In September 2019, the government announced a complete ban on e-cigarettes under the guise of preventing potential health risks for Indian youth. In what can now be called typical, this verdict was passed as a decree, without debate and deliberation in parliament, and mostly ignores both the evidence regarding health risks and the lessons from multiple previous Indian catastrophic experiences with bans. Approximately 1.5 years and a pandemic later, it is time to reconsider the (de) merit of the ban and possible ways to make further progress.
In the absence of data and evidence from India, it would be advisable to look at two policy approaches that have been followed elsewhere in the world and try to draw significant lessons for India’s next steps.
Also read: E-cigarettes banned in India: Why the government thinks vaping is not “cool”
Abstinence and harm reduction
When people engage in risky and dangerous behavior (especially non-victim activities), the government can take one of two approaches – abstinence or harm reduction; prohibition or regulation. Abstinence involves a paternalistic attitude, pointing out risky behaviors, and drastic changes in incentives to stop them.
This may include prohibitions with severe penalties for misdemeanors or the imposition of a high tax on sin. This approach may seem like the right move in many cases, where the harm is clearly identified, such as smoking or excessive drinking. However, as countless pieces of evidence point out, this rarely works.
Another approach is to acknowledge that some people will always behave risky and that the government has little control over how people express themselves. However, the goal is to reduce the damage by providing less risky alternatives. Examples of such harm reduction policies are the regulation of alcohol in beverages, the provision of sexual education and condoms to teenagers, or even the obligation to use motorcycle helmets to reduce damage in the event of an accident, rather than banning motorcycles altogether.
The United States (USA) and the United Kingdom (UK) had two contrasting approaches to ENDS or electronic nicotine delivery systems with significantly different results. The United States had a problematic history with the ENDS with many political Japanese women, which had dire 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 truly the story of two opposing public policy initiatives with valuable lessons for India.
Also read: E-cigarette ban: You can neither buy nor use
The U.S. Food and Drug Administration (FDA) originally classified e-cigarettes as drug delivery systems and therefore classified them as illegal. The lawsuit was later reclassified as tobacco products, which still have severe restrictions on promotions and advertising. Crucially, the FDA classifies e-cigarettes as no different from regular cigarettes, and they cannot be promoted as smoking cessation tools.
This approach to politics had important implications for society. The initial increase in vaping was mainly attributed to smokers who tried to quit. However, with these policy changes, when e-cigarette companies could no longer market their products as a safer alternative to adult smokers, a new demographic category was found.
The delicious flavors of e-cigarettes, such as blueberry, mint or mango, were especially appealing to the younger generation.
There was also the question of state capacity and regulations or lack thereof. The United States resorted to blunt instruments like bans and marketing restrictions, but did not focus on product quality, nicotine content, flavors, and so on.
The initial ban and lack of regulations meant that young people did not stop just nicotine vaping – nicotine dissolved in water was replaced by marijuana dissolved in oils, which led to death in the United States.
The UK preferred to look at e-cigarettes as a safer alternative to conventional cigarettes, and enough evidence points to the merits of this approach. Nicotine is far from harmless – it is an extremely addictive substance that can negatively affect the heart, respiratory and circulatory systems, among others – but it is definitely not the most harmful substance in a cigarette.
Ordinary cigarettes deliver 7,000 other chemicals (arsenic, benzene, ammonia, lead, etc.) to your lungs along with nicotine, and that is where the greatest danger lies. ENDS or e-cigarettes exclude all other chemicals.
Unlike the US, the UK has proactively approached ENDS regulation. He limited the nicotine content (20 milligrams per milliliter of nicotine in e-liquids). There is no such limit in the US, where it is not uncommon to find up to 54 milligrams per milliliter, which explains the much higher level of youth dependence on these products in the US. There are also restrictions on adding other additives to e-cigarette liquids (such as caffeine, taurine, etc.).
Advertisements for these products are not limited. The UK approach has led to better overall results – smoking among adults and young people continues to decline, and e-cigarettes have become the most popular smoking cessation aid. Juvenile vaping is almost non-existent in Britain, unlike in the United States.
Also read: The government is proposing to increase the legal age of smoking to 21, banning cigarette smoking
The way forward for India
India has taken an even stricter option than the US by completely banning the product, while inexplicably there are no additional restrictions on traditional cigarettes, which have been proven to be many times more harmful (long-term damage to e-cigarettes is less than 5% compared to other tobacco products) .
As with any other ban in India – be it disposable plastic, alcohol or pornography – the market is always finding a way. There are successful underground or black markets for all these substances that the government has banned, and even with e-cigarettes it is no different. People can easily buy e-cigarettes online on various portals, including Instagram, as the report suggests.
The problem with sending these products underground is that the government is losing all forms of control over the product. If the seller sells an illegal product anyway, what differences will the age of the buyer have – is he over or under 18? Furthermore, does it make sense for the seller to ensure the quality and safety of the product, as this is illegal? There are numerous reports of substandard and potentially dangerous products being sold on the black market in India.
The government should learn lessons from the UK and US and choose a harm reduction approach, which would include the development of a regulatory plan for e-cigarettes that maximizes smoking cessation in adults while limiting youth enjoyment.
Furthermore, the regulatory plan may include the collection of appropriate taxes, the issuance of guidelines for public use, the provision of product information, the determination of a minimum age for sale and individual product restrictions concerning the choice of flavors and nicotine concentrations in e-cigarette products. In this way, greater public health goals can be achieved far more efficiently.
(The author is an assistant professor of economics at the Takshashil Institution, Think Tank, and School of Public Policy.)
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