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ERS President Professor Francesco Blasi was in Brussels this week to present the ERS perspective in the debate surrounding electronic cigarettes.
MEPs called experts from across the continent to the Parliament to share their views on e cigarettes in a Workshop on Tuesday, 7 May.
The discussion centred on whether e cigarettes need to be regulated or not. Professor Blasi highlighted the lack of scientific evidence on the potential benefits and/or risks of e cigarettes and raised the issue that there are no long term studies showing effects of using the devices.
Professor Blasi called for more research on the positive or negative effects of these products, in particular medium and long term independent clinical trials, behavioural studies and individual/population level post marketing studies. He stated that until this strong scientific evidence exists, policymakers should proceed with caution.
Other speakers included European regulators and consumer associations.
Find out more about the workshop
- More on this topic Electronic cigarettes Tobacco
E-cigarettes: regulation – tobaccotactics
- 1 Bans in Public Places
- 2 UK Regulation
- 3 EU Tobacco Products Directive Revision
- 4 FDA Regulation in the USA
- 5 WHO s Position on e Cigarettes
- 6 Other TobaccoTactics Resources
- 7 Notes
Bans in Public Places
Due to a lack of regulations concerning e cigarettes, local authorities and commercial enterprises have started introducing their own rules. In the USA, the number of cities banning the use of e cigarettes in public places, such as bars, nightclubs and restaurants, and therefore treating them similarly to traditional cigarettes, is growing.
Boston, Chicago, New York and Los Angeles City Council have all voted to ban them. In the UK, different companies have adopted varying positions. The pub chains Wetherspoons and the Slug & Lettuce have banned the use of them insider their establishments, so has the fast food chain McDonald s. Some train operators, including First Capital Connect, have imposed a complete ban on passengers using the devices. 2
Meanwhile, Wales could be the first part of the UK to ban smoking e cigarettes in enclosed public spaces. In early April 2014, the Welsh Health Minister, Professor Mark Drakeford revealed that he was considering a ban amid concerns the products could re normalise the use of conventional cigarettes. He said there were also concerns that the spread of e cigarettes could undermine the ban on tobacco smoking in enclosed public spaces, making it more difficult to enforce. The proposal is part of a new set of ideas for public health legislation. 3
In the summer of 2013, the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK decided that e cigarettes should be regulated as medicines from 2016. This regulation would require manufacturers to present data on the quality of their products, how they deliver nicotine to the body and how they compare with nicotine replacement products like patches and gums. 4 However, a final decision will await the outcome of the EU Tobacco Products Directive Revision.
The UK government announced plans to ban sales of e cigarettes to under 18s. The new regulation could come into force within a year of the announcement in January 2014. 5
- More information on the policy decision process can be found on the Nicotine containing products page on the MHRA’s website, and their Q&A on the regulation of e cigarettes.
EU Tobacco Products Directive Revision
On 18 December 2013, after years of delay, a political agreement was reached on the text for a revised Tobacco Products Directive (TPD) between the European Commission, Parliament and the Council. 6 This compromise text now has to be approved at a plenary session of the Parliament (expected in February or March 2014) and again by the Council. Once this has occured, Member States will have two years to implement the new rules at national level. Although the European Commission 7 and the Council 8 proposed to regulate e cigarettes as a medicine, this approach was rejected by the Parliament in October 2013. In December 2013, a compromise agreement was reached between the three EU institutions which should see e cigarettes regulated for the first time at EU Level. The compromise agreement provides for two ways of placing e cigarettes on the market
- as a medicine, if companies choose to make a claim that e cigarettes help smokers quit smoking
- as a consumer product (if companies do not make any health claims) subject to certain safeguards, including
- a limit on nicotine strength of 20mg/ml
- quality and purity standards
- the same advertising bans as for cigarettes
- a size limit and safety mechanisms for e liquid bottles and refillable cigarettes.
This agreement will also allow the UK Government to introduce extra safeguards for instance on age limits and flavourings in e cigarettes.
After the final approvement of the regulation, the Electronic Cigarette Industry Trade Association (ECITA) and other market players vowed to fight the ‘unworkable’ EU rules. 9
- Also see E cigarettes Lobbying
FDA Regulation in the USA
In April 2014, the American Food and Drug Administration (FDA) published the long awaited blueprint for regulation on e cigarettes. 10 The new regulations would ban the sale of e cigarettes (and cigars and pipe tobacco) to Americans under 18, and would require that people buying them show photo identification to prove their age, measures already mandated in a number of states.
