The WHO Report on ENDS/ENNDS

It’s been rather busy outside of my vaper-sphere recently which has unfortunately led to a lot of things slipping, including this post. Many of you are aware that the World Health Organisation recently released all the documents for the upcoming tax-payer funded shenanigans to be held in India for Conference Of Parties #7 (COP7). There’s a number of documents that are of interest, some of which I’ll write about here but the main interest at the moment is the originally named document FCTC/COP/7/11 ‘Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS)’

When this document became public, there were a few that claimed the WHO had become more ‘supportive’ towards vapour products. The answer to that is…. not really. The WHO see vapour products (I flat refuse to call them ENDS or ENNDS – that’s tobacco control speak) as part of the overall ‘Endgame‘ to the “tobacco epidemic” – which, if you’ll remember from Chan’s opening statement at COP6 is more important than Ebola (emphasis mine):

Speculation is a very interesting hobby for many people. Some people speculated that I would not attend this meeting because I am so busy with so many other outbreaks of communicable diseases.
No. No. No. I will not cancel my attendance at this meeting because it is too important

Well we know how that all turned out don’t we? The WHO took substantially longer to combat Ebola than is strictly necessary because the FCTC COP6 was “too important”. Moving on to COP7:

If the great majority of tobacco smokers who are unable or unwilling to quit would switch without delay to using an alternative source of nicotine with lower health risks, and eventually stop using it, this would represent a significant contemporary public health achievement. This would only be the case if the recruitment of minors and non-smokers into the nicotine-dependent population is no higher than it is for smoking, and eventually decreases to zero.

Whether ENDS/ENNDS can do this job is still a subject of debate between those who want their use to be swiftly encouraged and endorsed on the basis of available evidence, and others who urge caution given the existing scientific uncertainties as well as the performance variability of products and the diversity of user behaviour.

The thing is, from the decision document on vapour products taken from COP6:

INVITES Parties, when addressing the challenge posed by ENDS/ENNDS, to consider taking measures such as those referred to in document FCTC/COP/6/10 Rev.1 in order to achieve at least the following objectives, in accordance with national law:

The WHO were, back in 2014, inclined to ‘suggest’ (which coming from the FCTC is tantamount to an order) any or all of the following “legislative options”:

  • Impede “ENDS” promotion to and uptake by non-smokers, pregnant women and youth
  • minimise potential health risks to ENDS users and non-users
  • prohibit unproven health claims from being made about ENDS
  • protect existing tobacco control efforts from commercial and other vested interests of the tobacco industry

Wait, isn’t that exactly what the TPD is doing?

Use of ENDS in public places. Since the reasonable expectation of bystanders is not a diminished risk in comparison to exposure to second-hand smoke but no risk increase from any product in the air they breathe, ENDS users should be legally requested not to use ENDS indoors, especially where smoking is banned until exhaled vapour is proven to be not harmful to bystanders and reasonable evidence exists that smoke-free policy enforcement is not undermined. If smoke-free legislation is not fully developed according to Article 8 of the WHO FCTC and the guidelines for its implementation, this should be done as soon as possible.

A large proportion of the ‘decision’ from COP6 is already in the Tobacco Products Directive, which as regular readers will know was passed at EU level early 2014. Finally there is this nugget from COP6:

INVITES Parties to consider prohibiting or regulating ENDS/ENNDS, including as tobacco products, medicinal products, consumer products, or other categories, as appropriate, taking into account a high level of protection for human health.

So, the FCTC “invites parties” to consider prohibiting vapour products, or if they can’t/won’t do that then regulate them as tobacco products, medicinal or consumer products. Considering that tobacco and medicinal products have the highest level of control and regulatory barriers, guess which way most Governments were likely to go?

From the time of COP6, much has changed in the legislative and scientific landscapes. 2015 saw the release of the PHE Evidence Update and earlier this year we saw the Royal College of Physicians report. Did they have any impact on the WHO FCTC? Well no, not really.

