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Regulating e-cigarettes: how the world is doing it

Regulating e-cigarettes: how the world is doing it

Close to 70 countries around the world are regulating the use of electronic cigarettes as well as how they can be sold and advertised. More commonly known as e-cigarettes, the devices are subjected to four common regulation methods:

• sale bans,
• restrictions around its use,
• age-of-purchase requirements, and
• advertising and promotion bans.

But other regulatory mechanisms that are used include alerts, circulars, decisions, decrees, notifications, orders, ordinances, rulings and statements.

Some countries are regulating e-cigarette products with legislation written before e-cigarettes were on the market. A few were applying a tax to the devices.

According to a study published in the Tobacco Control journal, e-cigarettes are gaining popularity across the world with at least 1.5% of the world’s population using the devices. Global sales for the devices are estimated at US$ 3.5billion compared to global tobacco sales estimated at US$698billion with more than 5.5trillion cigarettes sold to more than a billion people worldwide.

International classification recommendations

In 2013, the World Health Organisation’s Tobacco Free Initiative issued a report to help countries develop policies to regulate e-cigarettes. It recommended that e-cigarettes face the same restrictions that conventional cigarettes have. This includes using it where conventional cigarettes are prohibited, selling it to anyone who can’t legally by cigarettes and advertising it in places where conventional cigarettes have been restricted. In addition, the report suggested to ban the:

• co-branding e-cigarette products with cigarettes or marketing in a way that promotes dual use,
• use of characterising flavours in e-cigarettes, particularly candy and alcohol flavours,
• companies from making claims about tobacco-use cessation until manufacturers could provide sufficient evidence the devices could be used effectively for cessation, and
• e-cigarette companies from making health claims about their products unless approved by appropriate regulatory agencies, and
• calls for the development of standards for regulating product ingredients and functioning.

The devices are marketed as an alternative to conventional cigarettes, which can be used where cigarettes can’t.

Different perspectives

The study found that countries regulated e-cigarettes based on their classification either as tobacco, medicinal or consumer products. Some countries used more than one classification for e-cigarettes and this resulted in it having multiple regulatory approaches for the products. For example, in Thailand, devices could be classified as e-cigarettes, medicinal products or products that imitate tobacco depending on which regulation is applied.

A survey by the World Health Organisation shows that out of 90 countries, 22 classified e-cigarettes as tobacco products because it contained nicotine while 12 countries classified e-cigarettes as therapeutic products and 14 countries called them “consumer products”.

“Of the countries identified regulating e-cigarettes, about a third do not have regulations specifically written for e-cigarettes, rather they apply existing tobacco control regulations to these products. This may or may not be consistent with the intent of the original laws,” the study stated.

When new or amended policies regulated e-cigarettes, they were generally being classified as ‘e-cigarette’, or ‘electronic cigarette’, or ‘electronic smoking device’ or ‘ENDS’. But those that were using existing legislation to regulate e-cigarettes, classified the devices as a range of products. This included tobacco, tobacco derivatives, tobacco imitation products, consumer goods, chemical mixtures, drugs, medicinal products or devices and/or poisons/hazardous substances.

The devices are often classified as medical devices if the manufacturer makes a claim associated with health.

There are several areas within e-cigarettes that could be regulated:
• manufacturing,
• distribution,
• importation,
• sale including where sales are allowed and minimum age of purchase,
• use restrictions including vape-free public places,
• advertising, promotion, and sponsorship,
• taxation,
• trademark,
• health warning labelling,
• ingredients/flavours,
• safety/hygiene,
• reporting/ notification,
• nicotine volume/concentration, and
• child-safety packaging (table 1).

Some countries, all in Europe, have introduced policies to address flavourings of the devices. “This is important given that there is evidence that some chemicals used to flavour e-liquids, including diacetyl, are associated with lung disease,” the study noted.
But there were no policies regulating e-liquid ingredients beyond nicotine. And outside the European Union, there were only a few policies regulating e-cigarette sponsorship.

According to the study, Venezuela prohibits the registration of e-cigarettes as a brand/patent and its sale is banned in 23 countries including Argentina, Bahrain, Singapore, Seychelles and Switzerland. In addition, Austria, Denmark, Fiji, Finland, France, Germany, South Africa, the United Kingdom, and the US are among the countries that insist on market authorisation for the devices.

Many of those that do sell e-cigarettes have a minimum age of purchase policy. These are in line with conventional cigarettes. Honduras, for example, only allows people over the age of 21 to buy e-cigarettes .

