A fixture of the public health crisis since the announcement of the Government of India’s e-cigarette ban has been the expression of doctors’ concerns – and a number have been expressed since the ban was announced.
Doctors’ concerns have been collated in a NewsVoir piece circulated by multiple outlets. “There is data available regarding e-cigarettes as smoking cessation devices from the UK, so Indian studies should have been taken up by the government as well as health organisations,” said Dr Bharat Ghopal, the senior pulmonologist and director of the National Chest Centre in Delhi. ‘A lot of smokers come to us asking for alternatives so that they can quit smoking. Hence, the government should at least allow research and studies to be conducted on these alternatives so that in the future, this could be a tool for smoking cessation.
“A ban will also give rise to a black market and the government will not have any control over it. It would have been in the greater public interest if the government would have regulated e-cigarettes and allowed more research on harm reduction tools.”
Doctors’ concerns have been a staple of the conversation surrounding the Government’s e-cigarette ban, even before the prohibition came into force. The Indian Council of Medical Research (ICMR) reports that e-cigarette use can addict non-tobacco users to nicotine and thereby act as a gateway into tobacco use. The ICMR also connects e-cigarette use to “DNA damage; carcinogenic, cellular, molecular and immunological toxicity; respiratory, cardiovascular and neurological disorders; and adverse impact on [foetal] development and pregnancy.”
However, some have accused the ICMR of bias in their judgement on e-cigarettes. Before the ban came into force, 62 medical specialists wrote to the ICMR in protest. Practitioners have spoken up in the aftermath of the prohibition being enacted.
“The bill to ban e-cigarettes is surprising in a country like India where so many deaths are reported due to smoking,” said Dr Aparajeet Kar from the Pulmonology Department of BLK Super Specialty Hospital in New Delhi. “The government has neglected the harm reduction benefits of e-cigarettes and has been relying only on the biased whitepaper of ICMR.
“Those who gave up smoking with the help of vaping devices will now be vulnerable to diseases such as lung cancer, COPD [chronic obstructive pulmonary disease], bronchitis, etc. as they will move back to conventional smoking due to non-availability of e-cigarettes. The government should have considered regulation as it has been done in various other countries, but banning is not a solution.”
Concurring, Tagore Medical College researcher Dr Sree Sucharitha said “there are many ex-smokers in India who moved to e-cigarettes because they failed with nicotine gums and patches, and now with the ban, they will be forced to go back to smoking. This is a regressive step taken by the government, which is often sceptical about new developments. This happened with vaccines, condoms, etc. in the past but the policies ultimately changed. The bill to ban e-cigarettes is a defeat for science.”
Conversely, some medical bodies have expressed support for the e-cigarette ban. Tobacco control advocacy group, the National Health Forum, said “there is a concerned attempt by importers of e-cigarettes to ensure that the Ministry of Health’s good work done providing a platform for prohibition of imports of these products is frustrated.” It urged ministries to “support this move and ensure that such products are banned and are not included as legal products under the COTPA (Cigarettes and Other Tobacco Products Act) or the Drugs and Cosmetics Act.”
The World Health Organization has also voiced support of the e-cigarette ban. “[The WHO] congratulates India for banning [e-cigarettes],” its Southeast Asia Regional Office (WHO-SEARO) tweeted earlier this year. The WHO-SEARO describes e-cigarettes as “harmful” as “[they] heat a liquid to create aerosol that is inhaled by the user. The liquid contains nicotine & other chemicals that adversely impact health. [Six] deaths & 380 cases of lung infections have been associated with e-cigarette use in the US.” WHO spokesperson Tarik Jašarević commented that the “WHO has been consistent that if e-cigarettes cannot be regulated effectively they should be banned.”