ENDS and global health: India's stand matters

Approximately 80 % of the world's 1.3 billion tobacco users reside in Low- and Middle-Income Countries (LMICs) carrying significant associated disease burden. The advent of electronic nicotine delivery systems (ENDS) has the potential to either mitigate or worsen this burden, contingent on the regulatory approach to their accessibility and usage. While ENDS have garnered some popularity in LMICs, their prevalence still trails behind the current usage rates in high-income countries (HICs). Presently, ENDS products are prohibited in 34 countries, including India.1WHOWHO Report on the Global Tobacco Epidemic, 2023: Protect People from Tobacco Smoke. World Health Organisation, Geneva2023Google Scholar India's population is equivalent to 17.76 % of the total world population, and therefore, any adverse impact on public heath in India can have a major impact on overall global health. India has more than 50 % of its population below the age of 25 and over 65 % below the age of 35, which are highly vulnerable to addictive habits like ENDS. India's stance on ban of e-cigarettes is bold and commendable.2National Tobacco Control Programme. Available at: https://ntcp.mohfw.gov.in/assets/document/The-Prohibition-of-Electronic-Cigarettes-production-manufacture-import-export-transport-sale-distribution-storage-and-advertisement-Ordinance-2019.pdf (Accessed on 12th November 2023).Google Scholar Regrettably, e-cigarettes are easily available to anyone at retailer storefronts and pan shops, regardless of age. The seriousness of this issue is most evident in pubs and bars across the nation, where ENDS use by young population is clearly evidence. It is surprising to see such a significant discrepancy between the government regulation act and the actual practice by the population. We sense a dire need for awareness and intervention by the local responsible government authorities at grass root level. The Prohibition of Electronic Cigarettes Act in India states a ban on the production, manufacture, import, export, transport, sale, distribution, storage, and advertisement of e-cigarettes but does not mention anything about a ban on their use/consumption, which is quite surprising.2National Tobacco Control Programme. Available at: https://ntcp.mohfw.gov.in/assets/document/The-Prohibition-of-Electronic-Cigarettes-production-manufacture-import-export-transport-sale-distribution-storage-and-advertisement-Ordinance-2019.pdf (Accessed on 12th November 2023).Google Scholar The only information about the prevalence of e-cigarette usage in India is available from the GAT survey (2017), which is 0.02 %.3Tata Institute of Social Sciences (TISS), Mumbai and Ministry of Health and Family Welfare, Government of India. Global Adult Tobacco Survey GATS 2 India 2016-17. https://ntcp.nhp.gov.in/assets/document/surveys-reports-publications/Global-Adult-Tobacco-Survey-Second-Round-India-2016-2017.pdf (Accessed on 12th November 2023).Google Scholar Even after the long period of six years there is no update on the GAT survey which can give clearer picture. The availability and awareness about e-cigarettes have increased tremendously among youths on India and unfortunately still there is no data available on the extent of ENDS sales and usage. How can predictive modelling studies be executed without this vital information? In the absence of such transparency, India is bound to perpetuate the current situation, causing global health statistics on ENDS to remain severely underreported. Perhaps by legalizing ENDS, India will be able to determine the actual gravity of the situation, which will help in making appropriate policy reforms to mitigate this growing public health problem. According to the WHO's 2023 report, 85 % of HICs have implemented either regulations or sales bans on ENDs. In contrast, approximately 40 % of middle-income and around 80 % of low-income countries have not taken any regulatory action against ENDS.1WHOWHO Report on the Global Tobacco Epidemic, 2023: Protect People from Tobacco Smoke. World Health Organisation, Geneva2023Google Scholar Due to its high population, the health of the public in India plays a crucial role in contributing to the overall well-being of global health. However, India is grappling with distinctive issues related to the failure of regulation, the root cause of which is not clearly evident. All the authors associated with the present manuscript declared no potential conflict of interest concerning the research, authorship, and/or publication of this article. The author received no specific funding for this work.