The future of tobacco control is up for grabs. Nowhere was this more apparent than at this year’s US E-Cigarette Summit. Held virtually on May 24-25, the conference featured a wide range of speakers—doctors, tobacco control experts, notable employees of the Food and Drug Administration (FDA), drug reform advocates and industry alike—from across the globe.
The theme of the two-day publicly broadcast event was “discussing the role that e-cigarettes and alternative nicotine products could play in ending or extending the smoking epidemic.” But a second, simpler one quickly emerged: regaining trust.
Some countries like the United Kingdom and New Zealand have embraced e-cigarettes as safer alternatives to combustible cigarettes, but many others have yet to admit their potential. Alarmed by the once climbing—and now apparently declining—rates of teenage e-cigarette use, states, cities and smaller jurisdictions throughout the US have issued flavor bans.
They cite the bans as a primary factor in attracting youth to vaping. They also levy exorbitant excise taxes that could draw frugal adult vapers back to cheaper traditional cigarettes. Nations such as India have followed that poor, prohibition model. Even the World Health Organization (WHO) recently doubled down on its stance that vaping is essentially a conspiracy spearheaded by the tobacco industry to keep users dependent on nicotine.
In recorded video presentations coupled with live Q+A sessions, most of the panelists described the difficulty in bridging the gap between those in favor of reduced-risk products, like e-cigarettes, and those who clamor for an abstinence-only approach to nicotine. Most also criticized agencies like the FDA for misleading PR about the exaggerated harms of vapes, expressing the importance of reestablishing credibility with the public.
Nobody from prohibition-based organizations presented at the summit.
Among the presenters was Stefanie Miller, the managing director of FiscalNote Markets, who produces a financial newsletter about the tobacco sector. She compared tobacco control to the jumbled government messaging during the pandemic. “When public information is confusing, people revert to institutions and voices they trust,” she noted. “Which includes political and ideological sources.”
Cliff Douglas, the director of the University of Michigan Tobacco Research Network and the American Cancer Society’s former vice president for tobacco control, pleaded for harm reductionists and prohibitionists to find common ground. Ethan Nadelmann, the founder of the Drug Policy Alliance (DPA), drew comparisons to the long-waged drug war, warning that we must not repeat history’s alarmist mistakes. And Abigail Friedman, an assistant professor of the Department of Health Policy and Management at the Yale School of Public Health, shared studies that suggested tobacco control policies targeting e-cigarettes can actually increase tobacco use.
Ray Niaura, the interim chair of the Department of Epidemiology at New York University’s School of Global Public Health, went one step further by discussing how to frame the vaping debate for those wary or outright hostile of the technology.
You could persuade libertarians, he suggested, by contextualizing draconian vaping measures like outright flavor bans or steep excise taxes as government paternalism. You could persuade progressives by pointing out how the ongoing battle against vaping runs counter to social justice—limiting access to reduced-risk products like e-cigarettes disproportionately affects marginalized groups already disenfranchised from health care. Nearly 90 percent of people with schizophrenia, for example, smoke in the US, and a high percentage of the world’s current adult smokers live in low-to-middle income countries.
Nobody from prohibition-based organizations, like the Michael Bloomberg-funded Campaign for Tobacco Free (CTFK) or prominent public health entities like the American Heart Association, presented at the summit.
Two high-ranking members of the FDA both spoke about the authorization process that vaping products currently face. In September 2020, vaping companies had to file a premarket tobacco application (PMTA). If greenlit by the agency, their devices and e-liquids could stay on the market with the designation of being “appropriate for the public health”—an official admission by the government that vaping is less harmful than smoking.
Matthew Holman, the director of the Office of Science at the FDA’s Center for Tobacco Products, and Kathleen Crosby, the director of the Office of Health Communication and Education at the FDA’s Center for Tobacco Products, both implied that at least some of these vaping products will be approved.
If they are, they could clear up widespread misconceptions about teen use and “e-cigarette or vaping product-use associated lung injuries”—referring to EVALI. That string of vaping-related illnesses alarmed lawmakers in 2019, and the Centers for Disease Control and Prevention (CDC) eventually blamed on on vitamin E acetate, an adulterant found in illicit THC cartridges. (Which is to say, nicotine vapes were not the culprit.)
“I think having just evaluated the data and information for these products, and then to come out with a positive marketing order, might clarify some of the misunderstanding that the public has,” Holman said.
DPA previously provided a restricted grant to The Influence Foundation, which operates Filter, to support a Drug War Journalism Diversity Fellowship.