As you would expect, the section on health risks of “ENDS/ENNDS” relies heavily on possibly the most outlandish junk science:

The number and level of known toxicants generated by the typical use of unadulterated ENDS/ENNDS is on average lower or much lower than in cigarette smoke, with a few new toxicants specific to ENDS such as glyoxal. However, the levels of toxicants can vary enormously across and within brands and sometimes reach higher levels than in tobacco smoke. This is probably due, among other things, to the increased thermal decomposition of e-liquid ingredients with rising applied temperatures in open system devices.iii A number of metals – including lead, chromium, and nickel and formaldehyde – have been found in the aerosol of some ENDS/ENNDS at concentrations equal to or greater than traditional cigarettes under normal experimental conditions of use

Not to mention thin, baseless claims of “future problems”:

Based mostly on the levels and number of toxicants produced during the typical use of unadulterated ENDS/ENNDS made with pharmaceutical-grade ingredients, it is very likely that ENDS/ENNDS are less toxic than cigarette smoke. However, ENDS/ENNDS are unlikely to be harmless, and long-term use is expected to increase the risk of chronic obstructive pulmonary disease, lung cancer, and possibly cardiovascular disease as well as some other diseases also associated with smoking.

Well, we’ve already seen some of the “science” that would lead the WHO to make such outlandish claims haven’t we (here and here). While the use of vapour products isn’t without risk, a balance does need to be struck between the “risks posed by smoking” against the “risks posed by vaping” – or should we just mention the Parachute Conundrum?

They are, of course, highly concerned about the promotion of “ENDS” and claim that the “free for all” marketing and promotional material (which varies by manufacturer – who knew?) is:

An unquantified amount of advertising uses deceptive health claims and its targeting includes youth and incites rebellion against smoke-free policies.

One of the many, not so subtle statements that are saying “these things are going against all our previous tobacco control efforts” – which we all know is what they really want. Control. An elected UN agency has no business trying to control our lives. Think they may have overlooked their own definition of “tobacco control” as per their own document:

“tobacco control” means a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke

Do read Carl Phillips’s recent publication on tobacco harm reduction should a more detailed explanation be needed.

As for the regulatory options that are being proposed, consider it ling-ch’ih:

Objective: Prevent the initiation of ENDS/ENNDS by non-smokers and youth with special attention to vulnerable groups:

Parties that have not banned the importation, sale, and distribution of ENDS/ENNDS may consider the following options

  1. Ban the sale and distribution to minors
  2. Ban the possession by minors
  3. Ban or restricting advertising
  4. Taxation at a level that makes the products unaffordable to minors. In parallel, tax combustible tobacco at a higher level
  5. Ban or restrict the use of flavours
  6. Regulating places, density and channels of sales
  7. Take measures to combat illicit trade

The final point of that objective is an interesting admission – “combat illicit trade” – suggesting that the WHO recognises that their draconian measures may kickstart a black market for vapour products. Perhaps they’ve learned from their dealings with the tobacco industry? We’ve seen how the ridiculously high prices in Australia have led to a surge in the illicit market with large quantities of the product being seized outside of “official channels” – which begs the question, how much is still getting through?

Objective: minimise, as far as possible, potential health risks to users and protect non-users from exposure to their emissions:

  1. testing heated and inhaled flavourings used in e-liquids, and banning/restricting those to be of serious toxicological concern
  2. requiring the use of ingredients that are not a risk to health and are, when allowed, of the highest purity
  3. regulating electrical and fire safety standards
  4. regulating the need to manufacturers to disclose product content to government
  5. regulating appropriate labelling
  6. requiring manufacturers to monitor and report adverse effects
  7. providing for the removal of products that do not comply with regulations

Noble goals. Of course, testing the liquids should be bloody mandatory by now regardless of the regulatory landscape. The industry has proven that it can, and will react to concerns. However the big issue with testing is that there is currently no testing regimen to adhere to. The BSI PAS went a long way towards that goal, but that was only in reaction to the limited amount of wiggle room available within the TPD. Imagine what a free-rein would see in that area! Of course, the ability to monitor and report adverse effects is possibly one of three sensible options under this objective, the second being the ability to remove products that are not safe to use with the third being the electrical and fire safety standards.

