Vaping, opportunity or threat? Against a backdrop of lobbying and medical uncertainties, the battle rages

The WHO is currently adopting a wary stance towards vaping, refusing to affirm that it is less risky than cigarettes. The debate between opponents and defenders of electronic cigarettes is lively

As a WHO summit approaches, a simplistic confrontation between opponents and defenders of vaping, the latter sometimes supported by the tobacco industry. The research remains nuanced. Starting Monday in Panama, most countries will be brought together by the World Health Organization (WHO) to revise an international treaty against tobacco. “New tobacco products […] will probably be one of the main subjects discussed,” warned Adriana Blanco Marquizo, responsible for tobacco control at the WHO, at a press conference on Tuesday.

The most emblematic innovation remains the electronic cigarette, twenty years after its appearance and a good ten years since the real start of an immense commercial boom. An essential difference from cigarettes, the “vapoteuse” does not contain tobacco but a liquid, generally loaded with nicotine and inhaled in the form of vapor. There is no tar or carbon monoxide, the main culprits of the countless cancers and cardiovascular diseases linked to smoking. The risks are, therefore, a priori much lower.

Influence struggles

However, the WHO has so far distinguished itself by a radically suspicious posture towards vaping. The organization refuses to claim that it is less risky than cigarettes. This position, shared by a number of anti-tobacco associations, is based on a precautionary principle. Since almost no one has more than ten years of vaping under their belt, it is too early to rule out big long-term risks. Along this line, around thirty countries have banned vaping, such as India and Mexico.

These positions are ardently opposed by a host of pro-vaping organizations. They denounce a missed opportunity to promote a better option than cigarettes, the risks of which are well proven. Who is leading this offensive? Partly the traditional tobacco industry which, after being slow to react to this revolution, has invested heavily in vaping and other new products.

In October, the Guardian daily revealed a message from a senior manager of the tobacco company Philip Morris, who ordered his teams to fight against the WHO’s “prohibitionist” program on “smoke-free” products. When questioned, Philip Morris said it was responsible for “presenting to governments and the media the value of innovation in reducing smoking rates more quickly”. This type of lobbying goes beyond the Panama summit. According to several anti-tobacco organizations, it has been available for a long time in many countries.

“Very complex” situation

In the United Kingdom, between 2021 and 2023, “we have documented numerous interactions between the tobacco industry and legislators, and the vast majority concern vaping, other new products and their regulation,” reports Tom Gatehouse, researcher to Tobacco Tactics, an organization linked to the University of Bath. A way, according to him, to regain influence by improperly positioning themselves as players in the fight against tobacco, while the sector still largely draws its income from cigarettes.

However, Tom Gatehouse admits that the situation is “very complex” because pro-vape lobbying is also carried out by producers and resellers of electronic cigarettes, whose interests sometimes diverge from the tobacco industry. If some pro vape organizations are linked to it, others insist on their independence. “For some, there is a form of honesty and they really consider that vaping is a solution to smoking,” admits, in France, Amélie Eschenbrenner, spokesperson for the National Committee against Smoking, citing the Sovape association.

Among the major differences between these players, she notes that the tobacco majors knowingly maintain confusion between electronic cigarettes and heated tobacco, a product probably more dangerous than e-cigarettes. However, according to Amélie Eschenbrenner, even sincere defenders of vaping use scientifically unfounded speech, particularly when they oppose measures intended to protect adolescents such as the ban on flavors. Or that of disposable vaping devices, “puffs”, recently announced in France and the United Kingdom.

Useful for weaning

A review of the research provides rebuttals to both camps. Contrary to what pro-vaping people say, no study with serious methodology supports the idea that a ban on flavors would discourage smokers from switching to vaping. Conversely, anti-vaping advocates, starting with the WHO, downplay its promises as a cessation tool for smokers. There is “strong” evidence that electronic cigarettes are more effective for quitting smoking than nicotine patches, according to a highly respected organization in the scientific world, Cochrane, which compiles numerous studies and regularly updates its conclusions.

There remains a difficult question to resolve: is vaping, booming among young people in several countries such as France, leading them to switch to cigarettes? This is one of the main arguments of anti-electronic cigarettes. “We have clearly been able to show that young people who vape are more likely to smoke afterwards, but the cause and effect relationship is disputed,” says Jamie Hartmann-Boyce, who has supervised several studies on smoking for Cochrane.

In view of these data, the medical community, particularly in the Anglo-Saxon world, is instead calling for vaping to be preserved as a promising cessation tool, while limiting its consumption beyond that, particularly among young people. “If someone gives up cigarettes for vaping, they greatly reduce their risk of early death or disability”, but “we will also have to encourage them in the long term to give up electronic cigarettes”, summarizes Nicholas Hopkinson, professor of pulmonology at Imperial College London.