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Explosion in the Consumption of Disposable Electronic Cigarettes: Appalling Figures and a Cry of Alarm!

Since their arrival, disposable electronic cigarettes have been completely changing the nicotine consumption market and their sales are growing exponentially: the increase in sales could reach 2,200% in 2022! The consumption of these products by young people continues to spread massively in an invisible and dangerous way. Not only is our legal framework completely behind the times, but our public health policies are totally inadequate to deal with these very rapid developments.

from Luciano Ruggia

A jungle of diverse products

Electronic cigarettes (Electronic Nicotine Delivery System or ENDS), the vast majority of which are produced in China (95%), comprise many diverse devices, both in terms of the devices themselves and the e-liquids they contain, which are chemical mixtures containing nicotine heated at very high temperatures to create aerosols [the often-used term "vapour" is misleading, as these liquids contain only negligible percentages of water, i.e. less than 5%]. Referring to these products as one single product is therefore inaccurate. Even acknowledging the diversity of this class of product is inadequate; we should speak of the real marketplace jungle and chaos they have introduced.

The first disposable ENDS products appeared on the market in 2019 and are often called by the name of the first brand to come on the market, the Puff Bar (see "Puff Bar" fact sheet). [i] Since their first appearance, these products have presented worrying developments, in particular a wide variety of flavours, non-transparent chemical compositions (imported without any control), and the introduction of synthetic nicotine (a form of nicotine for which no health studies are available). These products are also extremely diverse: on a Chinese online wholesale site we counted 404,140 types of disposable electronic cigarettes from 40,414 producers and suppliers. [i]

]Deficient regulatory framework

In Switzerland, electronic cigarettes are subject to virtually no regulations or controls. These products are freely available, practically unregulated. No federal law bans their sale to minors under the age of 18, as is also still the case for tobacco. Such legislation will be introduced with the new Tobacco Products Act (TPAb), expected to come into force in mid-2023 after years of waiting and legal uncertainty. In the meantime, the cantons have intervened; but only a handful of cantons mainly in French-speaking Switzerland, which have banned the sale of electronic cigarettes to minors. [i] However, as is already the case for cigarettes, a sales ban ‘on paper’ is far from sufficient to limit access to these products by minors. One of the only regulations to which disposable ENDS are subject is the limitation of 20 mg/ml of nicotine concentration in e-liquids (already considered a strong dosage according to a European standard). However, this is far from being universally respected and we have been able to acquire products with concentrations of 50 or 60 mg/ml on the internet or in shops.

ENDS – in particular disposable ENDS – are readily available, especially from a large number of internet sites that often have no age control (and which deliver directly to the home in anonymous envelopes), but also from shops and kiosks, at very cheap prices compared to any other nicotine-containing products. [ii] These products are not subject to any taxation, and even with the forthcoming new taxation of tobacco products and nicotine, their taxation will at best be negligible and will probably have no impact on sales. For a vendor, the benefits can be very juicy. An example: the ‘Elf Bar Blue Razz Lemonade 2,500 puffs’ is sold on a Swiss online shop for CHF 19.90. Or, on a Chinese wholesale site, the same product can be purchased for prices ranging from USD 0.50 each for small quantities (fewer than 50 pieces) to USD 0.01 each for more than 20,000 pieces. Swiss retailers have the advantage of being able to buy these directly from the Chinese producer, unlike tobacco products, where distribution channels are controlled by multinationals or chain stores (e.g. Coop, Denner, Valora).

The situation today is such that virtually anyone can easily obtain disposable ENDS anytime, anywhere, at unbeatable prices.

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Retail shelf with disposable ENDS (Source: REUTERS/Arriana Mclymore)

A sales explosion

In Switzerland, we have no statistics on ENDS sales. For cigarettes, on which taxes are levied, we know that the number sold increased by 4% in 2020 compared to 2019 (and this despite the presence on the market of all sorts of so-called "alternative" products). [iv]

The United States has seen an explosion of sales, according to analyzes published in August 2022. [v] These new products accounted for only 2% of ENDS sales in 2019, whereas today they represent a third of this market and have already exceeded USD 2 billion in sales. However, this data may be a massive underestimate of actual sales, as one producer, Esco Bar, has stated that these sales would be USD 300 million, not the USD 82 million included in the estimate quoted by Reuters.

Even in the absence of any official statistics, Switzerland seems to be following exactly the same direction. In a recent article, the president of the Swiss Vape Trade Association stated that since the beginning of 2022, sales of disposable ENDS have been increasing by 30% every month and that they already represent 30% of the total ENDS market. [vi] We have no reason not to believe the president of this professional association; so this means that if the monthly rate of increase holds steady until the end of the year, we will have experienced an increase in sales of these products by more than 2,200% in 2022!

If the share of sales of disposable ENDS is increasing, they are not only replacing the market share of classic ENDS (the open systems, MODS type), they are also massively winning over new consumers, especially young people.

Health consequences

Many people, even some public health professionals, consider ENDS to be less dangerous than traditional cigarettes. While true that the potential for tobacco toxins in these products is apparently lower than that of traditional tobacco-containing cigarettes, ENDS contain many other toxins that are not present in tobacco smoke, and the consequences of young people taking nicotine can be serious. [vii] These products can by no means be considered harmless and their addictive potential, particularly for young people, is very high.

We still need more time to understand the risks of these products, especially the use of synthetic nicotine present in most disposable ENDS. However, recent cases already show that these products can have serious health consequences, such as the triggering of epileptic seizures, [viii] or even death in the case of pulmonary complications. [ix]

A broken surveillance system and outdated policies

In Switzerland, the surveillance system is not able to provide any valid data concerning the prevalence of consumption of these products among young people, nor their habits and modes of consumption.

Smoking causes more than half of all addiction-related social costs in Switzerland. Even if we lack population-based statistics for ENDS usage, we already know that ENDS allow even stronger, more potent and concentrated amounts of nicotine to be inhaled than a traditional cigarette; furthermore, young people commonly switch from these products to other tobacco products, or use multiple types of products. The risk that these products present in attracting young people to consume them, thereby developing a strong dependence on nicotine, is real and serious.

Along with creating a more robust surveillance system, public health policies must be urgently reviewed to shift the focus back to a product-specific approach. While public health experts are still discussing the theoretical and potential risks of these products, disposable ENDS have already conquered the young, and sometimes the very young. We only have to walk by a school or look on social media to see this. We must finally open our eyes and act: disposable ENDS are a new gateway to smoking that must be closed before it is too late for our youth.