Evidence, alarm, and the debate over e-cigarettes. That is the title of a new analysis published in the journal Science. The analysis was a collaboration of five prominent scientists from a range of disciplines and universities. Experts focused on the potential harm of the anti-vaping hysteria that has gripped the discussion in the latter half of 2019. As a result of the hysteria, several states have enacted vaping and flavor bans. The fear is that sweeping bans could prove detrimental to public health.
The Science vaping analysis concluded that if a significant number of Americans switched from smoking cigarettes to vaping nicotine, 1.6 million lives could be saved. Smoking still kills 480,000 Americans every year. This century, smoking will claim one billion lives around the world. The horrific death toll caused by smoking needs to be factored into any proposed vaping legislation.
“Restricting access and appeal among less harmful vaping products out of an abundance of caution while leaving deadly combustible products on the market does not protect public health. It threatens to derail a trend that could hasten the demise of cigarettes, poised to take a billion lives this century.” – From Evidence, Alarm, and the Debate Over E-cigarettes.
The analysis was published in response to the alarm raised over an outbreak of a mysterious lung illness that was attributed to vaping and to a dramatic increase in underage experimentation with vaping. The lung illness outbreak has since been traced to black-market THC products. The CDC has positively identified vitamin E acetate as the additive to THC oil that caused the outbreak of illnesses. Vitamin E acetate is not used in e-cigarettes or nicotine vape liquids.
However, the increase in underage vaping remains a serious concern. Underage past-30 day e-cigarette use rates among teens increased from 11% in 2017 to 28% in 2019. The analysis suggests that “threading the needle” between prevention and access is the key. The UK model is cited because while e-cigs are available to adult smokers, underage experimentation rates are stable. But, thus far in the United States the proposed solutions may do more harm than good.
On September 11, the President and Health and Human Services Secretary Alex Azar announced a ban on all flavored electronic cigarettes except for tobacco flavors. While the White House has since pulled back on a flavor ban, the ultimate outcome of national e-cigarette regulation is unknown. Despite a lack of final FDA guidance, many states enacted their own flavor bans. New York, Michigan Wisconsin, and others announced a ban on all vape flavors. Massachusetts Governor Charlie Baker enacted a complete ban on all vapor products. However, Governor Baker’s ban left cigarettes untouched. In New York, Governor Cuomo’s ban outlawed menthol-flavored e-cigs but left menthol cigarettes on the shelves. These are exactly the type of bans that are cause for concern according to the Science analysis.
“We share strong concern about the large surge in youth vaping (some call it an epidemic and point to studies of a possible but unproven causal gateway into smoking) and we promote harm minimization and management. Yet we suggest that careful analysis of all the data in context indicates that the net benefits of vaped nicotine products outweigh the feared harms to youth” From Science Evidence, Alarm, and the Debate Over E-cigarettes
The analysis revealed that while flavors may play a role in attracting underage experimentation, flavors are also vital to assist smokers to switch to vaping. While tobacco flavors are the usual starting point for a smoker switching to e-cigs, it is pointed out in the research that adult smokers generally transition to menthol and then to other flavors to help refrain from smoking cigarettes.
The Path Forward For Vaping
The researchers involved in the analysis derived a number of policy prescriptions designed to ensure access for adults while preventing underage use. The implementation and enforcement of a national 21 age limit for both nicotine and THC products. In addition, the analysis recommends the use of taxation on e-cigarettes but at a lower rate than tobacco cigarettes. In other words, e-cigarettes should not be cheap, but they should cost less than cigarettes.
Here is the list of recommendations proposed by researchers in Science:
No youth under 21 should use any form of nicotine
No youth under 21 should use any current form of THC
Taxation on vapor products but a lower rate than cigarettes
Communicate that vaping reduces risk compared to smoking
No predatory marketing to youth
Implement product quality standards
It is interesting to note that the FDA does not currently allow any e-cigarette company to claim that vaping is less harmful than smoking. However, researchers cite the UK example where Public Health England has determined that vaping is 95% safer than smoking.
Ensuring all purchasers are at least 21 years of age is crucial to the plan. The age limit must be enforced. Online sales, despite often the target of politicians, are actually the most secure. Age verification technology may hold the key to properly enforcing the 21 age limit. Of course, the technology must be current. For example, Mig Vapor, an independent American vape company, uses a multi-layered, AI powered age verification technology.
The overall summary of the analysis is that the threat from smoking is far from over. American families lose 480,000 loved ones every year from smoking. The progress we have made combatting tobacco harm could be derailed by policy decisions made in a state of alarm as opposed to reason. Finally, the researchers point out that it is worth the effort to thread the needle and to find a balance. Because there is a way to ensure access to vapor products for adult smokers and curb youth experimentation with e-cigarettes at the same time.
