Singapore has banned e-cigarettes to protect the public from the harms they can cause, said Senior Parliamentary Secretary for Health and Home Affairs Amrin Amin, as he laid out the comprehensive explanation for the Government’s policy. Speaking at a Health Promotion Board roadshow on Jan 26 to launch a campaign on the harms of e-cigarettes, he also cautioned against taking the words of “so-called experts” on the subject at face value. Below is an excerpt of his speech.

In a 2018 Health Promotion Board survey of 600 youths, over 70 per cent of youths were unaware that e-cigarettes contain nicotine and cancer-causing chemicals, and that its vapour contains fine particles (also known as PM 2.5) which can cause respiratory illnesses. What this campaign tries to address is this information gap on the harms of e-cigarettes.

There is an alarming global trend of e-cigarette use, especially among young people. We must ensure that our public and youths know the real facts, and understand the reasons why we are prohibiting Electronic Nicotine Delivery Systems, or ENDS, which include e-cigarettes.

Let me share the reasons briefly.

Let's start by looking at international developments. Let's look at the use of e-cigarettes in the United States and Hong Kong.

In the US, the Food and Drug Administration stated that youth use of e-cigarettes has reached epidemic proportions. There are some 3.6 million underage users of Juul and other e-cigarettes – and remember, this is just underage numbers, minors, very young people. Between 2011 and 2018, there has been an increase in e-cigarette use among middle and high school students (secondary school students here). Close to 21 out of every 100 high school students surveyed reported e-cigarette use in the past 30 days – this is according to data from the US Centres for Disease Control and Prevention.

Colourful packaging, flavouring, and other strategies are used by the tobacco industry to target youths and present these products as being less harmful than they actually are. Closer to home, in Hong Kong, the tobacco industry has been lobbying health authorities to regulate electronic cigarettes like other tobacco products, or in short, not to ban them. Hong Kong relaxed the use of e-cigarettes, allowing them to be used as pharmaceutical products as early as 2009. However, data from Hong Kong shows a worrying trend – more young children are experimenting with e-cigarettes.

There was a 55 per cent increase in the proportion of Primary 2 to 4 students who have tried e-cigarettes in the past two years. Medical societies and groups in Hong Kong are therefore pushing hard for a ban on e-cigarettes because of the health risks to youths.

Hong Kong recently announced that it would ban e-cigarettes. This is in line with our position, along with 27 other countries.

PRECAUTIONARY BAN

In Singapore, the import and sale of e-cigarettes have always been prohibited under a blanket ban for imitation tobacco products. In 2017, we extended the ban to cover purchase, use and possession. This blanket ban is intended to protect the public from the harms of emerging tobacco products.

Some of you have asked why not ban cigarettes, as we have done with e-cigarettes. If indeed all tobacco products are harmful, why not ban cigarettes too?

Is it because the Government wants to make more money from the tax we impose or levy cigarettes? The answer is no. Cigarette taxes are in fact meant to deter consumption.

If we had our way from the beginning, we would probably have banned cigarettes from the very beginning. But it would be very challenging to do so now and let me tell you why.

Cigarettes are deeply entrenched tobacco products globally, including in Singapore. About one in 10 Singaporeans are addicted to tobacco products, and they would need time and support to quit. Banning cigarettes, given the number of existing smokers, would create a black market and increase the flow of contraband cigarettes into Singapore.

Instead of a ban, the World Health Organisation (WHO) has recommended that countries adopt a comprehensive mix of strategies including public education, smoking cessation services, advertising restrictions, sales restrictions to minors and taxation, to bring down smoking prevalence. For e-cigarettes, the WHO recommended that countries take necessary actions to protect their populations from the harms of such products, including regulating and banning them.

We do not want new tobacco products to entrench themselves in Singapore as they could take root and increase overall tobacco use in our population.

Some of you may question if e-cigarettes are bad for your health. You may come across reports in the media about smokers switching to them for supposed “health benefits”.

Let’s be clear. E-cigarettes are harmful.

Nicotine, found in e-cigarettes, is toxic and can harm the parts of the brain that controls attention, memory and learning, and can result in permanent impulse control deficits. Nicotine can also affect the heart, reproductive system, lungs and kidneys. Nicotine is also highly addictive. That is why it is so difficult to quit smoking and e-cigarettes. You can become hooked on e-cigarettes and other tobacco products.

