Written by Nicole Scholz
The World Health Organisation (WHO) recently published a report on Electronic nicotine delivery systems (ENDS) . The report, which includes a negative appraisal of e-cigarettes and cautions on their use, informed the discussions on one of the main agenda items at the sixth session of the Conference of the Parties (COP6) to the WHO Framework Convention on Tobacco Control (WHO FCTC) , held from 13‑18 October 2014 in Moscow.
The WHO report
Based on an observed increase in the use of e-cigarettes and the rapidly evolving scientific evidence, the report raises three main questions and makes proposals and specific recommendations concerning regulation.
What are the health risks of ENDS to users and non-users?
The potential risks range from eye and respiratory irritation (propylene glycol) and poisoning by ingestion or skin contact (nicotine), to the long-term effects of chronic inhalation (nicotine, propylene glycol, formaldehyde and flavourings) on brain development, which warrants special caution for children, adolescents and pregnant women, regardless of whether or not they are actively or passively e-smoking.
How efficient are they in helping smokers quit?
As the limited evidence available to date suggests, ENDS lead to a reduction in the number of cigarettes smoked rather than a complete cessation of smoking. The result is predominantly a dual use (of conventional cigarettes and e-cigarettes) that has less health benefits than stopping smoking altogether.
What impact do they have on existing tobacco-control efforts?
There is a growing public health dispute on this point. While some experts have welcomed them as a useful cessation aid, others have argued that they could interfere with efforts to ‘de-normalise’ smoking. They have challenged the main message of tobacco control (i.e. smoking should not be started or, if started, should be stopped) and could undermine smoke-free policies since their use is allowed in places where smoking conventional cigarettes is not. Various appealing flavours might also entice young people to experiment with them.
The COP6 discussions
The discussions relating to the WHO report led to the drafting and final adoption of the decision on Electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS and ENNDS – the latter were added in the course of the debate). The participants thus followed the recommendations set out in the report by acknowledging the need for regulations in line with those for other tobacco products. Specifically, the decision invites parties to:
- prevent non-smokers and youths in particular from being encouraged to use ENDS/ENNDS;
- minimise their potential health risks to users and protect non-users from their emissions;
- prevent unproven health claims about them;
- monitor their use;
- protect tobacco-control activities from the influence of commercial and other interests, including those of the tobacco industry.
Parties are urged to consider banning or restricting promotion, advertising and sponsoring of these devices. As a follow-up, WHO is to prepare an update report for the seventh session of the COP expected to take place in the last quarter of 2016 or first quarter of 2017.