The rise of emerging tobacco products (ETPs) (ie, e-cigarettes, vaping, heated tobacco products) has added a new dimension to the already murky waters surrounding tobacco control. This is particularly true in the case of developing nations, such as Bangladesh, where a burgeoning youth population and a declining smoking trend, have made these markets too tempting for Big Tobacco to ignore.
Narratives of misinformation
While the industry-sponsored “ruckus” claiming ETPs being “safer alternatives” to traditional tobacco products is at its peak, history shows that the tobacco industry has never stopped pushing so-called “healthier” or “safer” options among its products to deceive consumers.
For decades following the release of monumental 1964 US surgeon general's report on smoking and health which established smoking as cause of cancers and other deadly ailments, the tobacco industry introduced a wide array of products, such as “low-tar cigarettes,” or “light,” “ultra-light” and “mild” alternatives, and aggressively promoted supposed health benefits of switching to these brands.
However, scientific evidence established that reduction in tar and nicotine only leads smokers to engage in “compensatory” smoking leading to higher level of exposure to deadly toxicants. Even the introduction of modified filters led to higher rates of lung adenocarcinoma.
In 2006, US District Judge Gladys Kessler exposed decades of lies and trickery employed by the tobacco industry and stated that “[tobacco industry] falsely marketed and promoted low tar/light cigarettes as less harmful than full-flavour cigarettes in order to keep people smoking and sustain corporate revenues” and added that “low tar/light cigarettes offer no clear health benefit over regular cigarettes.”
With this history in mind, one may easily come to the absolute conclusion that ETPs are only the latest addition to tobacco industry’s deception and duplicity.
The transition argument falls flat
In Bangladesh, the debate surrounding ETPs intensified as the Ministry of Health and Family Welfare (MoHFW) introduced an amendment to the tobacco control law, the Smoking and Tobacco Products Usage (Control) (Amendment) Act, 2013, which proposes a ban on the production, import, export, storage, promotion, and sale of electronic nicotine delivery systems (ENDS) and imposes imprisonment of six months or a financial penalty of Tk2 lakh for violation.
This was met with backlash from a number local and international pro-vape groups. Since the release of preliminary draft of the proposed amendment on June 19, 2022, at least three press conferences were held by Bangladesh Electronic Nicotine Delivery System Traders Association (BENDSTA); numerous webinars were held by BENDSTA's online-based activists' group Voice of Vapers (VoV).
Reports and articles, mostly penned by industry-sponsored front groups, lobbyists and sometimes by so-called experts with questionable credentials, have been flooding the webosphere: All criticizing the proposed amendment of limiting the freedom for the consumers to choose his/her options and restricting access to a “safer alternative.”
A recent article, encapsulated all core arguments of pro-vape groups against the amendment and even raised the allegation that the proposed ban on ETPs is a result of several international NGOs meddling in the internal affairs of Bangladesh.
At the very heart of the arguments, presented by the aforementioned article and narrative propagated by pro-vape groups, lies the claim that a ban on e-cigarettes, vaping, heated tobacco products would hurt smokers trying to transition from traditional combustible cigarettes to these so-called “safer alternatives” or “quitting tools” and that such transition, supposedly supported by scientific evidence, would benefit users by exposing them to less toxicants.
However, mounting scientific evidence and global experience would beg to differ. The World Health Organization (WHO) in its report on the global tobacco epidemic 2019 identified e-cigarettes and other emerging tobacco products as “harmful” and refuted the claims of potential health benefits, “the available evidence does not support the tobacco industry’s claim that these products are less harmful relative to conventional tobacco products.”
It should also be taken into account that in its 2021 report, WHO also did not change its position, as the report says, “Some of the nicotine and tobacco products fast emerging in different markets -- including ENDS, heated tobacco products (HTPs) and nicotine pouches -- pose serious health concerns.”
The 2016 report by US surgeon general, the first such report issued by any US Federal agency, also marked e-cigarettes and other such products containing nicotine as “unsafe.” While most pro-vaping media pieces praise the US’ regulation-based approach to e-cigarettes and vaping, the 2018 advisory on e-cigarette use among youth released by the US surgeon general declared e-cigarette use among American youth an “epidemic” and called for immediate meaningful action.
American Lung Association, in its statement, also deplored the Food and Drug Administration's (FDA) failure to make timely action to rein the menace. FDA’s failure eventually led to the 2019 outbreak of EVALI (e-cigarette, or vaping, product use associated lung injury) which caused at least 68 deaths all across the US. It is plausible to suggest that Bangladesh and other developing countries take note of the FDA’s stance and follow the agency’s footprints.
