Why e-cigarette ban in India will do more harm than good

India has taken an even more stringent option than the US by completely banning the product, while inexplicably having no extra restrictions on traditional cigarettes, which are proven to be multiple times more harmful

It would behove the government to learn the lessons from the UK and the US and choose a harm reduction approach It would behove the government to learn the lessons from the UK and the US and choose a harm reduction approach

In September 2019, the government announced a complete ban on e-cigarettes under the guise of preventing potential health risks to India's youth. In what can now be termed as typical, this ruling was passed as an ordinance, without debate or deliberation in the parliament and mostly ignoring both evidence regarding health risks and lessons from India's multiple previous disastrous experiences with bans. About 1.5 years and a pandemic later, it is time to revisit the (de)merits of the ban and possible ways forward.  

In the absence of data and evidence from India, it would be instructive to look at two policy approaches followed elsewhere in the world and look to draw meaningful lessons for India's next steps.  

Also Read: E-cigarettes banned in India: Why the govt thinks vaping is not 'cool'

Abstinence and harm reduction

When people engage in risky and dangerous behaviour (especially victimless activities), the government can take one of two approaches - abstinence or harm reduction; prohibition or regulation. Abstinence involves a paternalistic attitude, pointing out risky behaviour and drastically changing incentives to make them stop.

This can include bans with severe penalties for violations or imposing high sin taxes. This approach might seem like the right move in many cases, where harm is clearly identified, like smoking or excessive drinking. However, as countless evidence points out, this rarely works.  

The other approach is to acknowledge that some people will always engage in risky behaviour and that the government has little control over how people comport themselves. However, the aim is to reduce the harm by providing less risky alternatives. Examples of such harm-reduction policies are regulating alcohol content in drinks, providing sex education and condoms to teenagers, or even mandating the use of helmets on motorbikes to reduce harm when an accident occurs, instead of banning motorbikes altogether.   

The United States (US) and the United Kingdom (UK) took two contrasting approaches to ENDS or Electronic Nicotine Delivery Systems with significantly different results. The US has had a troubled history with ENDS with many policy flip-flops, which has had terrible consequences in society. 

The UK, on the other hand, has encouraged the use of ENDS as an alternative to far more dangerous traditional cigarettes. This is really a story of two contrasting public policy initiatives with valuable lessons for India.

Also Read: Ban on E-cigarette: Neither can you buy, nor can you use

The Food and Drug Administration (FDA) in the US originally classified e-cigarettes as drug delivery systems and therefore classified them as illegal. A court case later, they were reclassified as tobacco products, which still have severe restrictions on promotions and advertisements. Crucially, since the FDA classified e-cigarettes as being no different from normal cigarettes, they could not be promoted as smoking cessation tools.

This policy approach had important implications for society. The original growth in vaping numbers was largely attributed to smokers trying to quit. However, with these policy changes, when e-cigarette companies could no longer market their products as safer alternatives to adult smokers, a new demographic was found.

The delicious flavours that e-cigarettes come in, such as blueberry, mint, or mango, were especially attractive to the younger generation.  

There was also the issue of state capacity and regulation, or the lack of it. The US resorted to blunt instruments such as bans and marketing restrictions but did not focus on the quality of products, nicotine content, flavouring, and so on.

The initial ban and the lack of regulation meant that the youth didn't stop with just nicotine vaping - nicotine dissolved in water was replaced with marijuana dissolved in oils, which led to deaths in the US.  

The UK preferred to look at e-cigarettes as safer alternatives to regular cigarettes and enough evidence points to the merit of this approach. Nicotine is far from being harmless - it is an extremely addictive substance that can adversely affect the heart, respiratory, and circulatory systems among others - but it's definitely not the most harmful substance in a cigarette.

Regular cigarettes deliver 7,000 other chemicals (arsenic, benzene, ammonia, lead, etc) to your lungs along with nicotine, and therein lies the biggest danger. ENDS or e-cigarettes cut out all of the other chemicals.  

Unlike the US, the UK took a proactive approach to regulate ENDS. It limited the nicotine content (20 milligrams per millilitre of nicotine in e-liquids). No such limit exists in the US, where it is not uncommon to find up to 54 milligrams per millilitre, which explains the much higher levels of addiction among the youth to these products in the US. There are also restrictions on the addition of other additives in the e-cigarette's liquid (such as caffeine, taurine, etc).

Advertisements of these products are not restricted. The UK's approach has led to better overall results - adult and youth smoking continues to decline, and e-cigarettes have become the most popular quitting aid. Underage vaping is nearly non-existent in Britain, as against the US.  

Also Read: Govt proposes to increase legal age of smoking to 21 years, ban loose cigarettes

Way Forward for India

India has taken an even more stringent option than the US by completely banning the product, while inexplicably having no extra restrictions on traditional cigarettes, which are proven to be multiple times more harmful (the long-term harm of e-cigarettes is less than 5% compared to other tobacco products).  

As with any other ban in India - whether it is single-use plastic, alcohol, or porn - the market always finds a way. There are thriving underground or black markets for all of these substances banned by the government and it is no different with e-cigarettes. People can buy e-cigarettes online quite easily on various portals, including Instagram, as a report suggested.  

The problem with sending these products underground is that the government loses all forms of control over the product. If a seller is selling an illegal product anyway, what difference would the age of buyer make - whether it is above or below 18 years? Furthermore, since it is illegal, would it make sense for a seller to ensure product quality and safety? There have been numerous reports of substandard and potentially dangerous products being sold in India on the black market.

It would behove the government to learn the lessons from the UK and the US and choose a harm reduction approach, which would involve developing a regulatory plan for e-cigarettes that maximises smoking cessation among adults while limiting youth uptake.

Further, the regulatory plan can include levying appropriate taxes, issuing public use guidelines, providing information about the product, enforcing a minimum age for sales, and individual product restrictions surrounding flavour choices and nicotine concentration in e-cigarette products. This way, larger public health goals can be achieved far more effectively.  

(The author is an Assistant Professor of Economics at the Takshashila Institution, a think tank and school of public policy.)