E-cigarettes in Bangladesh create a cloud of debate

Seemingly the unhazardous cloud with sweet fragrance an electronic cigarette consumer or vaper emits is better than the bad odor that comes from a conventional smoker.

With such a comparison, e-cigarette campaigners portray the trendy form of addiction as safer than smoking a conventional cigarette.

As the tobacco control authorities have no regulatory instrument in hand to control it, young people are getting hooked on nicotine by vaping, anti-tobacco campaigners warn.

A study titled Electronic cigarettes (vaping) preferences among university students in Bangladesh, published in September 2020, finds 31.27 per cent of respondents were familiar with e-cigarettes and had taken it at least once in their lives.

A total of 408 respondents participated in the survey. More than 60 percent of them said that they were unaware of any harmful or beneficial effects of vaping, while 35.48 percent said vaping e-cigarettes had caused them or the people around them to become addicted to nicotine.

Although the study authors did not focus on the health hazards of vaping, they provide an assessment–‘undoubtedly it gives us a terrible message that e-cigarettes have penetrated in our young generation.’

Ismail Hosen, assistant professor at the biochemistry and molecular biology department under the Dhaka University, and one of the co-authors of the study says, “Any kind of addiction to toxic substances is harmful to health.”

A debate that whether vaping is an effective method of harm-reduction (by quitting smoking) or not has surfaced world-wide. Already there is a schism over vaping and health as vapers are campaigning for ‘rights to good health’.

Schumann Zaman, president of Bangladesh Electronic Nicotine Delivery System Traders Association (BENDSTA), is one of the campaigners. He imported e-cigarettes first in Bangladesh in 2012.

He says that vaping is gaining popularity. “Vaping is 95 per cent safer than smoking a conventional cigarette. This is proven to be an effective ‘quit smoking’ tool,” Zaman says citing a paper by Public Health England (PHE).

On 10 September a video interview of Rajib Hossain Joarder–a surgeon at the Dhaka Medical College and Hospital–was posted on the Facebook page of Voice of Vapers (VOV), a social media platform for vape campaigners.

In the video, Rajib, sitting at Zaman-owned Vapor Cloud outlet in Dhaka, endorsed vaping as ‘100 per cent safe’. Rajib also cited the PHE paper. This correspondent called Rajib over his cell phone several times but received no response.

The Guardian reports that the ’95 per cent safer’ term was picked from a paper published in 2014 by a group of experts led by David Nutt–a former chief drugs adviser to the British government. Nutt was sacked as he declared Ecstasy or MDMA (Methylenedioxymethamphetamine) and LSD (Lysergic acid diethylamide) were safer than alcohol.

Condemning social media campaign by the vapers, a local non-government organization Voices for Interactive Choice and Empowerment issued a press release recently.

VOICE’s executive director Ahmed Swapan Mahmud tells this correspondent that the VOV propagation, particularly using Rajib’s interview, was ‘misleading, despicable and a campaign against the prime minister’s call to make Bangladesh tobacco-free by 2040.”

E-cigarette works by heating liquid (vape juice) containing nicotine to produce vapour, which is then inhaled. Vaping requires higher levels of suction than smoking conventional cigarettes.

A World Health Organization (WHO) document titled 'A systematic review of health effects of electronic cigarettes', says that the total level of nicotine in 15 puffs of vapour generated e-cigarettes by an automatic smoking machine varied from 0.5 to 15.4mg whereas the typical level of nicotine from one smoked conventional cigarette ranges from 1.54 to 2.60mg.

WHO’s Global Tobacco Epidemic-2019 report identifies the e-cigarette as harmful for health.

Consumption of nicotine raises blood pressure, and spikes adrenaline, which increases the risks of heart rate and the likelihood of having a heart attack.

Michael Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, writes for Johns Hopkins Medicine website, “Emerging data suggest links to chronic lung disease and asthma, and associations between dual use of e-cigarettes and smoking with cardiovascular disease. You’re exposing yourself to all kinds of chemicals that we don’t yet understand and that are probably not safe.”

According to BENDSTA, there are approximately 50 importers and several e-commerce sites selling e-cigarettes and vape juices in Bangladesh. Prices of the vape kits range from Tk 4,500 and above while 60ml of vape juices can be avail at Tk500 and above Tk2,100.

This correspondent surfed websites of popular vape juice brands Bangladesh imports from the United States - where many state authorities have banned the selling of flavoured nicotine.

In their respective websites, the vape juice producers, citing the California Office of Environmental Health Hazards Assessment’s proposition 65, warn their potential customers about exposure to chemicals including formaldehyde, which is known to cause cancer, and nicotine, which is known to cause reproductive harm. They also forbid online shoppers aged below 21 to access the products.

None of the online sellers of e-cigarettes and vape juice in Bangladesh were found warning their customers. BENDSTA president Zaman, though, says that listed importers do not sell e-cigarettes and vape juice to customers aged below 18.

This correspondent refrains from mentioning the e-cigarette and vape juice brands and e-commerce sites to avoid advertising on tobacco.

There is concern about customised and counterfeited vape juice in Bangladeshi markets. While being enquired, Zaman says that standard authorities need to monitor the market.

Bangladesh still does not have any anti-e-cigarette regulations. So there is no regulatory body to monitor the e-cigarette market.

Professor Sohel Reza Chowdhury, an epidemiologist at the National Heart Foundation, tells Prothom Alo, “Vaping would raise chronic addiction to nicotine among the young people. The government should better ban the products before it becomes an epidemic.”

In late 2019 when neighbouring India had banned e-cigarette, the health ministry attempted the inclusion of e-cigarettes as harmful in the Tobacco Control Law (last amended in 2013). Ironically, the attempt was vetoed by some ministries.

Zillur Rahaman Chowdhury, coordinator at the National Tobacco Control Cell under the health ministry, however, tells Prothom Alo, “We will soon call a meeting to find the way of bringing e-cigarette under regulations.”