Monday 16 May 2022

The Philippine's graphic health warnings for e-cigarettes come into force -- or do they?

The Philippines was in the news last week, with the election of a new president with a familiar name: Ferdinand ('Bongbong') Marcos, Jr. 

This election happened on the very week that new restrictions on vaping products were due to come into effect -- adding more uncertainty to the future of that country's tobacco laws.  The post reports on these innovative regulations that may - or may not - set a global first for tobacco control.

2020: The Philippines adopts major reforms to its vaping laws 

In 2020, the Philippine government strengthened controls on the marketing of vaping products in several ways:

  • the minimum age for sale of tobacco and vaping products was raised to 21 years
  • excise taxes on e-liquids were imposed
  • requirements for health warning were extended to vaping products, effective 2022 
  • flavourings were banned, other than 'plain tobacco' and 'plain menthol', effective 2022 
2021: Fierce lobbying leads Philippine's Congress to roll-back legislation  

These restrictions became the object of a sustained lobbying campaign aimed at both houses of the Philippine Congress and by the end of 2021, a majority of legislators had called for some of these measures to be withdrawn. 

Both chambers of the Philippine Congress passed laws which would relax these provisions (Senate Bill 2239 and House Bill 9007). In addition to returning the age to purchase e-cigarettes or heated tobacco from 21 to 18, the law would also remove regulatory authority over these products from the  Food and Drug Administration (FDA) and place them under the authority of the Department of Trade and Industry (DTI). It would remove flavor restrictions on e-liquids and allowing more corporate promotions by tobacco companies.

2022: The out-going President has stalled the roll-backs, but the future is uncertain

The Congress' proposals to relax restrictions on vaping products were sent to the President of the Philippines, Rodrigo Duterte, who had the authority to sign them into law or to veto them. 

The Ministry of Health was reported as opposing these initiatives and President Duterte has neither signed nor vetoed these proposals, despite significant lobbying for him to do so. On July 1st, he will hand over to President-elect Marcos.

With so much this issue surrounded by uncertainty, controversy and politics, last week's deadline for e-cigarettes sold in this Pacific archipelago to begin displaying graphic health warnings and to cease being flavoured with anything but tobacco and menthol has passed by without much mention.

Administrative Order 2
021-0054

May 2022: The Philippine requirements for graphic warnings that were set for implementation   

It was 8 years ago that the Philippines required graphic health warnings on tobacco products (Graphic Health Warnings Law, Republic Act No. 10643). This obligation was extended to vaping product manufacturers as part of a tax law (Republic Act No. 11346), and a  Joint Memorandum of Finance and Health Ministries issued in November 2020, giving manufacturers 18 months to comply. 

Instructions for new warnings were set by an administrative order issued last November (Department of Health Administrative Order No. 2021-0054), which came into force on May 11, 2022.  (The order also includes similar requirements for graphic warnings for heated tobacco). Warnings must cover the lower 50% of each principal display space, and a separate text message is mandated for side panels. These warnings are required for 2 years, after which new instructions will be issued

Twelve warnings are required, covering 10 health effects: asthma, explosion injury, lung damage, eye irritation, exposure to toxic chemicals, cancer, exposure to second hand emissions, nicotine poisoning, throat irritation and pneumonia.  


On the side panel of each package, Quit-line information is provided with the encouragement to "Quit Vaping", as well a notice that sales to people under 21 years of age is forbidden. 


Message required on side panel
of vaping products sold in Philippines

May 2022: The flavour restrictions that were also due to come into force

Restrictions on flavourings were contained in the same Joint Memorandum that clarified warnings requirements. As with the warnings, this requirement came into force on last week.  

The Philippines has taken a similar approach to that proposed by Health Canada last year -- allowing tobacco and menthol flavourings. It is more restrictive than the proposed Canadian restriction in that these flavourings must be "plain tobacco" and "plain menthol" -- no mixture of the two flavours is permitted, nor are "mint" flavourings.  


It seems probable that these restrictions, like those for warning labels, will not be observed as officials "wait and see" how the outgoing and incoming Presidents decide on the Congress' proposal to roll-back vaping regulations. 

The bumpy road to health regulation 

It is not yet clear whether the Philippines will become second country to require graphic health warnings on e-cigarettes (South Korea issued requirements in late 2018), or the 5th country to implement national level flavour restrictions (following Finland, Estonia, Hungary and Denmark). 

Regulatory progress -- especially innovative and ground-breaking regulations -- too frequently experience political set-backs. Canada is not immune to this:  following an election in 2018, the Ontario government refused to implement vaping regulations passed under a previous government (although it later changed its mind), and last month the British Columbia government quietly rescinded its own innovative  restrictions on vaping product packaging. 

B.C.'s ban on designs on vapour product packaging
was rescinded in April 2022. 


Selected research and resources 

Fact sheets:

Research on graphic warnings on vaping products

Brewer NT, Jeong M, Hall MG, et al.  Impact of e-cigarette health warnings on motivation to vape and smoke. Tobacco Control 2019;28:e64-e70. https://tobaccocontrol.bmj.com/content/28/e1/e64

Villanti AC, LePine SE, West JC, Cruz TB, Stevens EM, Tetreault HJ, Unger JB, Wackowski OA, Mays D. Identifying message content to reduce vaping: Results from online message testing trials in young adult tobacco users. Addict Behav. 2021 Apr;115:106778. doi: 10.1016/j.addbeh.2020.106778. Epub 2020 Dec 11. 
https://pubmed.ncbi.nlm.nih.gov/33341530/

Stevens EM, Keller-Hamilton B, Mays D, et al. Optimizing Images for an E-Cigarette Messaging Campaign: Liking and Perceived Effectiveness. Int J Environ Res Public Health. 2021;18(24):12989. Published 2021 Dec 9. doi:10.3390/ijerph182412989
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8700893/

Li W, Vargas-Rivera M, Ebrahimi Kalan M, Ben Taleb Z, Asfar T, Osibogun O, Noar SM, Maziak W. The Effect of Graphic Health Warning Labels Placed on the ENDS Device on Young Adult Users' Experience, Exposure and Intention to Use: A Pilot Study. Health Commun. 2022 Jun;37(7):842-849. doi: 10.1080/10410236.2021.1872158. Epub 2021 Jan 21. 
https://pubmed.ncbi.nlm.nih.gov/33475000/