On World No Tobacco Day the International Union Against Tuberculosis and Lung Disease (The Union) advocates for the banning of e-cigarettesand heated tobacco productsalesin low-and middle-income countries

Ahead of World No Tobacco Day next Sunday, May 31, The Union has today publicly advocated for the prohibition of the sale of e-cigarettes and heated tobacco products (HTPs) in low-and middle-income countries (LMICs), which are home to more than 80 percent of the world’s smokers. The Union’s support of the ban is based on the release today of its new position paper, ‘Where bans are best: Why LMICs must prohibit e-cigarettes and heated tobacco product sales to truly tackle tobacco’.

The Union’s position paper is released as this year’s World No Tobacco Day theme turns the spotlight on the tobacco industry’s targeting of a new generation of young people with cigarettes and novel tobacco products,and with health systems in LMICs being further strained by the COVID-19 pandemic.

The position paper analyses scientific evidence documenting the health impact of novel nicotine products and cautions governments in LMICs to get ahead of the commercial incentives driving novel tobacco product producers to hook new users and expand the nicotine market in their own countries.

“The vast majority of LMICs are still contending with very serious tobacco epidemics,” said Dr Gan Quan, Director of Tobacco Control at The Union. “Introducing new, highly addictive products into these environments will overwhelm governments, stress already overburdened health systems, and distract from urgent implementation of the World Health Organization(WHO)’s Framework Convention on Tobacco Control (FCTC)and related MPOWER measures.

”E-cigarettes and HTPs are enormously lucrative businesses; the former was worth US $15 billion in 2018, and HTPs are expected to be worth nearly US $18 billion by 2021. In its 2019 report on the global tobacco epidemic, the WHO noted that there is “insufficient evidence to support the use of [e-cigarettes] as a population-level tobacco cessation intervention to help people quit conventional tobacco use” and also noted that these products are “undoubtedly harmful.”

To date,the discourse on the net public health impact of e-cigarettes and HTPs has been limited to and largely focused on high income countries. “Where bans are best” expands the narrative, emphasising that novel nicotine product policy must be context specific. In low-and middle-income countries, rapid roll out of new products will have deleterious effect, particularly for young people.

Low-and middle-income countries have traditionally been a playground for big tobacco and are presently home to more than 80percentof the world’s smokers.

“The data continue to emerge on e-cigarettes and HTPs,” said Dr Gan Quan.“But what we already know suggests a looming, new epidemic,and youth will be its face. In an abundance of caution, The Union believes policy makers should embrace the precautionary principal, which urges preventative action. For LMICs, that means e-cigarette and HTP sales bans.”