In 25 countries e-cigarettes cannot be used in enclosed public spaces such as bars, restaurants and other workplaces. And Advertising and promotion of e-cigarettes are banned in 35 countries. “Some countries did not have explicit advertising and promotion bans, but contend that such bans are inherent within their bans on sale, including Argentina and Australia,” the study noted,

The study identified 14 countries that require e-cigarettes to have a health warning label and 13 that regulate ingredients and flavours that can be used in e-cigarettes.

But it found that health warning labels presented an “interesting” challenge for e-cigarettes because there is a wide variety of devices and packaging. In addition, there is little understanding about the content of the health warnings.

Italy, Latvia, Portugal, Republic of Korea, Togo and the UK apply a tax to e-cigarettes.

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Better graphic warnings on smoke packs but Africa is still lagging behind

Better graphic warnings on smoke packs but Africa is still lagging behind

20161207_020910More countries  across the world are demanding bigger warnings that feature pictures showing exactly how detrimental smoking can be. And governments are becoming more emboldened to call for plain cigarette packaging.

In Africa, however, only 10 of the 52 countries have pictorial warnings on the packages of cigarettes that get sold.

According to the fifth cigarette package health warning status report, internationally there has been  tremendous progress in countries implementing pictorial health warnings on cigarette packaging. Released by the Canadian Cancer Society, the report  provides an overview of cigarette pack warnings and ranks countries based on how well they have been able to implement pictorial health warnings.

Nepal, which requires cigarette manufacturers to to use pictorial health warnings that cover 90% of the front and back of the pack, is the highest ranked country.  India, Thailand, Australia Sri Lanka and Uruguay were also among the top 10 countries with significant health warnings.

“Well-designed package warnings are a highly cost-effective means to increase awareness of the health effects and to reduce tobacco use. Pictures can convey a message with far more impact than a text only message can. The effectiveness of warnings increase with size,” the report states.

What the obligations are

Article 11 of the World Health Organisation’s frameworkconvetion on tobacco control, the global tobacco control treaty,  calls formal packages to carry health warnings which describe harmful effects of tobacco use  or other appropriate messages. These messages should cover at least 50% of the principal display area and should not cover less than 30%.

The messages must be in a national language and there must be several messages that are rotated.  They should be printed on both the individual packets as well as the cartons and other packages sold to consumers.

“Where tobacco advertising is not yet banned, tobacco companies use colour pictures in tobacco advertising. The tobacco industry has often printed colour pictures on packages. If tobacco companies have used pictures to promote tobacco products, then governments should be able to use pictures to discourage tobacco use,” the convention states.

More than 100 countries across the world have pictorial warnings. At least 50% of the countries who have ratified the treaty require warnings that cover 50% of the front and back of the package.

Some changes

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There has been progress since the last report in 2014. The Indian government has increased the size of the pictorial warnings from 20% of the pack to cover 85% of the pack.

There are also 14 countries where plain packaging is in process under formal consideration: New Zealand, Ireland, Norway, Slovenia. Canada, Uruguay, Thailand, Singapore, Belgium, Romania, Turkey, Finland, Chile and South Africa.

In Africa, South Africa is latest country  to consider graphic health warnings. Ten African countries have pictorial health warnings: Chad, Kenya, Madagascar, Mauritius, Namibia and the Seychelles. Cameroon, Ghana, Gabon and Togo.

Mauritius was first to implement the graphic pictorial warnings in Africa introducing the mechanism in 2009.  Madagascar came on board in 2012 while the Seychelles brought the first round of pictorial warnings in 2013 and revised them in 2016. Chad and Namibia introduced the mechanism in 2015 and Kenya started  implementing pictorial warnings earlier in 2016.

In the region Chad has the largest picture warning covering 70% of the back and front of the cigarette pack. Togo, Mauritius and Namibia all have picture warnings exceeding 50% and  are also considered better.

Plain packaging

In addition to improved graphic health warnings on cigarettes, there has also been an increased momentum around plain packaged cigarettes. According to the report, four countries have finalised requirements for plain packaging but 14 more countries are in the process of requiring plain packaging.

Australia implemented the policy in 2012  while France and the UK implemented it at manufacturer level in 2016. Hungary will implement by 2018. Those who are still in the process include New Zealand, Ireland, Norway, Canada, Slovenia Uruguay and Thailand among others. But Kenya, the Gambia Botswana and Brazil have expressed support to implement plain packaging in the future.

 

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