Context: The Indian Council of Medical Research (ICMR) has recommended ‘complete’ ban on Electronic Nicotine Delivery Systems (ENDS), including e-cigarettes. The recommendation is based on currently available scientific evidence.

Why ICMR has recommended a complete ban?

• Addictive in nature: e-cigarettes and other such devices contained not only nicotine solution, that was highly addictive, but also harmful ingredients like flavoring agents and vaporisers. Availability of flavour variants and attractive designs are adding to allure of devices, and globally there was an increasing trend of e-cigarettes consumption among youth and adolescents.
• Use of ENDS or e-cigarettes can open a gateway for new tobacco addiction among the masses as on the balance, these have a negative impact on public health.
• Prolonged use of ENDS or e-cigarettes has documented adverse impact on humans which includes DNA damage, respiratory/cardiovascular/ neurological Disorders, carcinogenic/cellular/molecular/immunological Toxicity and even have adverse effects on fetal development and pregnancy.
• Research has found that youths using e-cigarettes (or other such devices) are more likely to use regular cigarettes in later period. The exposure to ENDS increases the likelihood to experiment with regular products and increase intention to indulge in cigarette smoking.

What are e-cigarettes? 

• An electronic cigarette (or e-cig) is a battery-powered vaporizer that mimics tobacco smoking. It works by heating up a nicotine liquid, called “juice.”
• Nicotine juice (or e-juice) comes in various flavors and nicotine levels. e-liquid is composed of five ingredients: vegetable glycerin (a material used in all types of food and personal care products, like toothpaste) and propylene glycol (a solvent most commonly used in fog machines.) propylene glycol is the ingredient that produces thicker clouds of vapor.
• Proponents of e-cigs argue that the practice is healthier than traditional cigarettes because users are only inhaling water vapor and nicotine.

Why its hard to regulate them? 

As e-cigarettes contain nicotine and not tobacco, they do not fall within the ambit of the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA), which mandates stringent health warnings on the packaging and advertisements of tobacco products.

Need for regulation: The current unregulated sale of e-cigarettes is dangerous for a country like India where the number of smokers is on the decline (WHO Global Report, 2015) as it increases the possibility of e-cigarettes becoming a gateway for smoking by inducing nicotine addiction and perpetuating smoking by making it more attractive, thereby encouraging persons to become users of tobacco as well as e-cigarettes.

WHO report on e- cigarettes and effects:

• As per the report, Electronic Nicotine Delivery Systems (ENDS) (also known as e-cigarettes) emits nicotine, the addictive component of tobacco products. In addition to dependence, nicotine can have adverse effects on the development of the foetus during pregnancy and may contribute to cardiovascular disease.
• The WHO report further says that although nicotine itself is not a carcinogen, it may function as a “tumour promoter” and seems to be involved in the biology of malignant disease, as well as of neurodegeneration.
• Foetal and adolescent nicotine exposure may have long-term consequences for brain development, potentially leading to learning and anxiety disorders.
• The evidence is sufficient to warn children and adolescents, pregnant women, and women of reproductive age against ENDS use and nicotine.