With prohibition, illegal market boosts electronic cigarette consumption

Around 2.9 million Brazilians use electronic cigarettes regularly. The conclusion is from a survey by Intelligence in Research and Consulting (Ipec), with interviews carried out between July and October 2023. The number is almost six times higher compared to the first survey of its kind, carried out in 2018, when 499 thousand consumers declared who had had contact with the product in the 30 days prior to the survey.

Data from 2023 also indicate that around 6.3 million adults who smoke industrialized cigarettes have had at least one contact with these electronic devices in their lives, equivalent to 29% of all smokers. In 2019, this number was 3.6 million, according to Ipec.

These people have access to electronic cigarettes despite them being banned in Brazil. In 2009, the National Health Surveillance Agency (Anvisa) decided that these products cannot be sold in the national territory. The decision has remained in force since then.

Public consultation will reassess ban

In December 2023, a public consultation was opened to re-evaluate the issue. It remains active until February 9th. “Any interested person will be able to send contributions or comments on the proposed regulation, within this 60-day period. At the end of the suggestion period, Anvisa will evaluate the contributions and publish the public consultation report on its portal”, informs the agency, via press office.

Still, electronic smoking devices are easily found in airport stores, shopping malls, beach huts – and in e-commerce. Created in 2003, the different devices that vaporize liquid solutions containing nicotine are sold in more than 80 countries, while approximately 30 prohibit them, such as Brazil.

In the nations where they are released, such as the United States, Canada, United Kingdom, Portugal, Italy and Japan, there are rules for the content of the devices, standards for marketing and sanctions provided for in cases of non-compliance with the determinations.

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. In Brazil, the debate about whether or not to release sales is heated and divides experts.

In favor of prohibition

“The electronic cigarette is a modern form, with new packaging, of the same product”, says Vera Lucia Gomes Borges, technologist at the Division of Smoking Control and Other Risk Factors (Conprev) at the National Cancer Institute (Inca).

“It does not reduce nicotine exposure, has a dangerous appeal to young people and, contrary to what the industry says, does not work to reduce the harm caused by smoking.” For her, the ban is the correct decision, and should be maintained. “Brazil has adopted effective public policies to reduce harm since the 1990s”, reinforces Ricardo Meirelles, president of the Anti-Tobacco Commission of the Brazilian Medical Association (AMB).

“Electronic cigarettes are so dangerous that they already have a disease to call their own, Evali,” he says, referring to a new type of lung injury associated with electronic cigarette use, identified for the first time in 2019, in the United States. . The “Evali crisis” was caused in 2019 by the use of vitamin E acetate as a diluent for THC – the active ingredient in marijuana – in illegal or adulterated vaporizers. The substance is banned in electronic cigarettes legally sold in the country.

Regarding smuggling, the solution, for Meirelles, is to reinforce control. “These products are, for the most part, from abroad. They enter through ports and airports. It is necessary to improve supervision and enforce current regulations, which provide for prohibition.”

Action against illegal products should be accompanied by educational actions. “What is missing are measures to raise awareness among the population, especially young people. It is necessary to maintain the ban, with awareness, so that people understand that electronic cigarettes are harmful. It seems painless, has a pleasant taste, has no smell, but it can be even more harmful than traditional cigarettes. Nicotine is a very powerful drug.”

Against the ban

Alessandra Bastos Soares, a pharmacist working as a technical manager in companies in the pharmaceutical sector and former director of Anvisa, is in favor of regulation that allows control of what is sold and how marketing and communication actions are carried out – in addition to trying to limit the access to minors. “Anvisa is being a denialist by taking a stand in favor of maintaining the ban on this product. The rule exists: prohibition. But it doesn’t work. And a rule that doesn’t work is useless,” she criticizes.

“There is a large volume of scientific evidence that indicates that electronic cigarettes are, indeed, a harm reduction tool for nicotine consumers. We have before us a health crisis, caused by the consumption of a product over which there are no standards, no controls.”

The regulation and commercialization of products already released in more than 80 countries could also generate tax collection. “We know that nicotine addiction is a serious problem. But other products that represent harm reduction, such as non-alcoholic beer and sugar-free soft drinks, are authorized and regulated. Meanwhile, people don’t know what they are ingesting. The public authorities are omitting their role of monitoring and regulating.”

For David Sweanor, a Canadian specialist in tobacco control, awarded by the Pan American Health Organization of the World Health Organization (WHO), the risk reduction provided by electronic cigarettes is proven. “Cigarettes are an extraordinarily deadly product because they require repeated inhalation of smoke, it is this smoke that causes the enormous level of deaths and illnesses”, he says – for him, nicotine, present in electronic cigarettes, represents a lower risk to health .

Sweanor claims that countries that regulated electronic models have experienced a drop in cigarette consumption, such as Japan, Sweden, Norway and New Zealand. “If we can empower people who smoke cigarettes to replace them with non-combustible alternatives, such as electronic cigarettes, we would achieve one of the greatest advances in the history of public health.”

Ipec research methodology

Quantitative research with 51,575 interviews, carried out with the Brazilian population aged 18 to 64, residing in urban areas of municipalities with 20 thousand inhabitants or more. This sample represents 77% of Brazilian men and women aged between 18 and 64 years old. The interviews were carried out in person.