International harm reduction experts urge government to rethink proposed vape ban

A group of international tobacco harm reduction advocates has asked Bangladesh authorities to reconsider its proposed prohibition of electronic nicotine delivery systems (ENDS) and other smokefree nicotine alternatives in a letter addressed to the Ministry of Health. 

The letter states that smoke-free nicotine products have the potential to drive out smoking, and urges the Bangladesh government to prohibit less harmful alternatives to cigarettes. reads a press release.

"The Bangladesh government should support smokers by encouraging a mass switch from high-risk cigarettes to low-risk ENDS and accelerating the end of the epidemic of smoking-related disease," it reads. 

The Bangladesh authorities should establish evidence-based tobacco control and harm reduction policies, which would "deliver net public health benefit", the letter said. 

The letter is a response to a recent proposed amendment to the Smoking and Using of Tobacco Products (Control) Act, 2005 (Amended in 2013) that includes a new "Prohibition on Electronic Nicotine Delivery System". 

Electronic Nicotine Delivery System includes e-cigarettes or vapes, among other less harmful tobacco alternatives like nicotine pouches. 

The authors of the letter believe that the impact of the proposed prohibition "has the unintended effect of protecting the cigarette trade and incumbent business interests of the major tobacco companies – even though these companies are trying to switch to marketing lower risk products." 

The letter requests the Bangladesh government to "embrace tobacco harm reduction in Bangladesh's approach to tobacco control", saying that it "would meet the demands of people who cannot or do not wish to quit completely."  

The authors warn that "prohibition or excessive regulation of ENDS without considering the effects on smoking could easily lead to a net increase in harm to public health by "perpetuating smoking" or stimulating black market activity."

The letter calls on the government authorities to adopt a risk-proportionate approach to regulation and use of ENDS to address the health problems caused by cigarettes.

"ENDS should be used to drive down smoking, the dominant form of tobacco use in Bangladesh. ENDS should be seen as an opportunity, not a risk," it read. 

The letter also presents several pieces of scientific evidence that suggest e-cigarettes or vaping is much less harmful than cigarette smoking. 

"In 2018, independent experts for Public Health England reviewed the biomarker data and concluded… Vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits… Based on current knowledge, stating that vaping is at least 95% less harmful than smoking remains a good way to communicate the large difference in relative risk unambiguously so that more smokers are encouraged to make the switch from smoking to vaping," the letter cites. 

Urging Bangladesh to move toward a risk-proportionate regulation, the letter says that the primary goal of the country's tobacco policy should be to prevent and control tobacco-related excess mortality and morbidity.

Instead of prohibition, a new regulatory regime could specify age restrictions, product standards, labelling, marketing and use restrictions as appropriate. There is an opportunity for Bangladesh to gain from experience in the United Kingdom, European Union and elsewhere, where there are many valuable lessons to learn, the letter suggested.

The experts emphasised that in a risk-proportionate approach, the highest risk products face the most stringent regulation, and low-risk alternatives face fewer and lighter restrictions. 

Prohibitions are the worst possible policy option, which denies law-abiding smokers much safer options, creates black markets, increases criminality and corruption, ultimately creating new burdens on law enforcement. 

ENDS should be used to drive down smoking, the dominant form of tobacco use in Bangladesh. ENDS should be seen as an opportunity, not a risk, the letter said. 

The 17 signatories to the letter includes Dr Delon Human, who was a former adviser to WHO Director-Generals and UN Secretary-General Ban Ki Moon. 

Other signatories include Swedish academic and president of European Red Cross/Red Crescent Network on HIV/AIDS and Tuberculosis, Dr Andres Milton; New Zealand public health professor Marewa Glover; Professor of Social Scientific Addiction Research at the Frankfurt University of Applied Sciences in Germany, Heino Stöver, among others.