Regulatory Policy and Practical Issues Arising from a Disruptive Innovation: A Public Health Perspective on E-Cigarettes

Abstract

E-cigarettes are novel nicotine delivery devices that have emerged within the past decade to become highly popular consumer products and cigarette substitutes. This phenomenon has occurred in a regulatory vacuum, across many jurisdictions, with limited research on their safety, quality and efficacy as smoking cessation aids. Where research has been published its validity has often been contested within the tobacco control research and advocacy communities. E-cigarettes present many concerns to health care providers, policy makers and regulatory agencies. The growing involvement of the tobacco industry as key players in the e-cigarette market adds to these concerns. On the other hand, e-cigarettes could be an opportunity for millions of smokers to change to a less harmful product, with substantial benefits for health. In this paper I present a range of regulatory options being considered in different jurisdictions and consider the arguments, for and against. Given the wide variation in local smoking epidemiology, sociocultural contexts and existing regulations across jurisdictions, I propose a principle-based approach for e-cigarette regulation that draws on a public health perspective: one that is ethical, evidence-based, proportionate to risk, equitable, engaged with those most affected, transparent and efficient.