According to a June report by the Press Trust of India, a proposal by the Drugs Technical Advisory Board of India, suggests prohibiting the sale, manufacture, import and distribution of all ENDS, under Sections 26A and 10A of the Drugs and Cosmetics Act, 1940. The proposal states that, “After revisiting its earlier deliberations, the Drugs Consultative Committee has recommended that concluded that these devices fall under the definition of ‘drug’.

THE INDIAN COUNCIL OF MEDICAL RESEARCH HAS RECOMMENDED A “COMPLETE BAN” ON ENDS, SAYING SUCH DEVICES BECOME A GATEWAY TO SMOKING AND CAN GET A NON-SMOKER ADDICTED TO NICOTINE.

Moreover, this move comes highly recommended by the Indian Council of Medical Research (ICMR) who has recommended a “complete ban” on ENDS, saying such devices become a gateway to smoking and can get a non-smoker addicted to nicotine. Such a statement is ironic to say the least, when the devices proven to be safer alternatives are being banned but the actual products that are toxic: cigarettes, remain untouched and widely available throughout the country.

In 2017, the Union Health Ministry of India had formed a working group to assess the effect of e-cigarettes on local vapers, in an attempt to find out whether a ban is necessary. This committee had concluded that the products have cancer-causing properties and are highly addictive. Based on these arguments, the Union government had said it was planning to implement a ban.

Subsequently last September, in an advisory to state governments, the health ministry had suggested that e-cigarettes and Heat not Burn (HnB)s devices are banned, as they are “are a great health risk to the public at large, especially to children, adolescents, pregnant women and women of reproductive age”.

Picking on the safer alternatives to cigarettes

Meanwhile, public health experts amongst whom renowned anti-smoking researcher Dr. Konstantinos Farsalinos, agree that such a stance will prove counterproductive to the local smoking epidemic. The following article by the cardiologist on ET, discusses the situation in further detail:

“While India continues its fight against rampant tobacco use, especially cigarette smoking, policymakers are still grappling to understand the concept of e-cigarettes. E-cigarettes or Electronic Nicotine Delivery Systems (ENDS) are innovative clean nicotine delivery systems that involve no combustion and therefore produce reduced emissions and toxic byproducts by at least an order of magnitude.

World-over, ENDS are now touted as a proven tool for reducing harm caused by cigarette smoking. Undoubtedly, they also have immense potential for improving public health outcomes of a tobacco-dependent population like India’s.

The Union Ministry of Health and Family Welfare in 2018 issued an advisory to all states recommending them to prohibit the sale, manufacture or use of ENDS. Even the Indian Council of Medical Research has advocated for a pan-Indian prohibition on ENDS. This is in stark contrast to the path of comprehensive regulation adopted by countries such as the UK, New Zealand, Canada and European Union as a whole, keeping in sight the larger picture of maximizing the population-level benefits through less harmful alternatives like ENDS.

Presently, it is reported that the Government plans to amend the Drugs and Cosmetics Act, to include a ban on ENDS. This will only serve to reduce choices for smokers who want to switch to reduced harm alternatives. Moreover, the fitment under the Drugs and Cosmetics Act in itself is questionable as ENDS are clearly distinguished from therapeutic products in that they only seek to reduce harm associated with smoking and do not claim to have therapeutic value. In most countries, ENDS are treated as a separate category with its own standards and regulatory framework.

The government’s rigidity is also coupled with unfounded skepticism within the medical community with respect to ENDS. It is worrisome that sometimes prejudice and predisposition prevails over the unbiased review of the exhaustive literature on ENDS which overwhelmingly suppose the strong risk reduction associated with ENDS use as smoking substitutes. I was particularly concerned by claims from reputed doctors that ENDS are as harmful as cigarettes. Nothing could be farther from the truth and the medical community should protect its reputation and respect their ultimate duty to provide reliable and balanced information about currently available evidence on ENDS (and any other medical subject in general).

While I acknowledge that the medical community’s primary concern is the absence of long-term research on the health impacts of ENDS, it should not be a reason for present paralysis. We already have sufficient knowledge about the physical and chemical processes involved, the toxicology of emissions and biomarkers of exposure; there is no doubt that ENDS are much less harmful than smoking. This has been supported by countless leading public health institutions from across the globe.

At the same time, we do know with certainty that the incumbent product (combustible cigarette) is extremely harmful, and thus, the choice should be simple and straightforward. ENDS and their potential impact should be viewed in relation to cigarettes, and when viewed as such, it is clear that there is no sense in outlawing ENDS when cigarettes and other forms of tobacco are legally available.”

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