Let’s find a balance in the e-cigarette debate

Imagine for a moment that a new product has come to the market and has achieved very rapid uptake with an estimated two million users in the UK alone.  The product is available in a number of forms, some of which are brightly coloured and flavoured in a way that could easily appeal to children.  The substance they contain is highly addictive, there is evidence that some people can become addicted and develop dependency very quickly. There are some negative health effects to its use, particularly on the cardiovascular system. The contents of the product are poisonous when consumed in quantity – there is rising evidence of consultations with the national poisons service on overdoses – particularly among small children.  There are safety concerns that are arising on the quality of manufacture of some of the products with reports of injuries or fires arising from their use.  There are no restrictions on the use of this product so it is becoming widely used in public places, including where children and young people are present.  It is also being heavily advertised, including on television.  It is being sold in a wide range of outlets, crossing traditional product boundaries.

Setting aside what we know about the potential benefits to smokers – in any other circumstances is this a product that would be legally available at all, let alone without any restrictions on its sale or promotion?   The answer is clearly no; there would be widespread calls to ban it from sale.  The only reason that we are even considering its availability is because it is less harmful than a currently available lethal product.

Unfortunately, at the moment the public health/tobacco control community seems to be split.  One group expressing concerns about the product itself, others only seeing the potential benefits to current smokers.  Public Health Wales’ view is that it is possible to find a balance, a compromise position that addresses the needs and concerns of both sides.

The ‘precautionary principle’ is well established in public health.  Where we have some evidence, for example from theory or basic science or from other fields of health, that something may have negative health effects, we act on that basis not waiting for conclusive evidence of harm.  It is true that we don’t have conclusive evidence that children will take up e-cigs and start vaping in large numbers but there is sufficient evidence to suggest it is a risk.  Why wouldn’t they, they are seeing it all around them, it is being widely advertised, adults do it and perhaps of greatest concern – it is widely touted as being safe.

We believe that if e-cigs are regulated and treated as a tobacco product (providing they do not make claims about helping people quit) they should be legally available.  This means that they would be subject to the same sales and marketing restrictions as cigarettes and the same rules on where they can be used.  This, we believe, would help reduce the potential risks and harms of e-cigs, particularly to the young.  For smokers, they would be able to make the safer choice if that is their preference – we would advocate it should be a last resort, quitting is still the best option.  They would still be gaining compared to continuing to use tobacco; they can take steps to reduce their risk.  They cannot currently smoke tobacco where and when they choose so it seems illogical to argue that they are somehow disadvantaged by not being allowed to vape where and when they like.

There is a win/win situation possible here. It is important that the public health community does not allow the considerable vested interests in this debate to introduce tensions and divisions which ultimately can only harm public health.