272
[8] Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review:
Konstantinos E. Farsalinos and Riccardo Polosa
published online 13 February 2014 Therapeutic Advances in Drug Safety
[9] http://www.churnmag.com/news/smoking-rates-increase-new-york-e-cigs-banned/
[10] Professor Robert West speaking at the E-cigarette Summit, The Royal Society, London on the 12th of November 2013.
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