As noble global efforts to reduce smoking rates move into a higher gear with the fast-approaching Ninth Conference of the Parties (COP9) of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), member countries are running the risk of sacrificing the interests of smokers on the unfounded fear of an explosion in youth vaping.
Scheduled for 8-13 November 2021, COP9 will bring together governments, policymakers and anti-tobacco campaigners from across the world to discuss various ways to reduce smoking within the guidelines of the FCTC. The role of Electronic Nicotine and Non-Nicotine Delivery Systems (ENNDS) within the tobacco harm reduction agenda will also be thrust into the spotlight. Based on published Conference documentation, it is expected that youth vaping will feature prominently in the discussions.
The WHO has frequently raised concerns about the potential of ENNDS to appeal to young people and non-smokers, and act as a gateway to smoking, despite available scientific data not supporting this fear. On the contrary, emerging evidence from Canada, France, the UK and New Zealand seems to show fast declining smoking rates co-incidence with the rise in popularity of ENNDS.
According to 2020 data from Action on Smoking and Health UK (ASH), e-cigarette use remains relatively low amongst young people in the UK. The study reveals that the majority of young people had never smoked nor vaped, and that between 0.8% and 1.3% of young people who had never smoked were current vapers. According to the 2021 National Youth Tobacco Survey conducted by the United States Centre for Disease Control and Prevention (CDCP), teen use of electronic cigarettes fell sharply, marking another year of major declines. The survey, administered between 18 January and 21 May 2021, noted that 11.3% of high school students reported that they currently vape — down from 19.6% in 2020 and even lower than the 27.5% reported in 2019. Overall, the evidence seems to indicate that ENNDS use among youth may have been a passing curiosity related to risk-taking behaviour inherent in young people.
While the goal of ensuring that young people do not use ENNDS should never be abandoned, this should be balanced with the need to ensure that adult smokers are not robbed of the opportunity to access reduced-harm alternatives to combustible tobacco. Reputable institutions such as Public Health England (PHE) and the UK Royal College of Physicians have found that ENNDS are 95% less harmful than combustible smoking. ENNDS provide a breakthrough in tobacco harm reduction and to some extent, smoking cessation. The Cochrane Library found that ENNDS are a more effective smoking cessation tool than Nicotine Replacement Therapies (NRTs).
Regrettably, the overwhelming evidence in favour of ENNDS has not been enough to convince the WHO otherwise. Instead, the world body is intent on regulatory guidelines that will effectively deny smokers access to information about less harmful alternatives.
Youth vaping can be curbed through practical measures to discourage access and embark on education and awareness campaigns to teach young people about nicotine addiction and that vapes are not completely harmless, even though it is significantly less harmful compared to tobacco smoking. In South Africa, for example, the Vaping Products Association South Africa (VPASA) has taken the initiative to have its members sign a code of conduct and pledge not to sell vaping products to young people under the age of 18.
As the COP9 nears, it is important for the WHO and governments to ensure that they conduct a fair and balanced evaluation of the available evidence to support the development of appropriate ENNDS regulations. While there remains a genuine need to ensure that young people do not take up vaping, it would be a huge disservice to the WHO’s tobacco control agenda if ENNDS regulatory guidelines are developed based on ideology and instinct rather than scientific evidence. Ultimately, a non-scientific approach to regulating ENNDS will come at the expense of adult smokers looking for a less harmful alternative to smoking.