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.
More 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.