ENDS White Paper: Why ICMR is calling for a ban on ENDS or e- cigarettes

Delhi- The apex medical regulatory body of the country, Indian Council of Medical Research (ICMR), called for a complete ban on Electronic Nicotine Delivery System (ENDS) or e-cigarettes in a white paper released on May 31^st ,2019 on the eve of World No Tobacco Day.The decision was taken based on the scientific evidence which is in stark contrast with the growing claims made by the e-cigarette manufacturers that it facilitate the cessation of smoking

The white paper pointed out that smoke or ‘vape’ which is produced by the e-cigarette contains a varying concentration of nicotine which is considered as one of the most addictive substances and the rapidity at which it is introduced into the body, age of first exposure and the dosage administered all add to determine the potential risk of a person being addicted to it throughout life. These devices also contain other ingredients as flavoring agents and vaporizers, which are also found to be harmful to health.

The white paper adds the use of e-cigarettes not only poses a potential risk for the user causing adverse effects which include DNA damage; carcinogenesis; cellular, molecular and immunological toxicity; respiratory, cardiovascular and neurological disorders to its users but passive smoking can adversely affect on foetal development and pregnancy. Also, it stated that there are reports of poisoning due to accidental swallowing by children. These devices also can cause fire and explosion.

The ban is supported by the union health ministry after the release of the findings of a survey.

Studies have found that the percentage of students who initiate the use of e-cigarettes and hookah smoking before 10 years of age has increased from 26 percent to 45 percent in the last 15 years, reports PTI.

Based on the currently available scientific data from multiple streams of research, the ICMR recommends a complete prohibition on ENDS or e-cigarettes in India in the greater interest of protecting public health, in accordance with the precautionary principle preventing public harm from a noxious agent, considering the following facts and circumstances

Following are the key recommendations made by the ICMR based on evidence supporting a ban on e-cigarettes.

• ENDS or e-cigarettes contain nicotine solution, which is highly addictive and also contain other ingredients as flavoring agents and vaporizers, which are also harmful to health.


• Use of ENDS or e-cigarettes has documented adverse effects on humans which include DNA damage; carcinogenesis; cellular, molecular and immunological toxicity; respiratory, cardiovascular and neurological disorders and adverse impact on foetal development and pregnancy.


• The magnitude of potential short-term and long-term health risks to the users still remains undetermined at the population level since the products are recent and come in diverse forms.


• Whereas, the degree to which, if at all, the ENDS or e-cigarettes benefit as tobacco cessation aides is not firmly established, evidence suggests that there is a risk of dual-use to some extent and initiation to tobacco addiction to non-smokers. Hence, on balance, these products have a net negative impact on public health.


• Use of ENDS can open a gateway for new tobacco addiction which is a potential threat to the country’s tobacco control laws and on-going tobacco control programs.


• The rapidly increasing trend of use of ENDS or e-cigarettes by young persons, in countries where it was introduced, underscores a potential threat to public health.

Prof. Balram Bhargava, Secretary, Department of Health Research, Government of India and Director General ICMR, New Delhi said, “Given the extent of harmful health effects of e-cigarettes to the users as well passive exposure and multiple faces of the ENDS or e-cigarettes use epidemic around the world” where it was introduced, if no appropriate interventions are taken at the right time by bringing together all stakeholders under one umbrella to prevent these impending epidemics of e-cigarettes use, it can lead to a public health disaster in India.

Attached is the White paper below