Ban e-cig use indoors, says WHO

Cancer Research UK

Electronic cigarettes (e-cigarettes) should face greater restrictions on their use, sale and promotion, the World Health Organisation (WHO) has said.

"There isn’t enough evidence to justify a ban on the use of e-cigarettes indoors" - George Butterworth, Cancer Research UK

Although less harmful than real cigarettes, the nicotine vapour inhalers carry a risk to others from their vapours that means they should be banned indoors, the UN organisation said.

It added that they posed risks to children and recommended a clampdown on sales to under 18s with vending machines removed "in almost all locations".

The British Medical Association welcomed the report, released ahead of October's WHO Framework Convention on Tobacco Control in Moscow.

Many of the WHO proposals will be introduced in the UK under EU law in 2016. But both Cancer Research UK and Action on Smoking and Health (ASH) said they did not think there was sufficient evidence of harm to justify including e-cigarettes in ‘smokefree’ legislation.

In the report on electronic nicotine delivery systems (ENDS), the Geneva-based health body said: "The fact that ENDS exhaled aerosol contains on average lower levels of toxicants than the emissions from combusted tobacco does not mean that these levels are acceptable to involuntarily exposed bystanders.

But Hazel Cheeseman, director of policy and research at ASH disagrees, saying there was "no evidence of any harm to bystanders from use of these devices."

Public Health England reiterated the need for evidence-based regulations, saying: “It is important to balance regulations and base them on the evidence. England’s smokefree laws were based on strong scientific evidence of harm to bystanders and such evidence does not currently exist for exposure to e-cigarette vapour.

“Public Health England believe that regulations should reduce the confusion between e-cigarettes and tobacco smoking and we need to recognise that treating nicotine products as if they were smoked tobacco might make that confusion worse.” 

Regarding the claims they help people quit smoking, the WHO report added: "Although anecdotal reports indicate that an undetermined proportion of ENDS users have quit smoking using these products, their efficacy has not been systematically evaluated yet.

The one "randomised control trial" that has been carried out found that ENDS were about as effective as nicotine patches, it added.

Electronic cigarettes are currently regulated as consumer products in the UK but from 2016 any nicotine-containing products (NCPs) which make medicinal claims - such as being a stop-smoking aid - will be regulated by the Medicines and Healthcare Products Regulatory Agency, otherwise they will regulated in a similar way to cigarettes under EU law.

George Butterworth, Cancer Research UK’s tobacco policy manager, said: “There’s a wide body of health evidence to justify a ban on smoking regular cigarettes in public places but there isn’t enough evidence to justify a ban on the use of e-cigarettes indoors.

“Cancer Research UK supports light touch regulations of e-cigarette products and their marketing. E-cigarettes - although not risk free - are almost certainly far safer than smoking tobacco cigarettes that kill 100,000 people in the UK every year. 

“The UK is already implementing new regulations for e-cigarettes that should improve the quality and safety of the products while ensuring that they’re still accessible to smokers. But it’s important to ensure these products are not marketed to children and non-smokers.

“This is a fast-emerging market but we are optimistic about the potential benefits for helping smokers quit, whilst minimising the potential risks. There remain unanswered questions about the long-term impact of these products. Cancer Research UK funds research that helps support evidence-based policy making.”