Parties that have not banned the importation, sale, and distribution of ENDS/ENNDS may consider the following options to minimize health risks to non-users:

  1. prohibit by law the use of ENDS/ENNDS in indoor spaces or at least where smoking is not permitted
  2. requiring health warnings about potential risks (may additionally inform the public about the ‘addictive’ nature of nicotine)
  3. reducing the risk of accidental acute nicotine intoxication by introducing tamper-evident/child resistant packaging, leak-proof containers and limiting the nicotine concentration and total nicotine amount

So, to “protect” non-users, public space bans (which is wherever smoking is banned), health warnings (no doubt plain packs would follow that) and limit the nicotine strengths. Remember, this is exactly what is happening via the TPD and the various implementations. No consideration of the unintended consequences to users.

Then there’s the final objective recommendations.

Objectiveprotect tobacco control activities from all commercial and other vested interests, including interests of the tobacco industry.

  1. raise awareness about potential industry interference with Parties’ tobacco control policies
  2. establishing measures to limit interactions with the industry and to ensure transparency in those interactions that do take place
  3. rejecting partnerships with the industry
  4. taking measures to prevent conflicts of interest for government officials and employees
  5. require that information provided by the industry be transparent and accurate
  6. banning activities described as “socially responsible” by the industry, including but not limited to activities described as “corporate social responsibility”
  7. refusing to give preferential treatment to industry
  8. treating State-owned industry in the same way as any other industry

Gosh, these folks really do fear the tobacco industry don’t they? Perhaps a reminder of one of their founding articles. Article 5.3:

In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.

Interestingly, the report highlights the need for transparency in dealings with the industry, but of course the actual COP will not be transparent. You’ll remember of course that the press and public were turfed out of COP6, which was hardly transparent at all. Consider the WHO FCTC against the UN Framework Convention on Climate Change:

[pdf-embedder url=”http://factsdomatter.co.uk/wp-content/uploads/2016/09/FCTC-application-vs-UNFCCC.pdf” title=”fctc-application-vs-unfccc”]

The UN Framework Convention on Climate Change is far more transparent than the FCTC – getting observer status at FCTC requires a multitude of specific requirements that “align” with the goals of the FCTC – which rules me out then.

When talking about conflicts of interest, they aren’t just talking about financial conflicts, instead they mean anything that can potentially conflict with the goals of the FCTC – which in most cases rules out actual stakeholders such as NNA or ECITA, as both groups would conflict being entirely pro-vapour product, and mostly against a proportion of the draconian measures proposed by the FCTC.

Aside from the opening statement under the heading “Potential role of ENDS/ENNDS In Tobacco Control” there is very little in this “expert report” that is supportive of a product that, if left to innovate with light touch regulations stemming from strong standards, could very well do exactly what the FCTC want. But then, that’s a case of “not invented here”. The only thing the FCTC have contributed to this is the ridiculous terms “Electronic Nicotine Delivery Systems” and “Electronic Non-Nicotine Delivery Systems”.

Banning sale to minors is relatively uncontroversial (though I do disagree with that) and does have fairly widespread support, but to ban possession is very 1984. There’s no ban on possession of tobacco or alcohol by minors, so why impose such a ban on vapour products?

Bans on advertisements are just ridiculous. At least under the TRPR posters, billboards and leaflets are allowed but frankly, vapour products should be advertised far and wide. All that is needed is common sense.

Taxation to prevent youth buying them is bonkers. Taxation is the easiest method for Governments to generate a revenue stream on products that they can’t or won’t ban outright, but would rather people didn’t actually buy. In this context, the report states:

ENDS/ENNDS and cigarettes are substitutes, with higher cigarette prices being associated with increased ENDS/ENNDS sales.

