34th Anniv Suppl

E-cigs seen as less harmful relative to cigarettes—WHO representative

A representative of the World Health Organization who attended a congressional hearing in the Philippines acknowledged that electronic cigarettes are less harmful than cigarettes. 

Dr. Ranti Fayokun, a scientist in the National Capacity-Tobacco Control Prevention of Non-Communicable Diseases, made the comment in response to a question from a Filipino congressman during the hearing on vaping regulation conducted by the House of Representatives in December last year.

Fayokun’s admission was made amid the organization’s cautious stand on e-cigarettes despite the mounting scientific evidence that they are less harmful than traditional cigarettes.  

Public Health England has always maintained that e-cigarettes are 95-percent less harmful than tobacco and has encouraged smokers who could not quit smoking to switch to the less harmful alternative. 

The National Academies of Sciences, Engineering and Medicine in 2018 released a report stating that “completely switching from cigarettes to e-cigarettes will reduce exposure to numerous toxicants and carcinogens found in cigarettes”. 

“They [World Health Organization) are saying if you are a country that cannot produce regulation and cannot enforce regulation, you must ban. That, to me, is a contradiction. A country cannot regulate perfectly, but the last thing it should do is ban because the black market will proliferate. This is an issue that is extremely important to children.  If we ban things, if we do not regulate things, we create a black market that does not care about children, that does not care about elderly people, that does not care about us at all,” Dr. Andrew da Roza, an addiction psychotherapist and lawyer said in the congressional hearing. 

A ban on electronic cigarettes and heat-no-burn tobacco products will only create a black market that will be disastrous to public health, according to international public health experts who attended the hearing. 

“If you ban them, there will simply be a black market. When the United States banned alcohol in the 1900s, that did not work out,” said da Roza. 

Rep. Weslie Gatchalian, chairman of the House committee on trade, said the hearing was called because “the use of ENDS and heated tobacco products is now a national concern, so much so that the President [Rodrigo Duterte] recently issued a directive banning the importation and use of ENDS and HTPs in public spaces. “

“This committee respects the directive of the president, and sees this as an opportunity for the Philippines to finally regulate this innovative device,” Gatchalian said earlier.

Da Roza, who holds a Master’s degree in counseling from Monash University in Australia, said e-cigarettes, heat-not-burn tobacco products and other electronic nicotine delivery systems proved effective in getting smokers away from cigarette smoking which is extremely addictive and powerful.

“E-cigarettes are twice as effective as NRTs [nicotine replacement therapies],” he said.

“New technologies give public health policy a unique opportunity to eliminate cigarettes in a single generation. I truly believe that. We can have a smoke-free world if we use these heat-not-burn products and if we use these e-cigarette products,” said Da Roza.

He said that instead of a ban, the government should support and incentivize safer technologies that would encourage people away from the scourge of cigarette smoking.

“Any regulation that slows down the developments in science means the people of the Philippines will not benefit from safer products. The government, in my humble opinion, should be investing in research on e-cigarettes and heat-not-burn products,” da Roza said.

World-renowned e-cigarette research expert Dr. Konstantinos Farsalinos, a Greek cardiologist, said in the same hearing that e-cigarettes are 95-percent less harmful than combustible cigarettes, as attested by Public Health England, a health authority in the UK which has one of the most advanced regulations on these new technologies.

Da Roza agreed, saying e-cigarettes proliferate because they are attractive to smokers.  “We need to regulate them, not ban them,” he said.

“The health of the nation is at stake, and I believe there is an urgent need to follow the UK model of regulation. It is a working model, and it is extremely successful,” he said.

Da Roza said cigarettes are extraordinarily addictive as smokers use them regularly on a daily basis.  “It has a very powerful effect on the brain. If you are feeling depressed, smoking will lift your depression. If you are feeling anxious, smoking will calm you down. If you are feeling sleepy, smoking will pick you up,” he said.

“People are genetically geared to be vulnerable to enjoy smoking and to be tolerant to nicotine. They are sold to children in single cigarettes in the Philippines. They are horrible. They are available and cheap enough and all children know about it,” he said.

Da Roza said that while NRTs deliver nicotine in a safer way, they are not as effective as e-cigarettes in making people quit smoking.  “NRTs vs. e-cigarettes show that e-cigarettes are twice as effective as NRTs. This really understates the value. That huge difference is rarely seen in sales of cigarettes,” he said.

He cited the case of Japan, a nation of heavy smokers. “When heat-not-burn products entered Japan, in three years, 30 percent less cigarettes were bought. That’s how attractive these products are. That is a worldwide success story of historical proportions,” Da Roza said.

Da Roza said NRTs are less effective because they do not substitute for the sensation in the mouth of smokers. “It does not substitute for cigarettes. It does not substitute for the social life. It is really no substitute. However, heath-not-burn products and e-cigarettes are substitutes because of the social life wrapped around it, except that they are so much healthier,” he said.

He said that to become an effective tool in harm reduction, e-cigarettes and heat-not-burn tobacco products “should be more accessible to smokers than cigarettes at a price point equal to or less than cigarettes.” 

“Because we want smokers to switch and because smokers in the Philippines tend to come from lower socioeconomic levels, from people with mental illnesses, from people with addictions, these prices are extremely important to the Philippines. The lower the price, the more success you will have in smoking cessation. You can have a zero smoking nation,” he said.

“They should not be regulated in the same way as cigarettes,” Da Roza said. “E-cigarettes are a net benefit to public health. They should not attract sin tax. It is quite the reverse. They should attract government subsidy because they are net benefit to public health”.

Da Roza described ENDS as a “leapfrog technology,” which does not require governments to spend millions and millions of pesos in discovering new solutions.

“The Philippines must take up this sword. Banish cigarettes for the sake of our children, for the sake of our elderly and for the sake of everyone who smokes,” said Da Roza.  He said the government should instead get behind scientific studies for the development of e-cigarettes.

Topics: World Health Organization , Ranti Fayokun , e-cigarettes
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