Regulating vape retail market can reduce smoking epidemic

The experience of many countries, as well as the results of many studies, suggest that Indonesian lawmakers might want to consider regulating the domestic vaping market as part of the country's battle against its persistently high smoking prevalence.

Tikki Pangestu

Tikki Pangestu

The Jakarta Post


File photo of a person picking up an electronic cigarette, or vape, from a store. PHOTO: UNSPLASH

April 30, 2024

JAKARTA – Indonesia continues to struggle with a high number of smokers. It is estimated that there are approximately 60 million smokers in the country, accounting for nearly 300,000 deaths annually from smoking-related diseases such as cancer, heart disease and diabetes.

This represents a huge burden to an already fragile healthcare system, and the economic cost of smoking to the country is estimated to range between Rp 184.36 trillion (US$11 billion) and Rp 410.76 trillion, or 1.16-2.59 percent of gross domestic product, according to a 2019 study.

Many approaches are available and have been tested in the efforts to reduce smoking prevalence, including regulatory measures as well as pharmacological and behavioral approaches aimed at improving the quit rate among smokers.

A newer approach that has been implemented successfully in many countries involves the use of alternative tobacco products (ATPs), which includes vaping as well as heated tobacco products (HTPs).

The use of vaping products, or electronic cigarettes (e-cigarettes), has also been rising in popularity in Indonesia. A survey by the World Health Organization in 2021 found that 3 percent of the population aged 15 years and above used e-cigarettes on a daily or non-daily basis, compared to 0.3 percent in 2011.

While vaping products are available in Indonesia, regulations on their accessibility and use remain fragmented and inconsistent, and this reflects the situation in many other countries in the region. For example, Singapore and Thailand have imposed an outright ban on vaping products.

Based on good evidence that regulating the vaping retail market leads to a commensurate reduction in combustible tobacco consumption, this article argues that effective regulation of the vaping and ATP market is an important strategic policy to consider in Indonesia’s battle to mitigate its smoking epidemic. There are three key arguments.

First, a regulated retail market has the potential to reduce incidences of youth vaping in Indonesia. Evidence from many countries where vaping is regulated, such as New Zealand, the United States and the United Kingdom, has shown significant reductions in youth vaping numbers.

Effective regulatory settings within those markets to control youth access to vaping products, such as through licensing and fines, product restrictions, point of sale restrictions, labeling and enforcement activities, were instrumental in reducing the number of youth vapers.

This is an important issue, as the “gateway effect”, referring to the risk of youth vapers eventually becoming smokers, is a key argument often used to justify restricting or even banning e-cigarettes in many countries.

Second, regulated retail markets will help reduce illicit and black market operations in e-cigarettes. In markets where a total ban applies to vaping products, it is inevitable that a black market will become a major problem for governments.

Policy settings could be envisaged to enhance enforcement, such as stricter and enhanced surveillance capabilities for the entry of illicit supplies of e-cigarettes, increased fines for selling, supplying and possession, including jail time. However, such measures will require significant resources and may prove ineffective, almost futile, in the longer term, as criminals will almost always be one step ahead in finding innovative ways to supply vaping devices and liquids to the black market.

Domestic measures to curb black market operations also ignore the source of the problem: the likely external source of illicit vaping products. While the scope and size of this criminal activity are difficult to estimate, it is likely to diminish after regulation is introduced to the market.

Third, there is strong and persuasive global evidence that vaping offers long-term health benefits for people who switch from combustible cigarettes. The evidence conclusively shows that vaping is 90-95 percent less harmful than smoking combustible cigarettes, and it is more effective than nicotine replacement therapies (NRTs) in helping adults who want to quit smoking.

A review of various recent studies also indicates that vaping might be preventing young people from smoking who would have otherwise, contrary to the widely held belief of a gateway effect.

More specifically as regards regulating vaping retail markets, a recent study using a mathematical modeling approach compared a permissive versus restrictive vaping scenario between 2017 and 2080.

The results of this study indicated that the use of vaping products in a permissive scenario would result in an 8 percent reduction in deaths attributable to smoking and vaping, as well as a 17 percent reduction in life years lost, and concluded that relaxing regulations on vaping access had significant potential for achieving public health gains.

From an equity perspective, vaping also offers additional benefits for communities with above average incidences of smoking; for example, the population of males in Indonesia and smokers in lower income groups.

Overall, regulated vaping markets have many desirable features and advantages that should be considered as a way forward for amending Indonesian policies in this important area.

Eight advantages are highlighted here.

First, it will reduce the scope and size of illicit vaping devices entering the country through the black market and save on public resources devoted to surveillance and enforcement activities. Second, it will allow for regulations and measures that limit access to youth below 18 years. Third and most importantly, it will allow for systematic monitoring of the safety and quality of vaping devices and nicotine-containing vaping liquids that are sold in the market.

Fourth, it will provide a fiscal revenue stream through taxation of vaping devices and liquids, with the caveat that the taxes imposed should be proportionate to the health risk posed by such products compared to combustible cigarettes.

Fifth, it will allow for regulating sales and marketing of vaping products, including advertising, marketing, points of sale, permitted areas for use, labeling and health warnings. Sixth, at a sociocultural level, it will allow for the removal of stigmatization and fear associated with using a product that may originate from the black market.

Seventh, it will allow for the development of a robust retail industry of vaping products, thus opening legitimate employment opportunities for many.

Finally, it will help stimulate local research and development efforts to produce vaping devices that are more affordable and accessible to those who want to use them, with an attendant potential for exporting these products to countries in the region. This is an important issue, as many smokers in Indonesia who might want to consider switching to vaping to quit are from lower income groups.

In conclusion, regulating the vaping market can play an important role in mitigating the harmful impacts of tobacco use and should be considered in the context of ongoing reforms to Indonesia’s Health Law.

Importantly, it can help mitigate major public health crises associated with the harmful effects of tobacco use and at the same time, allow many Indonesians who want to quit smoking to access an intervention measure that enables them to live healthier lives and avoid premature death.

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