Public consultation reopens debate on electronic cigarette legalization

The National Health Surveillance Agency (Anvisa) released the results of a public consultation on the 2009 determination that prohibits the sale of electronic cigarettes in Brazil. The data will be included in a technical study on the possible repeal of the standard.

The agency received almost 14 thousand contributions, 98% of them from individuals. Of the total, 59% said they had “another opinion” about the rule prohibiting electronic cigarettes, 37% agreed that the rule should be kept as is and another 4% did not respond. Regarding the impacts of the current standard, 58% say they are negative, 37% positive and 5% point out positive and negative points.

The survey was carried out between December 12, 2023 and February 9, 2024, and there is no deadline for Anvisa’s position.

The arguments for and against legalization

Over the past decade, research has emerged in other countries regarding the possibility of using electronic cigarettes as a harm reduction strategy, considering that a significant portion of the potentially carcinogenic substances in a traditional cigarette are emitted when the cigarette is burned at temperatures which reach 950°C – vaporizing a liquid containing nicotine would minimize the chances of developing tumors.

In the United Kingdom, where electronic models are used as a public health measure for patients who are unable to give up traditional cigarettes, the Department of Public Health identified a drop in the smoking rate, from 16% to 11%. And concluded in 2015 that the devices can be up to 95% less harmful than conventional industrialized cigarettes. On the other hand, in the United States, where sales are also authorized and regulated, Evali was identified in 2019, a new type of lung injury associated with the use of adulterated electronic cigarettes.

The topic generates fierce debates. Some medical associations in Brazil are against the release of commercialization, claiming that these products attract a young consumer and continue to deliver nicotine, an addictive drug. “Brazil had an extremely positive result in reducing the number of smokers. Brazil had approximately 40% of smokers until about 25 years ago, and today the rate is just over 10%”, says Margareth Dalcolmo, president of the Brazilian Society of Pulmonology and Phthisiology (SBPT).

“Electronic cigarettes are more harmful to the population, especially young people, teenagers and even children. There is no control over the concentration of nicotine, which is the most addictive chemical. There are hundreds of other odorizing and flavoring chemical substances. It is a threat to the health of young people and children”, says Dalcolmo.

For doctors like Rodolfo Behrsin, a pulmonologist, on the other hand, a ban is not the best path. “A pure and simple ban doesn’t work, electronic cigarettes can be purchased anywhere in Brazil”, he claims. “Sweden has implemented a distribution program for combustionless nicotine consumption devices. The result, in approximately a decade of the program, was a 40% reduction in tobacco-related cancer cases and a 38% reduction in overall cancer mortality. It is close to being considered a tobacco-free country, which is when less than 5% of the population smokes tobacco.”

Nicotine is not the most toxic substance in cigarettes, although it is responsible for generating dependence and the sensation of pleasure. “The idea in harm reduction is to reduce toxic substances, considering that electronic cigarettes are not completely innocent,” says Behrsin. The ideal is not to use cigarettes at all, he claims. But approximately 20 million Brazilians smoke. “We have to be pragmatic. Many people are unwilling or unable to stop. And electronic cigarettes represent a viable risk reduction strategy, adopted in more than 80 countries.”

Change may occur by bill

Another possibility to debate the topic is via the National Congress. Recently, a project by Senator Soraya Thronicke (Podemos-MS) reached the Senate, which provides for the regulation of electronic cigarettes in Brazil. The proposal was presented after a public hearing held in September to debate the issue. The project includes an estimate that the ban prevents tax collection of around R$5 billion per year.

For the senator, regulation would also be important due to the increase in the number of users of products that are currently sold clandestinely and without sanitary control.

“Thus, the Brazilian position of simply banning sales, imports and advertising is the same as covering the sun with a sieve. The use of electronic cigarettes is growing and their users do not receive any type of protection or guidance from the State “, says the senator in the justification of the proposal. If the text is approved, the measure would oblige Anvisa to monitor the industry’s performance.

This Wednesday (13), the Senate plenary approved a request from Senator Eduardo Girão (Novo-CE) to hold a debate session on the topic, with no date yet set.

The industry’s vision

Lauro Anhezini Junior, head of scientific and regulatory affairs at BAT Brasil, argues that the industry is in favor of regulation, so that consumers do not depend exclusively on contraband. “We are an industry that has evolved, like many others. We have well-developed, peer-reviewed science published in scientific journals. We defend responsible consumption, for those over 18 years of age, and the prohibition of flavors that appeal to minors.”

For him, which emerged two decades ago, electronic cigarettes represent a “high level of safety”, as long as the consumer knows what they are buying. “The current situation is that Anvisa pretends to prohibit it and the population pretends to believe it.”

Junior considers Senator Thronicke’s project well resolved in terms of guaranteeing access to safe products. “On the day that marketing is authorized, we are ready to request the registration of safe products, which, in the United Kingdom, have already represented savings of 300 billion pounds in public health spending.”