Mexico Public Health Agency Lashes Out Against Tobacco Harm Reduction

    Mexico’s consumer health protection agency has effectively denounced the US Food and Drug Administration’s recent approval of IQOS, a heat-not-burn product—as well as warning against electronic nicotine delivery systems (ENDS), like e-cigarettes, in general.

    In a May 31 public communique, the government agency COFEPRIS adopted the staunchly anti-vaping position of the Mexican National Institutes of Health and Federal Hospitals and the National Commission Against Addictions. The document was endorsed by a slew of reputable public health institutions, like the government’s National Institute of Cancer and National Institute of Respiratory Diseases.

    Its concluding recommendations include: that ENDS be “regulated like any other tobacco product; sanitary warnings and pictograms in all packages (69% of the surface); prohibition of sponsoring; limited and restricted publicity; special taxes and restriction of usage in smoke free spaces, strict enforcement of sale to minors.”

    The strident anti-tobacco harm reduction messaging is concerning in a country where the smoking rate slightly increased—from 17.0 to 17.6 percent—between 2011 and 2016. Mexico suffers over 47,000 tobacco-related deaths each year.

    The paper’s argument to clamp down on ENDS—which arrived to the Mexican market in 2010, but were soon made technically illegal to sell—is based on a supposed lack of “independent evidence to document the effectiveness of the devices in smoking cessation.” The document also contends that “none of these devices provide better results in addressing [tobacco-related preventable deaths] than what actually exists,” like nicotine patches.

    Such arguments are common amongst tobacco control proponents, yet fly in the face of a recent study conducted by British researchers that was published in the New England Journal of Medicine. (The study was even recognized as valid by The New York Times, a publication often at the forefront of scaremongering around vaping.) Smokers in England were found to be almost twice as likely to quit by using e-cigarettes than through nicotine replacement therapy like gum or patches (18 percent versus 10 percent).

    The communique levels further attacks at vaping as harm reduction, including the claim that the “safety of the ENDS has not been demonstrated in the short term, much less in the long term.” Although there is no long-term study to date—no surprise, given that e-cigarettes have only been on the US market for a little over a decade—independent studies have estimated that vaping is 95 percent less harmful than combustible tobacco.

    The communique in fact concedes that “vapor/aerosol emissions have been proven to contain less toxicants than combustion produced tobacco smoke.” Yet it reinforces its point by citing cases of “poisonings in children” and “accidents…produced by the heating of batteries.” Such incidents are concerning but rare—and do not occur through proper use.

    The paper also argues that e-cigarettes ensnare people who did not previously smokea common element with the US Juul panicstating that these products are “not circumscribed to smokers” and have used “many and diverse flavorings” to attract non-smoking teens. Yet the contention of an “epidemic” of vaping among US teens is highly questionable. Flavored vapes have often been a target of tobacco control, yet research has shown that many adult smokers cite flavors as a crucial element in switching to vaping.

    The document also makes the unfounded claim that “The usage of the ENDS maintains the smoking conduct and affords a false sense of safety [regarding combustible tobacco products].”

    For Roberto A Sussman, director of Pro Vapeo Mexico AC, the document “has all the trappings of a hurried up last-minute political dictate (likely by the WHO) that the directors were handed with orders to sign.” In support of this idea, the communique is signed by “the directors of the 15 most reputable governmental health institutions in Mexico” but has “spelling mistakes” in the original Spanish language version, Sussman told Filter.

    Although Sussman’s interpretation is currently unverifiable, he argues “the sloppiness of the document is consistent with the way the government is proceeding in other issues.” This includes some of the signatory hospitals in the country, which have been hit with major spending cuts and a scarcity of medicines since President Andrés Manuel López Obrador took office in December 2018.

    Due to instability across the government, Sussman speculates that “it is unlikely that regulating ENDS will be a pressing issue. However, [Pro Vapeo Mexico AC] believes the government wants to regulate them in the second half of 2019,” just as is laid out in the document.

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