Four Truths About E-cigarettes: Should They Be “Sentenced to Death”?

Since the emergence of suspected fatal cases related to vaping in the United States, a wave of attacks on this new phenomenon has spread. On September 24, topics such as #Global Crackdown on E-cigarettes# and #National Standards for E-cigarettes Coming Soon# appeared simultaneously on Weibo. As a media platform that connects all circles and has the greatest influence in China, the attention on Weibo has always represented the pulse of public opinion.

The public opinion is completely one-sided. It seems that if you don’t jump in to criticize, your values are incorrect—extreme remarks such as "capital is like a bloodthirsty fly, targeting e-cigarettes" and "e-cigarettes get out of China" have emerged.

So, should e-cigarettes really be sentenced to death?

01 What exactly happened with the "American incident"?

Over 530 cases have been reported, with 8 deaths, and this is the truth—its source comes from local media reports in the United States. In response, the U.S. health department plans to stop the sale of all flavored e-cigarettes (mainly including fruit and cream flavors), and Walmart has begun to stop selling e-cigarettes.

However, the FDA (U.S. Food and Drug Administration) has not yet provided a final conclusion on the cause of death. The FDA is one of the executive agencies established by the U.S. government within the Department of Health and Human Services and the Department of Public Health. As a scientific management agency, the FDA's responsibility is to ensure the safety of food, cosmetics, drugs, biological products, medical devices, and radiological products produced or imported in the United States. It is one of the earliest federal agencies focused on protecting consumers, closely related to the lives of every American citizen.

The preliminary investigation by this authoritative agency shows that in the first six complaints related to e-cigarettes, five involved users of illegally purchased e-cigarette products. In the remaining case, the e-liquid was purchased by the user from a legal cannabis store in Oregon.

"These individuals purchased or made illegal e-liquids on the street, most of which contained cannabis components, such as THC (tetrahydrocannabinol). These products come from the black market and are completely different from e-cigarettes purchased through legitimate channels," said Martin Dockrell, head of tobacco control at the UK Public Health Department.

On the evening of September 13, U.S. President Trump tweeted: "I prefer vaping e-cigarettes to replace traditional cigarettes, but we need to ensure that this alternative is safe for everyone. Let’s clear the market of inferior products and keep our children away from e-cigarettes!"

Industry insiders analyze that President Trump's sudden reversal on the e-cigarette industry indicates that the U.S. government has set aside individual and emotional factors and is now considering the regulatory development of the industry from a broader perspective. This includes restrictions on flavored e-cigarettes that attract young users and control over sales channels—the key is how to ensure that young people are not attracted to e-cigarettes.

02 Global Crackdown on E-cigarettes?

On September 18, the Indian finance minister announced a complete ban on e-cigarettes in the country. This ban is very strict, prohibiting all activities related to e-cigarettes, including production, manufacturing, import and export, advertising, etc. Currently, this decree is awaiting parliamentary approval in November.

This is the most severe national-level ban in the current wave of opposition to e-cigarettes.

At the same time, the UK government supports e-cigarettes. All e-cigarette products in the UK are subject to strict quality and safety regulations by the Medicines and Healthcare products Regulatory Agency, which encourages e-cigarette users to report any adverse reactions.

"So far, there is no evidence that vaping e-cigarettes harms those around you. Existing evidence suggests that the risks of harm from e-cigarettes are extremely low, even compared to secondhand smoke," stated the UK National Health Service. Regarding future tobacco control efforts, both the UK National Health Service and the UK Public Health Department support the use of e-cigarettes instead of traditional cigarettes. In 2018, the UK Public Health Department recommended that hospitals sell e-cigarettes and provide e-cigarette lounges for patients to encourage people to switch from traditional tobacco to e-cigarettes.

On August 29, a research group from Tsinghua University released China's first blue paper on e-cigarette regulation. The report outlines the global regulatory situation for e-cigarettes, categorizing them into three types: as ordinary consumer goods, as traditional tobacco, and as pharmaceutical products, as shown in the following image:
 
Industry insiders generally believe that the reason why e-cigarettes in the UK and other EU countries have not encountered problems is due to the implementation of strict standards, such as nicotine content, concentration, and raw material quality. In contrast, the U.S. only requires manufacturers to disclose ingredients and safety certifications, and in fact, there are no unified standards—especially regarding "ingredients."

03 National Standards for E-cigarettes Coming Soon?

Yesterday, media reported that China's national standards for e-cigarettes are about to be released, citing screenshots from the "National Standard Information Public Service Platform" stating that "they should be released in October 2019."

In fact, this is just a "standard plan," and the release of the standards is still a different matter. More accurate information from official sources indicates that the standards may be released around New Year's Day 2020, unless there are very special circumstances.

For traditional tobacco, sales and regulation are managed by the China Tobacco Company and the Tobacco Monopoly Bureau—these two agencies are two brands with one set of personnel. The Tobacco Monopoly Bureau is under the Ministry of Industry and Information Technology, but its funding comes from the Ministry of Finance. The department responsible for tobacco control is the National Health Commission.

Multiple management agencies make coordination essential for policy implementation. However, from the perspective of the long-term development of the industry, regulation and standards are indispensable, especially for controlling product quality and sales channels. Currently, the domestic e-cigarette market in China is in a disordered state, with some leading companies striving to explore standards, while others, referred to as "wild chicken companies," operate with the mindset of making a quick profit, leading to unguaranteed product quality. There is a saying in the industry that you can invest in an e-cigarette company for 3 to 5 million, which is actually a very bad phenomenon.

The blue paper on e-cigarettes released by Tsinghua University strongly recommends the implementation of industry legislation and regulatory systems. The core issue is the protection of minors.

Industry insiders suggest that before the national standards are released, e-cigarette companies should take several actions:

1. There should be a clear label on the packaging stating that individuals under 18 years of age are prohibited from using the product.

2. Similar to cigarettes, offline channels should strictly prohibit sales to minors. In particular, no promotions should be made in primary, middle, high schools, or other places frequented by minors. If using vending machines, there must be an ID verification or facial recognition system.

3. No outdoor or media advertising for e-cigarettes.

4. In terms of product quality, EU standards can serve as an important reference. Additionally, no harmful ingredients—such as vitamin E—should be added.

04 What is the health impact of e-cigarettes?

Objectively speaking, there is currently no clear conclusion regarding the fatal cases in the U.S. Whether e-cigarettes are the cause or if components like cannabis are responsible is still under investigation by the FDA. Because the FDA is a very rigorous agency, such investigations may take a long time to conclude.

Therefore, the restrictions on e-cigarettes in the U.S. mainly focus on flavored varieties that affect youth, and policies vary from state to state.

Currently, the most authoritative conclusions regarding the impact of e-cigarettes on human health still come from the World Health Organization's report from July this year.

In 2014, the World Health Organization compiled existing research and expert opinions and submitted a report to the sixth session of the Conference of the Parties to the Tobacco Control Convention, summarizing the debates and limited evidence regarding e-cigarettes in the academic field. Five years later, the WHO's 2019 Global Tobacco Epidemic Report still retains many conclusions from the 2014 report, and the limited evidence has not improved. The study pointed out that compared to traditional cigarettes, the harm caused by e-cigarettes is smaller, and if established smokers can switch to well-regulated e-cigarettes, their toxic exposure may be reduced, but they are not harmless.