What they don’t realise is that higher e-cigarette prices are likely to lead to a stabilisation or even an increase in the sales of combustible tobacco. These people are insane.

The talk on flavours enticing kids is moot, considering that the vast majority of new users over the last two years cite flavours as one of the key reasons why vaping works for them. There is no such thing that flavours can only appeal to youth but not adults or vice versa. The very idea is simply ridiculous.

Indoor bans, as we saw with the attempt in Wales, is a ridiculous idea and is only really supported by people who just don’t like it. Even outdoor public space bans are a ridiculous idea, one that isn’t mentioned in the FCTC document but will no doubt be discussed. There is no evidence that the aerosol from a vapour product is harmful to bystanders and frankly, it’s not the business of the WHO to tell governments how to deal with it even if it did.

Bans, flavour choice reductions, bans on advertising, regulating places that can sell and taxation. Yes, these proposed regulatory options are indeed ling-ch’ih. This type of attitude towards a reduced risk product, which doesn’t just mean vapour products, but snus and other forms of smokeless tobacco, is where the real harms lie. It is this machine that not only propagates fear, but feeds on its own fears.

Tell me, isn’t the World Health Organisation supposed to be about health?

(image credit ra2studio/shutterstock.com)

  • Roberto S

    Very enlightening presentation that fully reveals the inner workings of the world health FIFA. It is amazing how 30 years away from the corporate scandals of the “Tobacco Wars” the WHO keeps peddling the “Big (Bad) Tobacco” scarecrow, while not being at all concerned with (even boasting about) their intimate links with the far far more powerful (and likely badder and meaner) “Big Pharma”. The stance of the WHO is simply a pedantic bureaucratic techno-clap-clop statement sanctioning the acceptance of e-cigs EXCLUSIVELY as medicinal devises for smoking cessation and ultimate total nicotine abstinence. Evidently, and without playing the conspiratorial game of blaming some horrible “Big X”, this stance contains rational (even if not ethical) elements that would clearly align with and
    please their pharmaceutical industry sponsors. Similar alignments of vested interest, though less obvious and apparently contradictory but none-the-less rational, tie the health FIFA with the tweeddledee evil Big T: if e-cigs are maligned, over-regulated and over-taxed, more smokers will keep smoking cigarettes. As these smokers become burdened by sin taxes and stigma they will (the plot suggests) try to quit. We will see then millions of about-to-quit cigarette smokers visiting their local pharmacy to choose between their favorite medicinal NRT: patches, gums or ENDS/ENNDS.

    The term “electronic non-nicotine delivery systems” or ENNDS is (translated from the Techno-Pedantic language to plain English) simply vaporizers without nicotine. I wonder why such devises should be regulated by tobacco control or the WHO at all: they lack tobacco and lack nicotine. Considering ENNDS in which the e-juice has only FDA approved artificial flavors without any controversial substance (no nicotine, no cannabis, no caffeine), such devises would be as harmful as a vanilla yogourt ice cream. Such vaping devices would be totally harmless to humans aged over 3. I fail to see what could justify the WHO taking action to regulate their use. In fact, the image of the WHO totem releasing its mighty bureaucratic machinery to regulate some ENNDS comparable to ice cream or bubble gum is really farcical, but perhaps the WHO is really becoming the new farcical evil “Big X”.

    • “but perhaps the WHO is really becoming the new farcical evil “Big X”

      Nail. Head.

  • jmshigham

    Bloomin eck – can’t these people just butt out and let it go? Who needs this c**p, seriously? But they insist on their conferences and jollies, do they not.

    • Yep. Jollies in..shall we say ‘interesting’ places with regards to “tobacco control”. Moscow for COP6 and India (which has a state owned tobacco company) for this boondoggle, and always via our cash too.