Targeting the next generation
Another concerning aspect which tobacco industry and pro-vaping groups willfully ignore is that most emerging tobacco products are marketed targeting children and young adults, thus easing the entry of susceptible youth into the deadly realm of tobacco addiction.
A report from US Centre for Disease Control (CDC) shows that the highest percentage of e-cigarette users lies in the 18-24 age group. This sharply contrasts the claim that ETPs are primarily quitting tools aiding the existing smokers. It may also baffle any reasonable mind as to why a product, which supposedly helps long-term smokers quit, is being marketed in at least 15,000 types of flavours, most of which are enticing to children and teenagers, such as candy, chocolate, cherry, bubble gum and so on.
The harsh reality is e-cigarettes, vaping and other ETPs are primarily tools for the tobacco industry to groom youth and turn them into replacement smokers in the long run. A growing body of research strongly warns of a “gateway effect” which suggests that “never-smoker” children and young adults hooked on e-cigarettes and vaping are at least three times more likely to switch to traditional combustible cigarettes.
A UK-based study, conducted among 10-25 y/o demographic, shows that the likelihood of e-cigarette users switching to traditional smoking rose over time from 14% in year one to 27% in year five.
Another study states that, “the products may be a gateway to smoking initiation or nicotine dependence among nicotine‐naïve users or may prolong continued dual use of tobacco among cigarette smokers.”
Global regulation against ETPs
It should be noted that the UK, which saw a 400% jump in the prevalence of vaping between 2012 and 2023, has recently declared a ban on the sale and supply of single use vapes to curb this concerning rise of vape use among the youth.
A total of 34 countries, including India, Sri Lanka, Thailand, Malaysia, Singapore, have already declared a complete ban on the production, import, sale, and marketing of ETPs. The interim government of Bangladesh has already incorporated e-cigarettes and vaping to the list of prohibited items in the import policy order by the Ministry of Commerce.
In addition, international NGOs collaborating with government bodies or local NGOs for knowledge and experience sharing to ensure economic, public health and social development of the country are well-recognized global practices. T
he allegation of INGOs meddling in the passage of the amendment to ensure the proposed ban is far from truth. The initiative to amend the tobacco control law was taken by the Ministry of Health and Family Welfare (MoHFW) in 2021. The draft amendment has been prepared following all due processes, as it is based on globally recognized best practices, assessment of public opinion, stakeholder consultation, and decisions taken during inter-ministerial meetings.
In contrast, pro-vaping international actors have inserted themselves in the ongoing debate surrounding the future of ETPs in Bangladesh far more often, compared to those external factors supporting the proposed ban.
On July 1, 2022, a group of 17 so-called public health experts, belonging to organizations with multi-faceted links with the tobacco industry, sent letters to the MoHFW referring e-cigarettes as “safe alternatives” and urged the government to withdraw its proposed ban. On May 27, 2023, local pro-vape group, Voice of Vapers (VoV) Bangladesh and Asian Harm Reduction Alliance (AsHRA) organized a summit and a roundtable, events that were supported by Foundation for Smoke-free World (FSFW), a PMI-funded front group.
Following these events, on May 31, 2023, a full-page supplement was published in a national daily, heavily promoting ENDS, that include two opinion pieces: One from Dr Derek Yach, the president of PMI-funded FSFW and one from Dr Marewa Glover, a well-known harm reduction lobbyist associated with FSFW.
Moreover, local pro-vape group Voice of Vapers is affiliated with World Vapers’ Alliance, a US-based organization secretly funded by British American Tobacco (BAT), as an investigation suggests.
Protecting Bangladesh’s future
The 2024 July Uprising in Bangladesh has, once again, reminded the world of the infinite power and vigour of the youth. Bangladesh is currently going through the phase of demographic dividend, meaning that the productive portion of the population is much larger than the dependent portion.
Unfortunately, it also makes Bangladesh susceptible to the greedy prying eyes of tobacco companies who see Bangladesh only as a potential market to expand in. The future of the country largely depends on how skillfully Bangladesh avoids the ill tactics and disinformation campaign of the tobacco industry and promptly adopts action to safeguard and improve its public health.
ABM Zubair is Executive Director of PROGGA (Knowledge for Progress). Email: [email protected]
