Special Edition
17 September 2019

No Room for Harm:
ENSP Calls for European Response to the E-Cigarettes
Rising Epidemic among Young People

With over 20 years of activity aiming to curb tobacco consumption, the European Network for Smoking and Tobacco Prevention (ENSP) has been closely following the development and transformation of tobacco and nicotine products, as well as their regulation at European and national levels. 

According to the WHO Report on the Global Tobacco Epidemic 2019[1], the tobacco industry has introduced in recent years a wide array of new products, the majority of which simulate the act of smoking while typically delivering nicotine into the human body.

We welcomed the introduction of an entire article (Article 20), which lays down rules for electronic cigarettes sold as consumer products in the EU in the updated Tobacco Products Directive (2014/40/EU). At the time, ENSP and the European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) issued clear guidelines addressed to Member States supporting the implementation of Article 20 at national level. 

To avoid renormalisation of smoking with the introduction of e-cigarettes across Europe, ENSP and EFA recommended Member States to go beyond the requirements included in the Directive, by applying: 

(1) a general ban on advertising at the national level and not only when there is a cross-border effect;
(2) a total ban on e-cigarettes use in all public places where smoking is not allowed;
(3) an complete prohibition on flavours to limit the vaping uptake of children and young people;
(4) a restriction on e-cigarettes sales to minors;
(5) a comprehensive regulation on prices and;
(6) an implementation of the Protocol to Eliminate Illicit Trade in Tobacco Products to e-cigarette trading.

To achieve the target of reducing the prevalence of tobacco use in Europe, ENSP systematically encouraged evidence-based smoking cessation treatments. ENSP adheres to the European Respiratory Society (ERS) position on Tobacco Harm Reduction[2]. We strongly dismiss the claim that it is in the interest of public health to replace a very harmful product like conventional cigarettes with potentially less, but still, harmful and addictive products, such as e-cigarettes. Reducing smoking-related health risks requires putting the focus on complete cessation.

It should also be stressed that the evidence showing the effectiveness of electronic cigarettes in helping people to quit smoking is not yet conclusive. On the contrary, electronic cigarettes have prolonged the addiction to nicotine of Europeans and their recent uptake by youth across Europe is of great concern. 

We support the WHO-FCTC Secretariat recent position[4] calling on the public health community and authorities to remain vigilant to the interference of novel and emerging nicotine and tobacco products. The FCTC highlights that allowing such products to penetrate national markets without adequate regulation could threaten the implementation of tobacco control strategies, as well as the undermining of the denormalisation of tobacco use upheld by the Convention. We welcome the Bloomberg Philanthropies project “Fight Flavoured E-Cigarettes” pledging $160 million to end youth e-cigarette epidemic in the US. 
ENSP took note of the six cases of confirmed e-cigarette use (vaping) related deaths in the United-States of America in the recent weeks, and the more than 450 possible cases of adults and youth experiencing e-cigarette related illness across the country. To date, no similar event has been documented outside the US. However, given the widespread availability of and easy access to e-cigarettes across Europe, such cases can potentially arise in European countries. We welcome the recent statement made by the Portuguese Society of Pulmonology[3] strongly advising against the use of e-cigarettes and we stand ready to support the spread of similar messages among other public health or health care professionals’ organisations from any EU Member States. 

Simah Herman has urged people not to vape as the US experiences a spate of deaths, according to METRO UK

In Europe, ENSP will remain at the forefront of supporting advocacy efforts including legislative and regulatory measures aimed at preventing a new generation of Europeans from becoming addicted to nicotine and developing e-cigarette related illnesses, putting an additional burden on health systems across Europe.  

In the current context of alarming levels of youth vaping, we have seen the senior US political leaders take a strong stance against e-cigarettes. We therefore urge Europe’s political leaders to take similar actions, highlighting the importance of the core precautionary principle with regards to public health. 

We call on European policymakers to support clear, coherent and efficient actions against the rising e-cigarette use and encourage them to stand firmly on the path towards a tobacco-free Europe. Because when it comes to protecting the health of our children, we should leave no room for harm.   

