International Debate on E-cigarettes as a Smoking Cessation Tool
A global discussion is underway in Geneva concerning the potential role of e-cigarettes, also known as vapes, heated tobacco products, and nicotine pouches, in smoking cessation. Over 1,400 delegates have convened to address the World Health Organization's (WHO) Tobacco Control Treaty and strategies to combat the "tobacco epidemic." The central question is whether these alternative nicotine delivery products can aid individuals in quitting traditional cigarettes, despite their own health considerations.
Divergent Perspectives on E-cigarettes
Arguments Against Use in Cessation:
- The World Health Organization (WHO) maintains that e-cigarettes should not be promoted as a smoking cessation tool.
- Concerns include the tobacco industry's promotion and profit from these products, and the rise of nicotine addiction among young non-smokers who initiate e-cigarette use.
- WHO Director-General Tedros Adhanom Ghebreyesus stated that companies producing these products are motivated by profit, not harm reduction, and cited a lack of evidence for net public health benefit, alongside mounting evidence of harm.
- Benn McGrady, head of Public Health Law and Policies at WHO, reported e-cigarette use rates among children as nine times higher than adults, with an estimated 15 million children globally using them. The WHO advocates for regulating these products at least as strictly as conventional cigarettes.
- The International Pediatric Association published a warning in Pediatrics last month, indicating associations between e-cigarette use and cardiovascular, metabolic, respiratory, oral diseases, and cancer. They noted that "dual users" (those who use both e-cigarettes and traditional cigarettes) face greater health risks, suggesting e-cigarettes could reverse progress in tobacco control.
- Stella Bialous of the University of California, San Francisco's Center for Tobacco Control Research and Education, described non-smokers' e-cigarette use as "harm-causing." She also noted that studies on exposure to metals, such as lead, from e-cigarette heating elements have yielded varied results.
- Dr. Tim McAfee, former head of the CDC's Office on Smoking and Health, drew parallels between current e-cigarette promotion and historical tobacco industry campaigns for filtered and low-tar cigarettes.
Arguments Supporting Harm Reduction:
- A group of doctors, scientists, and public health experts propose that while e-cigarettes are not without risks, they may be less harmful than traditional cigarettes, which are known to cause death in up to half of long-term users. They suggest e-cigarettes could function as a harm reduction strategy.
- Dr. Derek Yach, who previously played a role in drafting the WHO's tobacco treaty, advocates for harm reduction. He argues that traditional cessation methods are insufficient for individuals with complex nicotine addiction. Yach highlights that e-cigarettes heat nicotine liquid into vapor, avoiding the combustion process that creates many cancer-causing agents and toxins found in traditional cigarette smoke. He believes these products should be integrated into health programs to help current smokers reduce or cease tobacco use. Yach founded the Foundation for a Smoke-Free World (now Global Action to End Smoking), which is funded by the tobacco industry.
- The U.K.'s National Health Service has adopted e-cigarettes as a method to assist people in quitting smoking.
- Mike Cummings, a professor at the Medical University of South Carolina, supports e-cigarettes as a safer alternative for individuals already addicted to nicotine from traditional cigarettes, while emphasizing they are not for non-smokers. He has reported challenges in obtaining funding for harm reduction research and professional ostracization for his views.
- Phillip Morris International stated that the WHO should engage in dialogue and consider the approaches of governments that are incorporating smoke-free products into their strategies to end smoking.
Shared Context
Both sides acknowledge the significance of this issue for global public health, given that 1.2 billion people worldwide continue to use tobacco, with approximately 80% residing in low- and middle-income countries. The WHO's report acknowledges that the full extent of risks associated with these relatively new products will become clearer over time, and that there is significant variation in risks among different products.