Should some Arab countries rethink e-cigarette ban?

A leading public-health expert last month called for governments to reconsider their attitude to e-cigarettes, claiming that the devices could be a lifesaver for smokers.

Dr Derek Yach, a former cabinet director at the World Health Organization (WHO) spoke in favour of electronic cigarettes (e-cigarettes), stating that they should be brought “into the mainstream.”

He added that this change would end the “scary stories” that alter the public’s view of e-cigarettes, which he said are less harmful than regular cigarettes.

“The impact of these distorted media stories has led many smokers who had moved to e-cigarettes to move back to regular cigarettes,” he wrote in an article for the Johns Hopkins Bloomberg School of Public Health. “[Policy makers should] adopt regulations that encourage smokers to shift to reduced-harm products such as e-cigarettes and tighten up on regulatory actions aimed at regular cigarettes.”

In the Arab world, however, and there’s a very different viewpoint.

This week it emerged that Oman is considering banning e-cigarettes, with a senior Ministry of Health official questioning their safety.

“They have not been approved by international health agencies such as the U.S. Food and Drug Administration (FDA) or the WHO, and the safety of these cigarettes is yet to be proven,” Dr Jawad Al Lawati of the Oman Ministry of Health’s National Tobacco Control Committee told Muscat Daily.

If a ban is enforced, Oman will join 25 other countries where e-cigarettes are completely prohibited by law. They include Bahrain, Jordan, Kuwait, Saudi Arabia and the United Arab Emirates.

But some researchers are questioning if this decision is a move in the right direction.

Smoking in the Arab world

While the number of smokers in Europe and the United States continues to decline, the opposite is the case in the GCC and wider Middle East.

According to a recent report published by the Executive Office of the Gulf Health Ministries (GHM), Yemen tops the list of smoking prevalence in the region, closely followed by Saudi Arabia.

Speaking of the GCC, Dr Tawfeq Ahmed, GHM’s director-general of the executive office said at the time of the report’s release: “The consumption rate of tobacco in Saudi Arabia is between 17.5 and 20%. It is followed by Kuwait, which consumes 17.5%, then the UAE with 12.3% of consumption and then Oman and Qatar.”

More alarming is the fact that the average age at which smokers in the Gulf take up the habit is 13.8 years, said the report.

Meanwhile, at this year’s World Conference on Tobacco, conference president Dr Wael Al Mahmeed echoed the GHM’s sentiments.

“The prevalence of tobacco smoking in UAE is about 25-30 per cent among the men. It’s quite a large number of people,” he was reported as saying. “In Europe and the US, we have seen the numbers going down. Right now, the numbers in the Middle East are rising.”

Are e-cigarettes the answer?

Research shows that an increasing number of smokers are turning to e-cigarettes in an attempt to quit smoking.

Also referred to as ‘vaping’, these battery-powered devices resemble traditional cigarettes, but instead of burning tobacco, they burn a mix of glycerine, nicotine and other chemicals. When the e-cigarette is turned on, the liquid is turned into a vapour that is inhaled by the smoker.

At the recent Global Forum on Nicotine, Dr Konstantinos Farsalinos, a cardiologist who is one of the world’s leading researchers on e-cigarettes told Al Arabiya News that “based on current knowledge, e-cigarettes are about 95% less harmful than smoking.”

He elaborated: “It is not absolutely safe and we do not recommend it to non-smokers, but it is by far less harmful than smoking. It is almost certain that the life of smokers will become easier.

“The chemicals used are all those that have already been approved for use in food, and all the basic ingredients and flavourings, and of course, the nicotine, which substitutes nicotine intake from smoking.

“Furthermore, the levels of formaldehyde and other aldehydes are 30-250 times lover in e-cigarettes compared to smoking [regular cigarettes].”

His latest study released this week continues to support this theory. In his paper for the International Journal of Environmental Research and Public Health, Dr Farsalinos wrote: “Most studies have focused on examining e-cigarette liquid composition, showing that the levels of toxic chemicals present in e-cigarette liquids are by far lower than in tobacco cigarettes.

“Tobacco-specific nitrosamines, which are very potent carcinogenic chemicals, are present in minute amounts in e-cigarette liquids, usually at levels comparable to pharmaceutical nicotine products.”

Lack of research

But not everyone is convinced. Despite its supporters, a number of researchers argue that there’s not enough research to support the safety of e-cigarettes.

A report by the American Society of Clinical Oncology cited analysis by the U.S. FDA, which found that the tobacco solution used in e-cigarettes contains a toxic chemical found in antifreeze and several cancer-causing chemicals, such as nitrosamines.

“Little more is known about the types or concentrations of chemicals, including nicotine, in e-cigarettes,” it said.

“However, the chemicals in e-cigarettes, the potential harmful effects, and the addictiveness vary based on the brand.

“Among all of the alternative tobacco products, e-cigarettes are the least regulated. They have no warning labels and can be sold to people of any age.”

Whether e-cigarettes will eventually be legally sold in the Middle East remains to be seen – but such a move would doubtless hinge on more research being published, in order to convince the region’s health ministries.

In the meantime, a more immediate solution to the region's alarming smoking levels seems to be increasing the price of tobacco products. The WHO asserts that raising tobacco taxes – or the price of cigarettes – is by far the most effective strategy for helping smokers to quit.