“We are not smokers.”
Vapers and tobacco harm reduction advocates delivered this message in a gathering in Makati City on Feb. 28 to launch the Asia-wide education and information campaign #SmokeFree4Life that urges the World Health Organization and the Department of Health to respect the rights of consumers of smoke-free alternatives to combustible cigarettes.
The regional movement, spearheaded by the Coalition of Asia Pacific Tobacco Harm Reduction Advocates, was launched in the Philippines on the same day the government announced President Rodrigo Duterte’s issuance of Executive No. 106 that regulates vaping in the same category as smoking.
“As consumers, we hate the idea that smoking is categorized along with vaping because there is a huge difference between the two. Filipinos have to understand that vaping is so much different from smoking combustible cigarettes,” says Clarisse Virgino, the Philippine representative to CAPHRA.
EO 106 formally grouped electronic nicotine/non-nicotine delivery systems and heated tobacco products together with cigarettes. This means that they will be held to similar standards. The EO regulates the use, manufacture, distribution, marketing and sale of ENDS/ENNDS, HTPs and other novel tobacco products and requires the registration of such products and components with the Food and Drug Administration.
The FDA says e-cigarette manufacturers and vendors need to be enrolled in a “notification scheme” for traceability.
Under the EO, the minimum age to access both tobacco cigarettes and e-cigarettes was raised to 21 from 18. It prohibits cigarette smoking and vaping in public and enclosed areas such as schools, lifts and stairwells, fire hazard locations and medical facilities.
Designated smoking areas were expanded to allow vaping as well, making them designated smoking/vaping areas. “No Smoking” signages now include vaping.
Vaping may be allowed in a building or conveyance, which may either be an open space or separate area with proper ventilation but minors are prohibited from entering the designated vaping area.
It also imposes a general ban on advertising and promotion of ENDS/ENNDS and HTPs. The EO prohibits those younger than 21 from using, lighting up, selling, distributing, promoting or delivering e-cigarettes.
Health Secretary Francisco Duque describes the signing of the EO as a “solid step forward to compel the industry to comply with our regulations, which are specifically aimed at protecting children from nicotine addiction.”
Virgino, a law student, says she welcomes the regulation of smoke-free alternatives such as electronic cigarettes, heat-not-burn tobacco and snus as long as it is fair. “We also respect that some people are not vaping, so we are okay with designating vaping areas. But based on my friends’ concerns, some areas for smoking appear like a pig pen that is degrading not only as a vaper, but also as a person,” she says.
“We’d like to enlighten the people about the benefits of e-cigarettes, heat-not-burn tobacco or snus as safer alternatives to cigarette smoking,” says Virgino. “We are okay with regulation as long as it is fair. Consumer rights are also human rights.”
Vapers PH, a nationwide consumer advocacy group, with the support of Vaper Ako and CAPHRA, organized an event called “AscENDS: Standing Up for Our Rights to Choose Electronic Nicotine Delivery System or ENDS” on the same day.
The event was held to drum up support for smoke-free alternatives ahead of the 9th Session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control which will be held in the Netherlands in November 2020.
“We, vapers and former smokers, and advocates of tobacco harm reduction, have an opportunity to add to the global discussions on ENDS, heat-not-burn tobacco products and snus as much safer alternatives to combustible cigarettes. We stand up for our freedom of choice. We stand up for our rights as consumers,” says Virgino.
“We stand up for the well-being of more than a billion cigarette smokers globally who are now presented with better and innovative nicotine products. We are here united and collectively call on WHO and other health authorities to start caring for them by allowing them access to safer alternatives that they want and deserve,” Virgino says in her speech during the launch of #SmokeFree4Life in Poblacion, Makati.
Virgino also addressed the questions on the safety of vaping or the use of e-cigarettes, because of the e-cigarette or vaping-associated lung injury cases in the US. She says EVALI cases were eventually linked to the use of vitamin E acetate and tetrahydrocannabinol or THC oil—the same substance in marijuana. The US Center for Disease Control and Prevention, as earlier reported by the US FDA, concluded that vitamin E acetate, used as a thickening agent for THC—the principal psychoactive constituent of cannabis, was “a very strong culprit of concern” in EVALI cases.
“Those substances were not supposed to be there in the first place. This is why we need regulation to prevent people from taking these substances,” says Virgino.
She says Public Health England’s annual reviews of all available evidence have consistently concluded that e-cigarettes are around 95-percent less harmful than smoking.
