WHO's statement today is consistent with the concerns it has previously raised about the threat to public health raised by permissive marketing of these addictive products. WHO reminds governments that "The tobacco industry profits from destroying health and is using these newer products to get a seat at the policy-making table" and that it "funds and promotes false evidence to argue that these products reduce harm."
WHO's review of the evidence does not lead it to believe that e-cigarettes when sold as consumer products are effective as cessation support. Instead, the health authority advises "Cessation strategies should be based on the best available evidence of efficacy, to go with other tobacco control measures and subject to monitoring and evaluation. Based on the current evidence, it is not recommended that governments permit sale of e-cigarettes as consumer products in pursuit of a cessation objective."
For governments -- like that in Canada, the United Kingdom and New Zealand - which encourage the use of e-cigarettes as a cessation strategy, WHO recommends that the market be strongly regulated to protect the unintended use of e-cigarettes by children: "Any government pursuing a smoking cessation strategy using e-cigarettes should control the conditions under which the products are accessed to ensure appropriate clinical conditions and regulate the products as medicines (including requiring marketing authorization as medicines). The decision to pursue a smoking cessation objective, even in such a controlled form, should be made only after considering national circumstances, along with the risk of uptake and after exhausting other proven cessation strategies."
Among the Eight recommendations for e-cigarette regulation identified in WHO's Call to Action, only one is currently in place in Canada.
The recommendation currently in place across Canada is:
– Limiting the concentration and quantity of nicotine, to reduce the risk of dependence
The recommended regulations that have not been adopted by Health Canada are:
– Banning all flavouring agents, including menthol and synthetic menthol analogues
– Prohibiting attractive and/or promotional features related to the presentation and packaging of the products, such as colours or colouring properties, attractive descriptors, including names
– Regulating features that enable the user to manipulate the product, post-sale
– Setting a maximum volume for e-cigarette cartridges, to limit toxicants exposure and use
– Setting a maximum battery power, to limit the influence of power on nicotine and toxicant delivery
– Prohibiting device features that permit transmission of information to and from third parties (including manufacturers), such as connections to smartphone apps, that could be used to collect personal information, details of use topography, or to remotely control the product
– Prohibiting additives that have carcinogenic, mutagenic and reprotoxic properties.
Three important regulations have dropped from view
Health Canada's lack of progress in restricting flavours in e-cigarettes has been much discussed., but there are two other regulatory reforms that have also dropped from view. These are
Access Regulations (Age Verification for Online/Distance Sales). These regulations to require more than a box-tick to access on-line sales were identified on the Forward Regulatory Plan almost three years ago (February 2021), but no apparent action has been taken on them since.
Vaping Products Promotion Regulations (Package and Design Features). This regulation was intended to "place certain limits on what promotional elements can appear on vaping product packages. They would also impose restrictions on design features that are appealing to youth to prevent their use in the manufacture of vaping products." It was identified in the Forward Regulatory Plan in early 2021, but dropped in the revision to the list the following year.
