Washington, D.C. — A report published last week by the World Health Organization calling for greater regulation of the e-cigarette industry has divided public health experts.

The report argues that governments should stop the use of e-cigarettes in public places, that sales to those under the age of 18 should be banned and that the amount of nicotine in the devices should be regulated. It calls for regulations on how e-cigarettes are advertised – including the use of candy-like flavors to attract young people – and on their indoor use, until more is known about the effect of exhaled vapor  on bystanders.

According to national survey data published last week by the Centers for Disease Control and Prevention in the US, more than a quarter of a million teens who had never smoked a cigarette had smoked an e-cigarette in 2013. This is compared to 79,000 teens who reported the same behavior in the National Youth Tobacco Survey in 2011. This has led to concerns that e-cigarettes could act as a gateway for young people who previously had no nicotine dependency, and worries that regulators may not be able to keep up with the expanding market.

However, many public health experts and advocates of harm reduction urge WHO to consider the benefits of e-cigarettes. Professor John Ashton of the UK Faculty of Public Health says, “we need to weigh up the benefits of fewer people smoking against the risk of electronic cigarettes leading to more people starting to smoke.”

These sentiments were echoed by more than 50 public health experts who signed a letter asking WHO to approach regulation of the device with less force than cigarettes. They maintain that, “tobacco harm reduction is part of the solution, not part of the problem,” and that strict regulations could obstruct efforts to meet targets to reduce non-communicable disease.

E-cigarettes work by using a heated coil inside an atomizer to heat liquid nicotine so that it becomes a vapor. The vapor is then inhaled and nicotine is delivered to the brain. Whilst marketing companies insist that what is exhaled is mainly water vapor, WHO argues there is insufficient evidence to discount the presence of harmful chemicals.

It is believed that the long term consumption of nicotine without tobacco – as is the case with e-cigarettes – is safe for consumers, although overdoses have occurred from people drinking the liquid or spilling it onto their skin where it has been absorbed. The main ingredient of the liquid nicotine, propylene glycol, is used in foods and plastics but is dangerous when consumed at high levels and may irritate the respiratory system when inhaled. The long term consequences of this chemical as well as those used to add flavor are as yet unknown.

Almost six million people die each year from tobacco related illnesses. Earlier this year the Pan American Health Organization (PAHO) urged Caribbean governments to do more to tackle the ‘epidemic’ of tobacco use. The percentage of tobacco use varies across the Caribbean region with Antigua and Barbuda amongst the lowest in the world at 5% and Jamaica significantly higher at 28%.

The regulation of e-cigarettes will be discussed further at the WHO Framework Convention on Tobacco Control (WHO FCTC) being held this October in Moscow.

E-cigarette regulations divide public health experts

Deborah Almond

Deborah Almond is AMG's Health Editor and an infectious disease specialist, with experience in sexual and reproductive health and malaria in pregnancy. She holds an MSc from the London School of Hygiene & Tropical Medicine and a BSc from University College London.

Category: Health