Harm reduction advocates commonly argue the same point: Vaping is a viable means for cessation from combustible cigarettes. This is a true statement that has long been supported by a consistently growing body of academic and scientific work suggesting that vaping is alternatively safer than smoking traditional tobacco cigarettes that deliver over 7,000 chemicals (including scores of carcinogens) with the addictive additive, nicotine. In turn, vaping is 95 percent safer than smoking cigarettes, according to a highly cited and recently reaffirmed claim from Public Health England.

To date, 39 countries in the world currently outlaw vaping in all forms citing unfounded “epidemic” claims among youth and other at-risk populations.

Sadly, these facts are consistently misinformed or dismissed by elements within the global order that view vaping as the world’s next public health crisis. The World Health Organization (WHO), the premier public health group for the United Nations (UN), has led the push against vaping and other methods of harm reduction (e.g., snus) at a global scale. To date, 39 countries in the world currently outlaw vaping in all forms citing unfounded “epidemic” claims among youth and other at-risk populations. Though there is a case to fight for a reduction of nicotine use among the world’s youth, the claims of public health epidemics are nonetheless results of misinformed opinion.

As a result, the governments of the 39 countries as mentioned above have opened a Pandora’s box of unintended consequences for having banned e-cigarette use. To begin, I intend to reveal that countries who have vaping bans also have some of the highest combustible tobacco smoking rates in the world. Additionally, due to the elimination of a consumer-driven harm reduction method in these countries, there are several public health concerns that each of these national governments must face.

Higher smoking rates

The ironic case of the WHO endorsing countries who banned vaping despite an already binding international harm reduction treaty.

For this analysis, I utilized data from the groundbreaking 2018 edition of the “No Fire, No Smoke” study conducted by researchers of the London-based Knowledge-Action-Change organization. Vaping Post previously covered this study, reporting on the ironic case of the WHO endorsing countries who banned vaping despite an already binding international harm reduction treaty. The 39 countries in question include global centers in each hemisphere like Australia, Japan, Mexico, Brazil, Singapore, and even North Korea. There is also a high concentration of vaping bans among the Middle East and Muslim-majority countries all over the world such as Egypt, Indonesia, Lebanon, Malaysia, Oman, Qatar, Saudi Arabia, and the United Arab Emirates.

Further, applying smoking rates to the countries that banned vaping reveals a consequential connection to increased rates of smoking. For example, Saudi Arabia outlawed the sale, manufacturing, and importing of e-cigarettes by royal decree in 2012. This decree also regulates e-cigarettes as a tobacco product and was a result of a series of public bans and regulations, backed by the kingdom’s Ministry of Health, virtually outlawing the consumer and industry sides of the e-cigarette market in Saudi Arabia. By consequence, the rates of smoking in the kingdom were projected to double by 2020 to 10 million smokers, according to 2013 data. That 10 million would make up about one-third of the current population of over 30 million. Luckily, there has been a decline in total tobacco use among the Saudi population; however, the notable reductions are only among women.

I argue there is a connection to vaping legalization and cigarette smoking rates.

According to Tobacco Atlas, citing 2015 WHO data, smoking remains prevalent among men aged 15 years and up with 27.9 percent smoking regularly. Smoking cigarettes and cigarette-related disease are also among the country’s leading killers, according to the kingdom’s mortality rates. Other numbers dispute the Tobacco Atlas rate among male smokers with a range of 22 percent to over 30 percent. As a whole, 12.2 percent to 17 percent of the total Saudi population smokes, additionally evidenced by the kingdom being the world’s 10th largest importer of tobacco in 2017. Plus, the country is in the top 50 in the world for most cigarettes consumed per person per year.

Other countries of note with high smoking rates and vaping bans include Japan at 33.7 percent of males aged 15 years and above indicating that they smoke. This rate is the highest among all highly developed countries.

Keep in mind; there was no noteworthy reductions attributed to harm reduction methods like vaping. The bans and the current numbers are merely consequential as stated; however, I argue there is a connection to vaping legalization and cigarette smoking rates.

The proliferation dynamic

When it comes to the inverse relationship between cigarette smoking rates and vaping legalization, there is a small but developing body of work that suggests the existence of what I refer to as the “proliferation dynamic.” Here, the proliferation dynamic applies to the population-level disparity between countries that have vaping bans and the ones that allow vaping in a market-friendly, regulated environment. Ultimately, the proliferation dynamic multiplies when there is a vaping ban, and the cigarette smoking rates increase, among other factors (e.g., regulation, other cessation methods, taxation, etc.). The proliferation dynamic only decreases when vaping is legalized in a jurisdiction thus contributing to the reduction of overall cigarette smoking rates, among the same additional factors.

I’ve reached the conclusion of the proliferation dynamic theory based on three principle studies. The first study was conducted by the United Kingdom’s Royal College of Physicians (RCP) in 2016. RCP concluded: “the availability of e-cigarettes has been beneficial to UK public health,” at a broad population-level. Additionally, the RCP study also argues that the “large-scale substitution of e-cigarettes… has the potential to prevent almost all the harm from smoking in society.”

Lower smoking rates occur among the population when e-cigarettes aren’t banned.

The second study that helped term the proliferation dynamic, published in the Tobacco Control journal in 2018, was conducted by a group of multinational researchers from the United States, Canada, and Australia. In this study, the researchers concluded that vaping could be playing a contributing role in the historical declines of cigarette smoking rates among high schoolers in the United States. Utilizing publicly available data from national tobacco control surveys sponsored by the U.S. federal government, the researchers offer an approach to the data that suggests that the rising popularity in e-cigarettes in recent years could contribute to lower rates of combustible cigarette use in demographics of young people under the age of 26 years. “It is possible that vaping may be playing a contributing role to the recent steep declines in youth and young adult smoking,” the same researchers wrote.

The third and final study that influenced the proliferation dynamic theory was published in the International Journal of Environmental Research and Public Health in 2015. Here, the researchers tracked smokers that purchased e-cigarettes in Italy for a whole year. In the end, the conclusion that was reached involved a series of follow-ups and additional analysis of the study’s participants which yielded results that vaping is a viable harm reduction method. “At 12 months, 40.8% of subjects could be classified as [cigarette] quitters, 25.4% as reducers and 33.8% as failures,” the researchers wrote. “We have found that smokers purchasing e-cigarettes from vape shops with professional advice and support can achieve high success rates.”

Based on these three studies, we can conclude that the proliferation dynamic is approached from a perspective that suggests lower smoking rates occur among the population when e-cigarettes aren’t banned. In turn, the lower the proliferation dynamic metric, the better the public health outcomes.

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Michael McGrady Jr is a columnist for Vaping Post's English edition. He is a critically acclaimed journalist with awards and recognition from across the industry. He was a finalist for ECigClick's annual vape awards in 2019 and 2020, a KAC Tobacco Harm Reduction Scholarship Fellow in 2019, among other honors. All articles express his own opinion and do not necessarily reflect the Editor's view.