Could the e-cigarette related deaths in the US be averted in South Africa?

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Recently, 18 deaths and over 1000 e-cigarette-related acute lung injuries have been reported in the United States, prompting the banning of flavoured e-cigarettes in the US.  India has also banned e-cigarettes or vape products in an attempt to protect the health of its citizens.

Researchers are continuing to update our knowledge on the adverse health effects of short-term e-cigarette use but South Africa is yet to join the more than 98 countries that regulate e-cigarettes.

The e-cig research landscape is constantly changing and churning out evidence showing the health harms they cause. Although it will take some time for all the facts about e-cigs to be researched and published, what is clear is that they are not harmless. A 2016 European Public Health Association statement specifically mentions that “The health risks associated with e-cigarettes remain uncertain, but they cannot be considered safe. What is certain is that statements that they are some percentage safer than conventional cigarettes are so far unjustified”. The growing body of evidence confirms that e-cigarettes are harmful to health and that short-term use is linked to severe health conditions including respiratory and cardiovascular diseases, chest pains, ulcers in the mouth, asthma, and a high risk of strokes.

E-liquids and aerosols include propylene glycol (not found in cigarettes). The health effects of regularly inhaling propylene glycol and glycerin which are base components of e-cigarette liquid are not properly understood.

Although these are common food additives and declared safe to eat, they are not declared safe to inhale, just like water, which is  safe to drink, but cannot be considered safe to inhale. Those who are heavy e-cigarette users receive large doses of these over long periods of time delivered in ultra-fine particles to the deepest part of the lungs.

A 2019 study exposed mice to a mixture of propylene glycol and glycerine, both with and without nicotine and no flavourings. It found that immune cells in the mice became abnormally jammed with fat as had been seen in a human patient with severe lung disease.

The researchers showed that the fat deposit was coming from inside the lungs and might have been caused by vape solvents, which disrupt the ability of lung cells to keep the air sacks open.

In addition, nicotine, a known additive drug is found in both cigarettes and electronic cigarettes. Nicotine causes  adverse health effects including the impairment of adolescent brain development, and increased risk of cardiovascular, respiratory, gastrointestinal disorders.

Researchers also found that “e-cigarette aerosol contained metals, including nickel (a carcinogen), at a level 2 to 100 times higher than found in Marlboro cigarette smoke.” While nickel is present in the air we breathe, the water we drink, and jewelry we wear, this is at very low levels which are not harmful unless a person is sensitive to it. But at a high level and prolonged exposure, such as in e-cigarettes, nickel is known to be carcinogenic and also affects lung function.

Both e-cigarette smoke and third-hand exposure to nicotine from e-cigarette aerosols could cause health problems for users and second-hand smokers. Third-hand exposure includes exposure to particles or substances from e-cigs aerosol which stick to the furniture, walls, painting, and surfaces of items in an environment where e-cigarettes were used.

More young people are using e-cigarettes globally and more young people who have never smoked any tobacco products are reporting using e-cigarettes.

Evidence shows that e-cigarettes are contributing to an increase in addiction to nicotine among young people and re-normalising smoking. E-cigarette use risks the creation of a new generation of nicotine addicts and a reversal of decades-long progress in tobacco control.

Unfortunately, e-cigarettes were not tested for their impact on population health before being introduced into the market. Instead they have been promoted with marketing propaganda devoid of scientific evidence. Therefore, most health scientists have been compelled to play “catch up” with regards to making sure that this product does not begin yet another phase of the tobacco epidemic.

The widely quoted report by Public Health England (PHE) about the safety of e-cigarettes, used often by the e-cigarette industry, has been discredited by the Lancet because it’s not based on scientific research. The Lancet further notes that the PHE’s report is based on the opinions of a small group of individuals with no expertise in tobacco control, and includes a few who have been involved with the industry itself.

The World Health Organisation (WHO) has noted that e-cigarettes are undoubtedly harmful and that claims that they are an effective quit smoking tool are not backed up by sufficient evidence.

The WHO has called for the regulation of e-cigarettes to focus on four areas: discourage the promotion of e-cigarette to non-smokers and young people; reduce the potential health risks to e-cigarette users and non-users; prohibit the promotion of unproven health claims about e-cigarettes; and prevent the marketing and promotion of e-cigarettes.

While e-cigarettes may have been helpful to some individual smokers to quit, population level scientific studies of e-cigarettes as a quit smoking aid have shown that it does the opposite in fact – it reduces the likelihood of quitting for many people.

All but one of the top five e-cigarette companies globally are tobacco companies and are still producing and marketing e-cigarettes alongside cigarettes. These are Altria (formerly Philip Morris Companies), British American Tobacco, Imperial Brands, Japan Tobacco International, and NJOY. NJOY is the only company not known to be a tobacco manufacturing and marketing company.

The growing evidence raises serious concerns about the harmful effects of short-term e-cigarette use. The long-term health effects are largely unknown at this stage, but present evidence points to the need for caution with regard to e-cigarettes.

For smokers struggling to stop, we advise them to try less harmful methods of stopping such as nicotine replacement therapy and counselling, rather than e-cigarettes which will definitely cause health harm. We call on the government to take swift action to avoid the public health risks of e-cigarettes and speedily pass the Draft Tobacco Bill which will provide for the regulation of e-cigarettes.

Savera Kalideen is the National Council Against Smoking (NCAS) Chairperson based in JHB.