To vape or not to vape

Thousands of people are getting hooked on vaping in Bangladesh, marketed as a “safer” alternative to conventional cigarettes despite numerous health warnings from health experts.

Aggressive marketing by the e-cigarette companies and their local vendors has helped spread its use among many non-smokers. But it has not been around long enough for the long-term effects to be known. E-cigarettes heat a liquid into an aerosol or vapour cloud that is inhaled by the user, typically delivering doses of nicotine to the lungs.

In a 2019 report, the Tobacco Induced Diseases estimated the number of tobacco users in Bangladesh to be around 37.8 million and 0.2 per cent of them are addicted to e-cigarette.

Sumon Ahmed, who has been using e-cigarette for the last couple of years, said that he started vaping to quit smoking and considered it to be a “safer alternative”.

“Vaping tastes and smells better than the traditional cigarettes. I am using e-cigarette to quit cigarette,” he said, dubbing vaping “more enjoyable” than regular cigarettes.

In a report released last year, the World Health Organization noted that advertising, marketing and promotion of e-cigarette had grown rapidly. But much of the marketing around these products gives rise to concern about deceptive health claims.

“E-cigarettes do not contain tobacco but are harmful to health and are not safe,” it concluded.

Conflicting studies

Data from Euromonitor International put the global market for e-cigarettes at $15.7 billion in 2018 and projected that it would more than double to $40 billion in 2023.

Some of the prominent players in e-cigarette market are – British American Tobacco, Japan Tobacco Inc, Imperial Brands, International Vapor Group, Philip Morris International Inc, R J Reynolds Vapor Company, Shenzhen IVPS Technology Company Limited, Shenzhen IVPS Technology Company Limited, NicQuid, Shenzhen KangerTech Technology Company Limited and Shenzhen IVPS Technology Company Limited.

There have been some researches since vaping first took off more than a decade ago but they offered different views. While some insisted that vaping is harmful to health, others advocated their use as a “safer alternative” that helps smokers of conventional cigarette quit.

Interestingly, the potential long-term effects of e-cigarette consumption have been hardly investigated.

Health risks

In July last year, researchers from the University of Tasmania wrote in the European Respiratory Journal that there was evidence “all electronic nicotine-delivery systems may put users at greater risk of succumbing to coronavirus”.

E-cigarettes are also damaging to lungs. A US study published in August last year suggested that young people who use e-cigarettes are “five to seven times” more likely than non-smokers to be infected with coronavirus.

A 2019 study by scientists from the New York University on a small cohort of mice suggested that long-term exposure to vaping liquids that contain nicotine could increase the risk of cancer.

Another study conducted in the same year by scientists at the University of Adelaide suggested that vapour from e-cigarettes can kill off cells which line human airways and are important for keeping the lungs and airways clean. They also found that the vapour could interfere with the immune system.

In May this year, a study presented at the American Thoracic Society 2021 International Conference noted that the current e-cigarette use is associated with significantly increased odds of having asthma.

A 2017 study conducted by researchers at the Virginia Commonwealth University and published in the PLOS One journal found that smoking e-cigarettes during pregnancy could cause birth defects of the face and oral cavity.

The wide variety of available flavours in the market also attracts non-smokers to try vaping and eventually getting hooked on it.

Dr Graham Eyres of the University of Otago says that recent international research has shown that 74 per cent of commercial liquids in e-cigarettes contained diacetyl, with more than 40 per cent at concentrations higher than the recommended safety limits.

Diacetyl is used as a flavouring agent in foods but evidence suggests that it can be dangerous when inhaled, according to Harvard T.H. Chan School of Public Health.

USA’s Centers for Disease Control and Prevention says vaping causes fatigue, coughing, fever, trouble breathing, vomiting and diarrhoea associated with lung injury. Until February last year, the CDC reported 2,807 hospitalisation and 68 deaths linked with e-cigarette associated lung injury in the US.

Bangladesh in the dark

There has not been any study in Bangladesh on the effect of e-cigarette on human health. There is also no data on the number of vapers in Bangladesh and the market size. But the majority of the users appear to be young people.

Schumann Zaman, president of Bangladesh Electronic Nicotine Delivery System Traders’ Association (BENDSTA), said there are 14 vape shops in the capital affiliated with them. “Our sales volume is growing day by day. We think that people are taking up vaping to quit smoking more and more,” he said.

He uses a UK Department of Health and Social Care study to justify his claim. The study insisted that vaping is approximately 95 per cent less harmful than tobacco.

Sales of e-cigarettes and substandard liquid are common across the capital and some parts of the country.

Sajib, a salesman of Vapor Hub, said they usually sell vape products to people above 21 years of age.

“Our products mainly come from abroad. We have different types of products in our collection. The prices of our liquid range from Tk 50 to Tk 10,000,” he told The Business Post.

Acting before it’s too late

ABM Zubair, the Executive Director of anti-tobacco platform PROGGA, said, “Despite growing health concerns, the government’s bid to ban e-cigarette hasn’t materialised yet.”

India banned e-cigarettes in September 2019 considering the risks they pose.

“I think the government should immediately ban e-cigarettes as their sale and vaping have increased exponentially over the years,” Zubair said.

Professor Dr Abdul Wadud Chowdhury, the head of the cardiology department of Dhaka Medical College Hospital, was not convinced that vaping was a “safer alternative”.

“E-cigarettes are very harmful to health,” he told The Business Post.

He categorically pointed out that smoking raises blood pressure and causes heart attack and increases the risk of brain stroke.

“Cigarette reduces the effectiveness of medicines and so does e-cigarette. It also creates problems in the blood supply of the human body,” he added.

In December 2019, Shaikh Yusuf Harun, Secretary, Medical Education and Family Welfare Division, said that the government was “actively working to impose a ban on the production, import and sale of e-cigarettes and all vaping tobaccos to prevent health risks”.

There has apparently been no progress. The proposed national budget presented in parliament on June 3 did not mention anything about e-cigarette or vaping.

When asked about progress in formulating a policy for e-cigarette, Maidul Islam, the public relations officer of the Ministry of Health and Family Welfare, told The Business Post: “We are still working on the issue.”

“The government discourages the consumption and use of both tobacco and vape,” he said, dubbing the introduction of e-cigarette by cigarette companies a “sort of cheating”.