Regulations, research, health impact, success stories, sales, taxes, packaging. All of these topics were addressed at a recent e-cigarette congress in London. British doctors, researchers, teachers and civil servants shared their views on these controversial devices.
The debate comes at a pivotal moment in Argentina. The departing government on December 10 banned the electronic cigarette. This means that it directly impeded its regulation. Javier Milei's stance on the issue is still unknown, but some actors are seeing a new opportunity in the change of command and the possibility of a bill moving forward.
On the one hand, there are those who promote the e-cigarette as a way to quit smoking; the previous step to abandon the traditional tobacco cigarette. The British state considers this technology as one of the fundamental tools – among many others – to achieve its goal of reaching "smoke free" standards by 2030, that is, that less than 5% of its population smokes; a target that they will not reach (they will be around 8% by that year), as Sweden did, considered the first tobacco-free country.
On the other hand, there are those who believe that there are still no robust studies that demonstrate safety for people's health over time. In fact, these days, the Costa Rican Ministry of Health confirmed the first case of death from vaping in its territory; An adolescent boy diagnosed with severe pulmonary syndrome. The use of these devices is allowed in that country, but the sale to minors is prohibited.
The World Health Organization (WHO) considers them harmful, understands that they are unsafe and even that, in the future, they may double the chances of smoking traditional cigarettes among young people. For this reason, the organization recommends that countries regulate and control it. Currently, there are 30 countries that prohibit it, almost 80 that regulate it, and another 80 that do neither.
Proponents of the e-cigarette see it as a tool to curb smoking. Photo: Shutterstock.
Regulated or not, they are already found all over the world, their use is growing, especially among young consumers; And tobacco companies turn their research and their business, of course, to these devices.
Two of the companies operating in Argentina – both international – want their use to be regulated and for the National Administration of Medicines, Food and Medical Technology (ANMAT) to exercise control over the quality of the products.
The current ban in Argentina includes everything related to these devices – both electronic cigarettes and vapes – they cannot be imported, distributed, marketed or promoted. In 2011, the ban was imposed on e-cigarettes and in March, on tobacco heaters. "Not harmless", this is how the Ministry of Health of the Nation considers it.
On the other hand, there are local NGOs that promote the use of these devices and encourage their regulation as a "tobacco harm reduction" (THR) option and as a public health strategy. At the legislative level, Congressman Ricardo López Murphy (of the United Republicans) presented the bill that goes in the same direction.
In an interview with Clarín, López Murphy said that the change in management could encourage the project to move forward in the precinct: "I understand that it is a controversial issue and so far I have not been received with this project. I believe that we will now have a more level playing field for the debate. Prohibition is the worst option and also removes the authorities from a role they should exercise, which is the control of the devices," he said.
The lack of regulation means that there is a lack of control among people who still use electronic cigarettes. Photo: Shutterstock
"The bill is not new, it is what is already being implemented in the most advanced countries in the world, such as the regulations that Europe has, for example. It is to offer the smoker a tool, an intermediate step, on the path that leads him to quit smoking," he explained. According to him, the project should be able to be integrated with the country's existing anti-smoking health policy, i.e. it should be part of the whole.
BAT (British American Tobacco) also understands that this change in management can be an opportunity to achieve regulation. While the company had held meetings with outgoing government officials, there was no progress on this issue. "The ban is the worst-case scenario, because people use these devices anyway, but they do so without any health control and without quality traceability," they explained to this media.
In countries where they are permitted, BAT markets a vape pen (Vuse) that is the best-selling vape in the world.
Going back to the beginning, the place where this electronic cigarette congress was held could not have been more eloquent about what the State's promotion of the use of these devices as an objective to reduce cigarette consumption implies: the Royal College of Physicians, founded by King Henry VIII in 1518.
One of the debates was about consumption among young people. In this sense, in advanced regulations, what to do with packaging and flavors is already being debated. Specialists understand that colors, attractive designs, and tastes (fruity, for example) encourage its use. For this reason, in the future it is envisaged that it will be possible to move towards a limitation: that they contain neutral flavours (i.e. the taste of the cigarette and, at most, mint) and neutral colours (grey wrappers, for example).
Research is still weak
Some of the participants brought the discussion to an issue of general concern: the extent of studies. Peter Hajek (from the Wolfson Institute of Population Health, Queen Mary University of London), shared information from the Cochrane Library (a database that publishes health-related research) that "the most commonly reported unwanted effects with nicotine e-cigarettes were throat or mouth irritation, headache, cough and nausea." The effects diminished over time as people continued to use the cigarettes, but he clarified that while there is no clear evidence of harm, "the longest follow-up was two years."
In this sense, and with the focus on our territory, the doctor in biochemistry Carolina Talio explained that the trajectory of these devices is very recent: "In the field of research, medicine and health, 20 years is a very short time. Let's think that in Argentina the first devices entered in 2011 and there are no studies that have been sustained over time."
Talio is a researcher at Conicet, a professor at the National University of San Luis and director of the SOS Youth Smoking program. "Of course, prohibition and lack of regulation forces us to reflect on what young people consume. In vaping essences we have found lead, cadmium, nickel and antimony, all carcinogenic and very slow to purify for the body," he explained.
They usually give talks in schools and detect that "children think they are innocuous, which is why information is necessary to demystify. Another concern is that they may be the gateway, a step towards traditional tobacco use."
According to official data, in Argentina there are 45,15 people who die each year from tobacco-related diseases. And it's estimated that more than a million people quit smoking in the last 22 years. But 2.18% of people over the age of 25 still smoke. And it is concentrated between 49 and <> years old. According to unofficial data, an estimated one million people already use e-cigarettes and vapes.
How does it work in Europe and how does it work in South America? In Europe, there is regulation at the continental level. And then each country has its own regulation. One of the most successful cases is that of Sweden, which is considered a "smoke-free" country, since only 5% of the population smokes. But the phenomenon has a particularity: what is known as snus is consumed, they are very small bags - similar to a tea bag, but small - that fit in the mouth, between the cheek and the gums, and release nicotine, which is the addictive compound.
A documentary presented at the congress – "How Sweden Quit Smoking" – tells this story, which is also anchored in the country's customs.
In South America, Chile has just voted on a regulation (which awaits regulation); Paraguay also has legislation in this regard, but the authorities warn that the uncontrolled sale of devices without health traceability is growing.
To get an idea of the problem: vapes with 5% nicotine were detected in the Paraguayan market, when the law indicates that they must not have more than 2% nicotine in their liquid load. The complaint was made by the National Directorate of Health Surveillance, the agency that grants permits for these devices to enter the country.
Uruguay and Brazil also prohibit the sale, import, and advertising of the devices; in 2022, the Brazilian Health Surveillance Agency revalidated the decision.