With over 20 years of activity aiming to curb tobacco consumption, the European Network for Smoking and Tobacco Prevention (ENSP) has been closely following the development and transformation of tobacco and nicotine products, as well as their regulation at European and national levels.

According to the WHO Report on the Global Tobacco Epidemic 2019[1], the tobacco industry has introduced in recent years a wide array of new products, the majority of which simulate the act of smoking while typically delivering nicotine into the human body.

We welcomed the introduction of an entire article (Article 20), which lays down rules for electronic cigarettes sold as consumer products in the EU in the updated Tobacco Products Directive (2014/40/EU). At the time, ENSP and the European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) issued clear guidelines addressed to Member States supporting the implementation of Article 20 at national level.

To avoid renormalization of smokingwith the introduction of e-cigarettes across Europe, ENSP and EFA recommendedMember States to go beyond the requirements included in the Directive, by applying: (1)a general ban on advertising at the national level and not only when there is a cross-border effect; (2) a total ban on e-cigarettes use in all public places where smoking is not allowed; (3) an complete prohibition on flavours to limit the vaping uptake of children and young people; (4) a restriction on e-cigarettes sales to minors; (5) a comprehensive regulation on prices and; (6) an implementation of the Protocol to Eliminate Illicit Trade in Tobacco Products to e-cigarette trading.

To achieve the target of reducing the prevalence of tobacco use in Europe, ENSP systematically encouraged evidence-based smoking cessation treatments. ENSP adheres to the European Respiratory Society (ERS) position on Tobacco Harm Reduction[2]. We strongly dismiss the claim that it is in the interest of public health to replace a very harmful product like conventional cigarettes with potentially less, but still, harmful and addictive products, such as e-cigarettes. Reducing smoking-related health risks requires putting the focus on complete cessation.

It should also be stressed that the evidence showing the effectiveness of electronic cigarettes in helping people to quit smoking is not yet conclusive. On the contrary, electronic cigarettes have prolonged the addiction to nicotine of Europeans and their recent uptake by youth across Europe is of great concern.

ENSP took note of the six cases of confirmed e-cigarette use (vaping) related deaths in the United-States of America in the recent weeks, and the more than 450 possible cases of adults and youth experiencing e-cigarette related illness across the country. To date, no similar event has been documented outside the US. However, given the widespread availability of and easy access to e-cigarettes across Europe, such cases can potentially arise in European countries. We welcome the recent statement made by the Portuguese Society of Pulmonology[3]strongly advising against the use of e-cigarettes and we stand ready to support the spread of similar messages among other public health or healthcare professionals’ organisations from any EU Member States.

We support the WHO-FCTC Secretariat recent position[4]calling on the public health community and authorities to remain vigilant to the interference of novel and emerging nicotine and tobacco products. The FTCT highlights that allowing such products to penetrate national markets without adequate regulation could threaten the implementation of tobacco control strategies, as well as the undermining of the denormalization of tobacco use upheld by the Convention.  We welcome the Bloomberg Philanthropies project “Fight Flavoured E-Cigarettes” pledging $160 million to end youth e-cigarette epidemic in the US.

In Europe, ENSP will remain at the forefront of supporting advocacy efforts including legislative and regulatory measures aimed at preventing a new generation of Europeans from becoming addicted to nicotine and developing e-cigarette related illnesses, putting an additional burden on health systems across Europe.

In the current context of alarming levels of youth vaping, we have seen the senior US political leaders take a strong stance against e-cigarettes. We therefore urge Europe’s political leaders to take similar actions, highlighting the importance of the core precautionary principle with regards to public health.

We call on European policymakers to support clear, coherent and efficient actions against the rising e-cigarette use and encourage them to stand firmly on the path towards a tobacco-free Europe. Because when it comes to protecting the health of our children, we should leave no room for harm.

[1]https://www.who.int/tobacco/global_report/en/

[2]https://www.ersnet.org/advocacy/eu-affairs/ers-position-paper-on-tobacco-harm-reduction-2019

[3]https://www.sppneumologia.pt/noticias/surto-de-doenca-pulmonar-aguda-relacionada-com-o-uso-de-cigarros-eletronicos

[4]https://www.who.int/fctc/mediacentre/news/2019/remain-vigilant-towards-novel-new-nicotine-tobacco-products/en/#R4