Global vaping snub suggests other nations are learning from United States’ bad example

Here’s a glimmer of good health news: It seems that nations around the world may be avoiding what, just a blink ago, was one of the United States’ significant public health concerns — vaping and e-cigarettes.

Juul, the San Francisco-based company at the heart of this controversy, has seen doors shut in its face as it tries to expand its U.S.-curtailed business, the New York Times reported:

“The company has been met with ferocious anti-vaping sentiment and a barrage of newly enacted e-cigarette restrictions, or outright bans, in country after country. As a result, its ambitious overseas plans have collapsed. Juul was kicked off the market in China last fall after just four days. The company has had to abandon plans for India after the government there banned all electronic cigarettes. Thailand, Singapore, Cambodia and Laos have also closed the door to e-cigarettes. In the Philippines, President Rodrigo Duterte ordered the arrest of anyone caught vaping outside designated smoking areas. Juul has postponed its launch in the Netherlands and has pulled out of Israel. In South Korea, the number of Juul customers has plummeted after the government issued dire health warnings about e-cigarettes, and the company has scaled back its distribution there.”

The global rejection of Juul and its wares may be even more surprising because many of the nations just saying no are big time Big Tobacco lands, as Kathleen Hoke, director of the Network for Public Health Law at the University of Maryland, told the newspaper, saying:

“It has been an extraordinarily quick backlash. Countries that you wouldn’t necessarily describe as progressive public health nations are attacking this new product so that it doesn’t become embedded in their culture as cigarettes have.”

As the New York Times noted:

“Even Indonesia, which has no restrictions on vaping and one of the highest percentage of smokers in the world, has not worked out for Juul. Last month, the company announced it would stop shipping its devices and nicotine pods to that country, too.”

The United States, of course, took a starkly different path with vaping and e-cigarettes. The Trump Administration opened the door to the unhealthy practices, purportedly to reconsider how to better deal with the addictive power of nicotine, mostly as that chemical keeps users hooked on burning tobacco cigarettes — a proven cause of cancer, heart disease, and other significant health harms.

Juul and other e-cigarette makers marched through the regulatory loopholes, creating a demographic fad and potentially a whole new generation hooked on nicotine and potentially marching toward not only vaping but also cigarette use, too.

The FDA for months played catch-up with its oversight, finding itself consistently overmatched, as Juul and other vendors targeted the youth market with social media and other means that flummoxed regulators and lawmakers. The agency steadily increased its actions, restricting sales to minors, forcing vendors to change their displays, and imposing bans on certain flavorings in liquids used in vaping.

Vaping devices also became a wildly popular way for young users to get high with tetrahydrocannabinol or THC, the intoxicant commonly found in marijuana. This use, combined with vaping devices’ sometimes high prices, led, in turn, to a burgeoning street and bootleg market.

Officials soon found themselves not only with regulatory nightmares but also significant health problems — a rash of lung-damage cases serious enough to require thousands of hospitalizations and leading to dozens of deaths. As of February, the toll was 2,807 so-called EVALI hospitalizations and 68 deaths, the federal Centers for Disease Control and Prevention reported. The agency has blamed many of these harms on bootleg vaping products tainted with substances, notably Vitamin E acetate.

While the Covid-19 pandemic has shoved the vaping menace off the front pages of newspapers and prime news broadcast spots, regulators have not stopped their battles with e-cigarette makers. The Federal Trade Commission has sued Altria, the company whose brands include Marlboro cigarettes, to unwind its $12.8 billion, 35% investment in Juul. The FTC says Big Tobacco’s move into e-cigarettes turned competitors into collaborators, unfairly restraining competition. Investors already have seen the Altria moves as a financial debacle, with the company over-paying for what has become a dramatically under-performing asset.

In my practice, I see not only the harms that patients may suffer while seeking medical services, but also the significant benefits they can enjoy by staying healthy, notably by avoiding smoking and vaping. This is especially true with Covid-19 attacking the respiratory health of so many people globally. If you don’t smoke or vape, please don’t start, and if you do, it would be wise in this pandemic time to stop. The last place anybody wants to be right now is in the coronavirus-overwhelmed U.S. health care system. Besides its problems with infections acquired in hospitals, nursing homes, and other medical care giving facilities, it also has major challenges with medical error and misdiagnoses.

That said, at this difficult moment, we need to support doctors, hospitals, and public health officials as they marshal science, evidence, and facts to battle the menace of Covid-19. Stay calm, limit your contacts with others, listen to and heed medical and scientific experts as they — and we — try to protect ourselves, as well as others in our community and country. While you are home, please don’t smoke or vape.