Does India's Ban on Electronic Cigarettes Improve Public Health Outcomes?

Abstract

In 2019, India banned Electronic Nicotine Delivery Systems (ENDS) – a broad category that includes electronic cigarettes, vaping devices, and Heat Not Burn (HNB) devices – because of concerns about health impacts, youth vulnerability, and their potential to undermine tobacco control efforts. This is a missed public health opportunity to reduce tobacco consumption, if ENDS actually help reduce and wean users off nicotine dependency in less harmful ways. This paper applies a risk analysis framework to examine whether India’s ban on ENDS improves public health outcomes, or whether an alternative approach such as regulation would be more effective. It studies global responses and compares how public health goals are served in the United States of America and the United Kingdom, based on four key parameters of concern – health impacts, normalisation of ENDS usage among non-smokers, appeal among youth, and device safety. This comparison demonstrates that the United Kingdom’s regulation-focused approach delivers superior outcomes across all four parameters. Thus, the evidence-based recommendation for India would be to regulate at least HNB devices under the Cigarettes and Other Tobacco Products Act (as they utilise tobacco), as this can help reduce harm and promote innovation in devices that can wean users off nicotine dependence.