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Quebec appears to be winning its battle against the rising tide of measles after 45 cases were confirmed province-wide this year.
“We’ve had no locally transmitted measles cases since March 25, so that’s good news,” said Dr. Paul Le Guerrier, responsible for immunization for Montreal Public Health.
There are 17 patients with measles in Quebec currently, and the most recent case is somebody who was infected while abroad, he said.
But it was no small task to get to this point.
Le Guerrier said once local transmission was detected, news was spread fast among health centres to ensure proper protocols were followed — such as not letting potentially infected people sit in waiting rooms for hours on end.
Then about 90 staffers were put to work, tracking down those who were in contact with positive cases and are not properly vaccinated. They were given post-exposure prophylaxis, which prevents disease, said Le Guerrier.
From there, a vaccination campaign was launched, especially in daycares, schools and neighbourhoods with low inoculation rates. There was an effort to convince parents to get their children vaccinated.
Vaccination in schools boosted
Some schools, mostly in Montreal, had vaccination rates as low as 30 or 40 per cent.
“Vaccination was well accepted and parents responded well,” said Le Guerrier. “Some schools went from very low to as high as 85 to 90 per cent vaccination coverage.”
But it’s not only children who aren’t properly vaccinated. Le Guerrier said people need two doses after age one to be fully inoculated, and he encouraged people to check their status.
There are all kinds of reasons why people aren’t vaccinated, but it’s only about five per cent who are against immunization, he said. So far, some 10,000 people have been vaccinated against measles province-wide during this campaign, Le Guerrier said.
The next step is to continue pushing for further vaccination, but he said, small outbreaks are likely in the future as measles is spreading abroad and travellers are likely to bring it back with them.
Need to improve vaccination rate, expert says
Dr. Donald Vinh, an infectious diseases specialist from the McGill University Health Centre, said it’s not time to rest on our laurels, but this is a good indication that public health is able to take action quickly and that people are willing to listen to health recommendations.
“We are not seeing new cases or at least the new cases are not exceeding the number of cases that we can handle,” said Vinh.
“So these are all reassuring signs, but I don’t think it’s a sign that we need to become complacent.”
Vinh said there are also signs that the public is lagging in vaccine coverage and it’s important to respond to this with improved education and access. Otherwise, microbes capitalize on our weaknesses, he said.
Getting vaccination coverage up to an adequate level is necessary, Vinh said, or more small outbreaks like this will continue to happen.
“And it’s very possible that we may not be able to get one under control if we don’t react quickly enough,” he said.
Pregnant women urged to get whooping cough vaccine
Babies are routinely given the vaccine at eight, 12 and 16 weeks
Pregnant women in the Black Country are being urged to get vaccinated against whooping cough after a rise in cases.
The bacterial infection of the lungs spreads very easily and can cause serious problems, especially in babies and young children.
The Black Country Integrated Care Board (ICB) is advising pregnant women between 16 and 32 weeks to contact their GP to get the vaccine so their baby has protection from birth.
The UK Health Security Agency warned earlier this year of a steady decline in uptake of the vaccine in pregnant women and children.
Symptoms of the infection, also known as “100-day cough”, are similar to a cold, with a runny nose and sore throat.
Sally Roberts, chief nursing officer for the ICB, which covers Wolverhampton, Dudley, Walsall and Sandwell, said anyone could catch it, but it was more serious for young children and babies.
“Getting vaccinated while you’re pregnant is highly effective in protecting your baby from developing whooping cough in the first few weeks of their life – ideally from 16 weeks up to 32 weeks of pregnancy,” she said.
“If for any reason you miss having the vaccine, you can still have it up until you go into labour.”
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The number of measles cases has stabilized, according to the Montreal Public Health.
Since March 25, there have been no contaminations reported within the community.
“Our teams have identified all contact cases of measles,” said media relations advisor Geneviève Paradis. “It’s a laborious task: each measles case produces hundreds of contacts.”
All community transmission cases since February 2024 have been caused by returning travelers who were either unvaccinated or partially vaccinated.
Currently, there are 18 measles cases in Montreal – with 46 total in Quebec. This according to the April 18 figures from the provincial government.
“With the summer vacations approaching, if you’re travelling, it is essential to check if you are protected against measles,” explained Paradis.
According to Montreal Public Health, a person needs to have received two doses after the age of 12 months to be immunized against the virus.
They’ve launched a vaccination campaign throughout the region, and currently, 11,341 people have been vaccinated against measles in Montreal between March 19 and April 15.
Vaccination is also being provided in schools and at local service points.
“The vaccination operation is under the responsibility of the five CIUSSS of the territory,” concluded Paradis.