In fact, a number of studies conducted in the US, Canada, Poland and the UK have shown that e-cigarette use is associated with cigarette experimentation among adolescents. Adolescents who have used e-cigarettes are more likely to become regular smokers. This is what is known as the “gateway effect”, where e-cigarette users eventually switch to smoking, or continue to use both tobacco products interchangeably as dual users. Apart from nicotine, e-cigarettes also contain harmful cancer-causing substances like benzene and heavy metals like lead.

There is no data on the long-term health effects of e-cigarette use because these are relatively new products. There is hardly any research on how e-cigarette vapour affects the lungs in youths in the long term.

So our advice is do not take the risk. Be familiar with the facts, don't be swayed by half-truths or falsehoods!

What we are talking about is your health. E-cigarettes are not harmless.

DIVERSIFICATION AND SO-CALLED EXPERTS

Tobacco companies invest billions of dollars to develop new products that can drive the industry beyond cigarettes. The evidence on cigarettes is clear, convincing and indisputable. New tobacco-based products seem to provide a diversification option and an additional revenue stream. So we see today e-cigarettes and heated tobacco products promoted as “smokeless” tobacco products that are healthier than cigarettes.

The e-cigarette industry is increasingly dominated by the tobacco industry and it is hard to clearly distinguish between the two. For example, tobacco giant Altria, which makes Marlboro and other cigarette brands, is now the largest shareholder of Juul, a major e-cigarette manufacturer in the US. The tobacco industry is powerful in lobbying. If you hear so-called experts sharing their views – ask if they are funded or influenced by tobacco lobbyists. In the 1960s and 70s, so-called experts funded by the tobacco industry tried to downplay evidence linking smoking and diseases.

Tobacco companies used their research to claim there was no “scientific causality”, “conclusive evidence”, or “scientific proof” that smoking caused diseases like lung cancer.

Where are these experts today and what are they saying now, given that it is clear and indisputable today, and there is overwhelming and conclusive scientific evidence on the harms of cigarettes, linking smoking to a range of diseases – cancer, for example. Lung cancer is a top risk factor for smokers. This is an important lesson. Do not take the words of so-called experts without studying the evidence.

We must do what is right for our people. That is our public duty and responsibility.

QUESTIONS OVER EFFECTIVENESS FOR CESSATION

Another argument we often hear is that e-cigarettes should be allowed because they can help smokers to quit. Let me share our current thinking on this.

First, public health authorities are divided on whether e-cigarettes can help smokers to quit. Some countries, such as the UK and New Zealand, are supportive of this. But the evidence for the use of e-cigarettes as a smoking cessation aid is actually mixed and limited. Unlike Nicotine Replacement Therapy (NRT) products, there is no clinical trial evidence showing the safety and effectiveness of e-cigarettes in smoking cessation.

In fact, it is very common for smokers to use both e-cigarettes and cigarettes concurrently. Surely, this does not reduce the risk of smoking-related illnesses. Even where there are clinical trials that observe the safety and effectiveness of ENDS for smoking cessation, none have reported conclusive results so far. If there is indeed evidence of its usefulness as a smoking cessation aid, Singapore is prepared to study it.

There is a mechanism for it, a scientific mechanism and not a PR machine or campaign. Manufacturers can apply to register their products as NRT products under the Health Products Act, for them to be legally available in Singapore. We have not received any applications so far.

Second, there are many approved smoking cessation aids – you don't need e-cigarettes to quit. There are safe and effective methods such as smoking cessation counselling, and the use of NRTs, for those who require more nudge and help. There is also HPB's Quitline for smokers to get more information and support for their quitting journey.

Third, there are practical challenges if we limit e-cigarettes as a smoking cessation aid. Recall how e-cigarettes are marketed as lifestyle products and flavourings. There is always a risk that non-smokers and youths could get their hands on them. Look at the experience of Hong Kong. Monitoring who is supposed to have e-cigarettes and who is not, as well as restricting access for non-smokers and youths would present significant challenges.

Given the highly questionable efficacy of e-cigarettes as a cessation aid and the fact that there are many existing cessation aids available plus the challenges I have highlighted, we are taking a prudent step in prohibiting ENDS, with public safety and interest at heart and in mind.

If there is good, strong evidence to prove otherwise, we would be happy to look into it.

Source https://www.todayonline.com/commentary/why-singapore-bans-e-cigarettes