Awarding ministers for banning e-cigarettes is incredibly dangerous
Smoking is very bad for you.
No, seriously. Smoking is astonishingly bad for you. Something like 15% of all deaths worldwide are attributable to tobacco smoking: about 8 million deaths a year, out of about 55 million. In India alone, it probably contributes to about 800,000 deaths a year, if my calculations (9% of all deaths in India; about seven people die per 1,000 in India per year; 1.3 billion people in India) are correct.
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I mention India in particular because the WHO has just given Dr Harsh Vardhan, an official in India’s Ministry of Health and Family Welfare, an award for “special recognition for tobacco control”. “His leadership was instrumental in the 2019 national legislation to ban E-cigarettes & heated tobacco products,” tweeted the WHO secretary-general, Dr Tedros Ghebreyesus. “Thank you, Minister!”
Now. According to a literature review by the widely respected Cochrane Collaboration, e-cigarettes are very effective at helping people quit: about 10 out of every 100 people who use e-cigarettes to try to quit smoking are successful, compared to about six out of every 100 who use nicotine patches, and about four who go cold turkey.
Of course, if you quit smoking for vaping, but vaping is just as bad for you, then you’re out of the frying pan and into the fire. But it’s not. Cochrane’s review didn’t find “any clear evidence of harm”, albeit only in the first two years of use; Public Health England say that e-cigarettes are 95% less harmful than smoking, and a PHE review of the evidence suggests they are 0.5% as likely to cause cancer.
Cancer Research UK says: “The evidence so far indicates e-cigarettes are less harmful than tobacco smoking and can be an effective quitting tool.” The anti-smoking charity ASH uses the 95% less harmful stat and agrees that they are effective in helping people quit. It also points out that there is no evidence of harm from passive e-cigarette smoking or of vaping being a gateway to actual smoking (“gateway” theories are usually rubbish anyway). All of them say that the long-term effects are unknown, but since the long-term effects of actual smoking are known, and are extraordinarily bad, it’s a very safe bet that, if there are long-term effects, they’re nowhere near as bad as those of smoking.
A recent attempt in the BMJ to model what would happen if all smoking was replaced by vaping found that it would save between 1.6 million and 6.6 million lives over 10 years in the US alone.
It’s worth noting that public communication of the risk of vaping has been absolutely terrible. Two surveys (1, 2) have found that, while people used to think, correctly, that vaping was much less dangerous than smoking, they now often think it is just as bad. The PHE evidence review says that it is important to “communicate the large difference in relative risk unambiguously so that more smokers are encouraged to make the switch from smoking to vaping”, but that has conspicuously failed to happen.
Why is that? Because (among other things) the World bloody Health Organisation keeps telling us that vaping is bad! Astonishingly, in a Q&A last year, the WHO said that it wasn’t clear that vaping was safer than smoking (one tobacco addiction researcher, understandably, called that Q&A “malign” and “blatant misinformation”). On Monday they were telling people not to switch. In February last year they said: “Both tobacco products and e-cigarettes pose risks to health and the safest approach is not to consume either.”
I don’t know what happened to make the WHO so implacably opposed to vaping. No one sensible thinks that vaping is without risk, but it pretty obviously is many, many times safer than smoking, and clearly effective at helping people quit. They are making the perfect the enemy of the good, like those dimwitted American campaigns trying to stop STDs and teen pregnancy via abstinence.
(And I haven’t even mentioned the fact that some people enjoy vaping; so there is some small amount of risk which they would consider acceptable, just as I accept a small risk from drinking alcohol or eating unhealthy foods. We shouldn’t pretend it’s all downside.)
The WHO does important work. It hasn’t been perfect during Covid by any means, but it hasn’t been conspicuously worse than a lot of other institutions. But it is weirdly, awfully, terribly bad on vaping, and it is not hyperbole to say that this weird awful terrible badness could kill thousands or even millions of people. Giving people tobacco-control awards for banning vaping is like giving people a Nobel Peace Prize for banning diplomacy.