Virgino expresses hope that the education and information campaign about the benefits of ENDS or electronic cigarettes, heat-not-burn tobacco products, snus and other smoke-free nicotine products will gather the needed support ahead of the 9th COP to the WHO FCTC.
The regular sessions of the Conference of the Parties are held every two years. The WHO has asked every signatory country to the treaty to submit a summary of its position on ENDS preparatory to FCTC CoP9. The Philippines is among the 181 signatories to the WHO FCTC.
Peter Paul Dator, president of Vapers PH, says WHO continues to insist on the quit-or-die approach “which we all know is ineffective against smoking as WHO’s own data show that there are still 1.1 billion smokers globally, resulting in 8-million deaths due to smoking-related illnesses annually”.
About 80 percent of the 1.1 billion smokers in the world live in low- and middle-income countries like the Philippines. In the Asia-Pacific region, smoking causes a million deaths a year, says Dator. “Because of WHO’s unsympathetic position, smokers in many countries are highly vulnerable to stick with smoking until they die. In the Philippines, more than 100,000 Filipinos reportedly die each year from smoking-related diseases, such as lung cancer and heart failure, according to WHO,” he says.
“Data from the Department of Health and the Philippines Statistics Authority show that there are 15.9 million smokers in the Philippines, representing 14.7 percent of the population. Nearly 12 million or 76 percent of these smokers are interested or plan to quit smoking tobacco. Yet, WHO deprives them of the most effective option to make the switch,” he says.
“We believe that e-cigarettes and other smoke-free alternatives such as snus and heat-not-burn tobacco products which offer the same pleasure as cigarettes can help smokers quit smoking,” says Dator.
President Duterte earlier signed Republic Act No. 11467 to amend the Sin Tax Law and further increase the excise taxes on alcohol, heated tobacco, and vapor products. Dator says this legitimizes smoke-free alternatives as commodities in the Philippines.
CAPHRA executive director Nancy Loucas, however, says it is important to separate vaping from smoking, as cigarette smoking causes a million deaths per year in the Asia Pacific region, with smoke from combustion as the main culprit.
“We all know, from years of messaging and public service announcements, as well as from personal experience, that the use of combustible tobacco has killed millions and millions of people over the last 50 years. We also know, from science, that it is the smoke that kills the users of combustible tobacco, not the nicotine. We know that nicotine is no more harmful to adult humans than caffeine, and science has recently shown that nicotine can actually benefit adults with cognitive disabilities,” Loucas says.
“However, in spite of the science around nicotine and the various alternate consumption methods therein, there are those in positions of influence who would have the world believe that the use of alternative forms of nicotine is just as deadly and harmful as lighting up a cigarette,” she says, referring to global bodies such as WHO.
Loucas criticizes WHO FCTC’s lack of engagement with the major stakeholders, the public, as they are mandated to do. She says WHO also ignored a letter sent to them in October 2018 by 72 tobacco harm scientific experts who stated that, “it is time for tobacco control to embrace tobacco harm reduction”.
She says that as the FCTC has a mandate to pursue “harm reduction” as a core tobacco control policy, it has failed to acknowledge or implement this policy over the last 18 years. It has effectively deprived smokers of an effective way out of smoking, she says.
Loucas says this should not be the case as WHO FCTC is a non-governmental organization that is not eligible for public funding directly from any sovereign nation and therefore relies on private donations from anti-vaping groups such as the foundations/private trusts of Michael Bloomberg and Bill and Melissa Gates.
“We want you to understand that the WHO cannot compel or force a signatory to comply with their advice or guidelines, as they have no authority over sovereign nations’ legal systems,” she says.
Loucas asks local health authorities such as the DOH to bring up to FCTC-CoP9 discussion the consumers’ rights to choose less harmful products as a way to protect themselves from cigarette smoke.
Virgino says it is the reason they are launching the information campaign. “We are standing for our rights to be heard and included in the WHO discussion. We also want WHO to look at the science again and not ignore them, instead of resorting to moralistic approach, regarding ENDS and other alternative nicotine products which we consider to be the most revolutionary products in harm reduction. If we allow digital technologies to disrupt industries, why cannot we allow electronic innovation to improve public health?” she says.
“We want to inform the public as well as our government officials, including the DOH Secretary that we want to be heard. We say ‘No’ to smoking. We say ‘No’ to ban on vaping. We say ‘Yes’ to public health. We say ‘Yes’ to safer smoke-free nicotine products. We also say ‘Yes’ to regulation with representation,” Virgino says.