WHO calls for greater regulation of e-cigarettes to protect young people

In a report released on Tuesday, the WHO branded e-cigarettes and other similar devices as “harmful” and called on governments to introduce better regulations, saying such products were often marketed to children and adolescents.

Some 5.3 billion are now covered by at least one of the WHO’s recommended tobacco control measures, which include enforcing bans on tobacco advertising and raising taxes – yet a whopping one billion people worldwide still smoke.

Still, in the last decade the popularity of traditional cigarettes has declined, whilst the use of electronic cigarettes and heated tobacco products has steadily risen, particularly amongst teenagers.

According to the WHO’s 2021 tobacco epidemic report, electronic nicotine delivery systems (ENDS) are “promoted aggressively as ‘safer’ or ‘smoke-free” alternatives to conventional cigarettes and often evade regulations.

"Nicotine is highly addictive, and electronic nicotine inhalers are just as dangerous, so their use should be better regulated," said Tedros Adhanom Ghebreyesus, head of the WHO.

Marketing techniques as old as time. Although the alleged harm of “e-cigs” continues to be debated, the WHO has been more direct in its approach, branding them as harmful whilst calling out tobacco industries for using the “same old marketing tactics to promote new tools to hook children on nicotine and circumvent tobacco legislation”.

Dr Rudiger Krech, responsible for the health promotion department the WHO said the thousands of flavours on offer – from bubble gum to vanilla ice cream –  are a big factor for getting younger generations hooked.

“I think [these flavours] speak more to my grandchildren than to me. And we know very well that children are two to three times more likely to become smokers when they consume these products,” he said.

Between 2014 and 2019, global sales of e-cigarettes and e-liquids rose from around $2.8bn to $15bn. Regulating this domain is not an easy feat as the variety of the product evolves very quickly, Krech explained. “This is one of the ways manufacturers use to undermine regulations. and control measures," he added.

So far, 79 countries have adopted measures to regulate the use of electronic cigarettes and 32 have completely banned the sale of them. At the same time, the WHO points out that as many as 84 countries do not have regulations that would prevent the sale of these products.

Switzerland, one of the 84 countries lacking regulation. In 2004, Switzerland signed the WHO Framework Convention on Tobacco Control, but is part of the handful of countries yet to ratify it. In 2017, almost a third of Switzerland’s 8.5 million population smoked, of which 31.7 per cent were between the ages of 15 and 24.

Speaking to Markus Meury from Lausanne-based Addiction Suisse, he tells Geneva Solutions that apart from Germany, Switzerland has the worst record for tobacco control measures in Europe.

“One reason for this is that ‘big tobacco’ have their headquarters here and have a huge influence on policy because they finance political parties,” he said.

When it comes to ENDS, so far there are only cantonal rules, rather than federal laws. Still more and more cantons are adopting policies to ban the sale of these products to those under 18, in addition to the new tobacco law being negotiated, which “could take years to put into force.”

According to Meury, in 2017 only two to three per cent of the population used ENDS, however this has increased significantly in the last few years, after popular brands like Juul “boomed” in Swiss schools.

“From our research in Switzerland, we know that the nicotine industry very closely follows young generations encouraging them to smoke or vape, since it is unlikely for people to start smoking after the age of 21,” he said.

Controlling tobacco use to protect the population’s health has been a long, complicated relationship, housing tobacco giants like US-Swiss Philip Morris International (PMI).

The company has been accused of preventing countries from adopting policies to curb the use of ENDS.  “PMI spent billions of dollars on developing IQOS [A heated tobacco product], whilst trying to overrule cantonal bans on the use of ENDS in restaurants,” Meury said.

Switzerland has also battled with its economic identity and freedoms when it comes to regulating tobacco companies, ensuring that these industries “pay very low taxes, whilst gaining high profits,” he added.

The WHO report also comes at a time where PMI has said they plan to stop selling their famed Marlboro cigarettes and associated tobacco products in the UK over the next ten years.

But this move is to promote smoke-free alternatives, where recently the organisation said they wanted half of their turnover to come from these as part of their “evolution into expanded health and wellness.”

Groups opposed including the WHO have said this move undermines the progress made in controlling the “deadly products.”

Aerosols inhaled from the heated liquids in e-cigarettes contain toxic substances that can cause cancer, cardiovascular diseases and damage to children’s brain development according to the WHO. Tobacco use is also responsible for killing an estimated eight million people, including one million from second-hand smoke each year.

“If companies like PMI were honest about banning cigarettes, they would stop pushing sales to young people in Africa, Asia and Latin America,” Meury explained.

“The long-term effect of ENDS will only be known in 20 years. But by not consuming nicotine products is the only way to make a big difference. The nicotine industry is not interested in people quitting nicotine consumption, this stimulant drug is as addictive as heroin, and these companies are interested in keeping people addicted.”