Once finalized, the regulations will establish oversight of what has been a market free for all of products, the New York Times wrote, including vials of liquid nicotine of varying quality and unknown provenance
Under the new rules, companies would no longer be able to offer free samples, and e cigarettes would have to come with warning labels saying that they contain nicotine, which is addictive. Companies would also not be able to assert that e cigarettes were less harmful than real cigarettes unless they got approval from the F.D.A. to do so by submitting scientific information. In the proposed restrictions on sales to minors, vending machines in public places where minors are allowed would no longer be able to carry them. A ban on Internet sales to minors, already in place for cigarettes, would extend to e cigarettes and cigars. Companies would have to apply for F.D.A. approval for their products, but would have two years after the new rules are finalized to do so. Companies can keep their products on the market in the meantime. 11
However,the new blueprint did not contain proposals to ban flavors in e cigarettes, like bubble gum and grape, that public health experts say lure children to use the products, nor any move to restrict the marketing of e cigarettes, as is done for traditional cigarettes, which are banned from television, for example.
The new regulatory proposal is open to public comment for 75 days, and then the agency will make final changes, a process that will take months, and possibly significantly longer if affected companies sue to block them. 11
At present, only e cigarettes that are marketed for therapeutic purposes are regulated by the FDA Center for Drug Evaluation and Research (CDER) at the national level. Furthermore, 26 US States have banned sales to minors on the basis that smoking e cigarettes, or vaping, might tempt them to try smoking. 5
Until new regulation is in place, the position of the FDA is a cautious one. The agency s website warns that as long as e cigarettes have not been fully studied, consumers do not know the following
- the potential risks of e cigarettes when used as intended,
- how much nicotine or other potentially harmful chemicals are being inhaled during use, or
- if there are any benefits associated with using these products.
Additionally, it is not known if e cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which cause disease and lead to premature death. 12
WHO s Position on e Cigarettes
In July 2013, the World Health Organization (WHO) issued a statement on e cigarettes and advised that consumers should not use e cigarettes until they are deemed safe. It said the potential risks “remain undetermined” and that the contents of the vapour emissions had not been thoroughly studied.
Contrary to what some marketers of the e cigarette imply in their advertisements, WHO does not consider it to be a legitimate therapy for smokers trying to quit. Furthermore, the efficacy of e cigarettes for helping people to quit smoking has not been scientifically demonstrated. According to WHO, they are
often touted as tobacco replacements, smoking alternatives or smoking cessation aids. But we know that for smoking cessation products to be most effectively and safely used, they need to be used according to instructions developed for each product through scientific testing.
The WHO conclu
ded it was best to stay away from electronic nicotine delivery systems (ENDS), as they call them
Until such time as a given ENDS is deemed safe and effective and of acceptable quality by a competent national regulatory body, consumers should be strongly advised not to use any of these products, including electronic cigarettes. 13 Other TobaccoTactics Resources
- E cigarettes
- E cigarettes Marketing
- E cigarettes At The Pharmacy
- E cigarettes Lobbying
- Harm Reduction
- Product Innovation
- Library of the European Parliament, Electronic Cigarettes, Library Briefing, 27 March 2013, accessed January 2013
- Kevin Hughes, The rise of the e cigarette, 3 April 2014, accessed April 2014
- Ronan Hegarty, Wales weighs e cig ban in public places and minimum unit pricing, The Grocer, 2 April 2014, accessed April 2014
- MRHA, Nicotine containing products, December 2013, accessed January 2014
- 5.0 5.1 Andy Coghlan, UK government to ban e cigarettes for under 18s, New Scientist Health, 30 January 2014, accessed January 2014
- European Commission,Commissioner Borg welcomes agreement on the revision of the Tobacco Products Directive, 18 December 2013, accessed December 2013
- European Commission, Proposal for a Directive of the Revision of the European Parliament and of the Council on the approximation of the laws, regulations and administrative provisions of the Member States concerning the manufacture, presentation and sale of tobacco and related products, 19 December 2012, accessed December 2012
- Council of the European Union, release 3247th Council meeting Employment, Social Policy, Health and Consumer Affairs, 21 June 2013, accessed June 2013
- Ronan Hegary, E cigarette players vow to fight ‘unworkable’ EU clampdown, The Grocer, 8 March 2014, accessed May 2014
- FDA, Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products, a proposed rule, 25 April 2014, accessed April 2014
- 11.0 11.1 Sabirna Tavernise, F.D.A. Will Propose New Regulations for E Cigarettes, 24 April 2014, accessed April 2014
- FDA, Regulation of e Cigarettes, no date, accessed January 2014
- WHO, Questions and answers on electronic cigarettes or electronic nicotine delivery systems (ENDS), Statement, 9 July 2013