Banning E-cigarettes could do more harm than good

Only a strong public health system can conquer nicotine addiction. The nation is facing two distinct vaping-related health crises: surging e-cigarette use among teenagers and a lung-injury outbreak that has sickened more than 2,000 people and killed at least 40. Both have exposed yawning gaps in the nation’s public health apparatus. But instead of closing those gaps, policymakers have turned to a much more straightforward fix: banning products.

A federal ban on flavored e-cigarettes is reportedly in the offing.Several states have already enacted their own flavor bans. And Massachusetts and several California cities have taken steps to outlaw e-cigarettes altogether.

The impulse to remove e-cigarettes from the market is understandable. The Food and Drug Administration’s hands-off approach to vaping and e-cigarette regulation has backfired badly. The Centers for Disease Control and Prevention – and state and local health departments around the country – are struggling to pick up the slack. And after more than a decade, neither federal agency has a clear sense of the overall risks and benefits of these products.

But prohibition is not a good long-term solution, for a number of reasons. Such measures are not guaranteed to prevent teenagers from getting e-cigarettes. And they would almost certainly force people who already use these products, including roughly 11 million adults, to choose between traditional cigarettes (which remain widely available, despite being deadlier than e-cigarettes) and black-market vaping products.

Because these black market products are a leading suspect in the lung-injury outbreak, product bans are more likely to exacerbate this crisis than to mitigate it.

The better, if more complicated, option would be to build a public health system that’s strong enough to combat all nicotine addiction in the long

term. That, in turn, could help drive a cultural shift for e-cigarettes akin to the shift that took place for traditional cigarettes. Policy changes and growing public awareness – not product bans – helped turn what was considered a chic, stress-relieving diet tool into what is now more commonly viewed as a smelly, overpriced cancer stick.

With sustained and careful investment, e-cigarettes might become nothing more than a harmreduction option for adult smokers – no more appealing to teenagers than a nicotine patch or a piece of nicotine gum. Here are some ideas for making that vision a reality.

Treat e-cigarettes like cigarettes. Traditional cigarettes and other tobacco products are already bound by a number of rules – including special taxes, advertising restrictions and age-verification requirements – that helped sharply lower both youth and adult smoking rates in recent decades. E-cigarette makers have evaded similar regulations, through a combination of lawsuits and intensive lobbying. (Among other things, the vaping industry has argued that e-cigarettes are not tobacco products because they contain only nicotine – but nicotine comes exclusively from the tobacco plant.) Congress could stop such antics with new legislation. A recently passed House bill that would mandate age verification for all online ecigarette purchases is a welcome step in the right direction. Additional laws are needed to ensure that any rules applying to tobacco products also apply to e-cigarettes.

Learn from Britain. So far, the country has managed to make e-cigarettes available for adults who want to quit using regular cigarettes without triggering an epidemic of nicotine dependence among its youth. Public health experts say at least part of that success is due to the way these products are regulated in Britain. Packaging and advertising are tightly restricted – no bright, colorful labels or kid-friendly media campaigns allowed. And the nicotine content is capped. In America, where there are no such limits, e-cigarettes often contain more than twice as much nicotine as they do in Britain and are still being sold in ways designed to appeal to young children.

Invest in public health. The CDC and state and local health departments across the country are struggling to hold the line on public health gains made over the past century. For tobacco control, that means educating the public about the risks of nicotine addiction and countering the tobacco industry’s efforts to lure young users. It also means detecting outbreaks of vaping-related illness or injury, pinpointing the causes of those outbreaks and advising governments on how to respond. This crucial work is in desperate need of a funding boost. The House has approved $40 million to increase the CDC’s tobacco control efforts and $100 million to upgrade the agency’s data system, which is currently so antiquated it relies on fax machines and CD-ROMs. The Senate should follow suit. Invest in research. There remains much we don’t know about ecigarettes. Are these products truly effective at helping people quit smoking, and is there a way to maximize that effectiveness? For example, do flavors that attract children also help adults quit? Would adults be more likely to quit if e-cigarettes were paired with other supports, like counseling? How safe is longterm e-cigarette use, and are some products safer than others? What are the risks to people who end up using both electronic and traditional cigarettes? What about those who switch completely to e-cigarettes but end up smoking much more because vaping is easier to get away with indoors? Health officials need answers to these questions to set effective policies.

Maintain pressure. Scientists and universities have refused to take “research” money from companies that make e-cigarettes; advertising agencies and health and wellness companies are pledging to do the same. These movements reflect a growing public wariness that is itself a powerful check on the industry. For example, it was after a tsunami of bad press – investigations, congressional hearings, lawsuits – that Juul, the nation’s leading e-cigarette maker, closed some of its social media accounts, put in place an ageverification system and stopped selling many of its flavored pods.

Critics are right to be skeptical of such voluntary measures – the tobacco industry has a terrible track record of self-policing. But the fact that the company took these steps at all, after fighting them so aggressively for so long, is proof that even while regulatory efforts falter, public sentiment can still hold sway.