Outbreak of Lung Disease related to Vaping
CDC, the U.S. Food and Drug Administration (FDA), state and local health departments, and other clinical and public health partners are investigating a multistate outbreak of lung disease associated with e-cigarette product (devices, liquids, refill pods, and/or cartridges) use.
As of September 11, 2019 at 5pm, 380* cases of lung illness associated with the use of e-cigarette products have been reported to CDC from 36 states and 1 U.S. territory and 6 deaths have been confirmed in California, Illinois, Indiana, Kansas, Minnesota, and Oregon, reports CDC. The most alarming part is that all cases have a history of e-cigarette product use or vaping, as many patients have reported using THC and nicotine. Some have reported the use of e-cigarette products containing only nicotine.

WHO FCTC Secretariat Warns about
Novel and Emerging Nicotine and Tobacco Products

On 13 September 2019, the WHO FCTC Secretariat published a statement  on novel and emerging nicotine and tobacco products, stressing the need of establishing a regulatory framework and monitoring their presence in the market.
WHO FCTC calls on all COP Parties to remain vigilant towards these products, to recognise them as tobacco products and expose them to relevant domestic legislation and controls.

According to the terminology used in reports submitted to the COP, the leading novel and emerging nicotine and tobacco products can be classified in three broad categories: electronic nicotine delivery systems (ENDS)
[1] , electronic non-nicotine delivery systems (ENNDS) and heated tobacco products (HTPs). Allowing such products to penetrate national markets without regulating them could threaten implementation of tobacco control strategies, as well as could undermine the denormalization of tobacco use upheld by the Convention.
"The threats of these novel products to human health are seriously looming in the horizon, flooding our streets and shops. The public health community and authorities have to be vigilant in countering the aggressive tactics by the industry to market its products to youth, cleverly using the loopholes of existing legislations. Moreover, the history of the harms of use of tobacco and tobacco-like products should not be allowed to be rewritten based on unproven and misleading claims. Vaping is a treacherous and flavored camouflage of a health disaster yet to happen if no action is taken now."

Dr. Vera Luiza da Costa e Silva, Head of the Convention Secretariat
Further, aware of the importance of the need to prohibit or regulate these products, the Convention Secretariat issued an Information Note on the classification of novel and emerging tobacco products that compiles all COP decisions related to these products, as well as the ongoing process for the amendment of harmonized customs codes concerning tobacco and nicotine products at the World Customs Organization (WCO).

1. These are sometimes commonly referred to as e-cigarettes, e-hookahs, etc.

Tobacco industry's misinformation on e-cigarettes
Global Center for Good Governance in Tobacco Control (GGTC) published an article supporting the position of the WHO on e-cigarettes. These products are “undoubtedly harmful”, and furthermore, the WHO warned that misinformation spread by the tobacco industry in claiming that they are “safer” constitute “a present and real threat” to public health.
The tobacco industry has been aggressively marketing e-cigarettes as a less dangerous alternative to traditional cigarettes and as smoking cessation aids. However, the WHO stated that “the available evidence does not support the tobacco industry’s claim that these products are less harmful” compared to traditional tobacco products. E-cigarettes are “not harmless and must be regulated”, the health organization affirmed. The WHO also warned against the use of e-cigarettes by smokers trying to quit, as there is insufficient evidence on their effectiveness as smoking cessation aids. The WHO reported that, in most cases, e-cigarettes are used concurrently with traditional cigarettes, “with little to no beneficial impact on health risk and effects.” 


Read again the 2019 WHO Report on Global Tobacco Epidemic...


TackSHS Project Final Conference 
8 October, European Parliament, Brussels

The TackSHS Project Consortium is pleased to announce that the project’s final conference will take place on October 8th at the European Parliament (Brussels).

Tackling tobacco-related chronic diseases in Europe: towards healthy populations protected from tobacco and second-hand smoke

Tuesday, 8 October 2019 from 10:30 to 15:30

European Parliament, Brussels

Meeting hosted by MEPs Cristian-Silviu Buşoi and Rosa Estaràs Ferragut
Chaired by Professor Esteve Fernandez

Dr Esteve Fernández, TackSHS Coordinator, would be delighted to welcome you at this event. During the conference, the main project findings and key lessons learned will be presented as well as the trajectory of further tobacco control policy and research in Europe will be discussed.

In order to attend the event, please fill in the Registration Form at your earliest convenience.

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