Response to the public consultation on the Draft First Report of the WHO Independent High-level Commission on Non-Communicable Diseases

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Consultation on NCDs
Vapers Finland

Cardiovascular diseases, cancers and respiratory diseases account for more than 80 per cent of all NCDs, and smoking is the most significant risk factor for these diseases. There are currently over a billion smokers in the world for whom the recommended therapies — such as NRT and prescription medication — are of limited help in stopping smoking. Success rates with nicotine replacement therapies and medicines has been modest at best. According to studies only less than ten percent of those who are trying to quit smoking with these methods are successful in quitting permanently.

In addition to the low success rate, problems also stem from low utilization rates. Smokers don´t consider medicines as a real alternative to smoking and thus medical products do not offer them a tempting way for smoking cessation. They also do not appeal to smokers because most of them do not consider themselves as ”patients” in need of medical care.

Recently, tobacco harm reduction has become an increasingly important response to these problems. Over the last decade, especially electronic cigarettes have emerged as an effective means of reducing smoking-related health hazards. It has been estimated that to date, more than six million Europeans have quit smoking with the use of electronic cigarettes (vaping). In the UK alone, there are 1,5 million people who have quit smoking by switching combustible cigarettes to e-cigarettes. In addition, millions of smokers have reduced their health risks by substituting at least a part of smoking with vaping (1,2).

At the same time as electronic cigarettes have displaced smoking among smokers, their uptake among never-smokers has remained negligible. They have not tempted never-smokers for regular use in worrying numbers even in those countries where electronic cigarettes have only been subject to relatively light regulation. For example, in the UK, only 0.1%-0.5% and in the United States only less than 0.1% of never-smoking youth report regular use of electronic cigarettes. (3,4). At the same time the decline in smoking has accelerated in both countries, including among young people. For example, smoking among US high school students has dropped by half in five years, down from 16 per cent in 2011 to about 8 per cent in 2016. (5-8).

Thus the observational evidence is very clear: popularity of vaping hasn´t increased smoking prevalence or even nicotine use. On the contrary, vaping has significantly replaced smoking which has never before decreased as rapidly as after the rise of e-cigarette sales.

There is a consensus among researchers that the health risks from electronic cigarettes and other smokeless nicotine products are considerably lower than the health risks from smoking. The most profound evidence comes from highly respected independent public health institutions, such as Royal College of Phycisians (RCP) and Public Health England (PHE). RCP and PHE have both estimated that health risks of vaping are at most 5% of risks of smoking. Therefore switching smoking to vaping may dramatically improve smoker´s health by decreasing substantially the risk of cardiovascular diseases, cancers and respiratory diseases. Accordingly, promoting the switching from smoking to vaping may offer a significant tool to reduce the burden of smoking-induced NCD’s. (9,10).

For the above-mentioned reasons, the public health benefits of electronic cigarettes clearly outweigh the potential disadvantages. The key to proper regulation is evidence-based proportionality. Smoking and vaping are two different things, and they should be regulated accordingly: electronic cigarettes should not be regulated in the same way as combustible tobacco products, but as products with a considerably lower risk level and with a clear potential for public health benefits. Accordingly, smokers must be provided with accurate information on the relative risks between combustible and smokeless nicotine products. Regulation should focus on keeping the products on the market as safe as possible without undermining innovation in the field or the efficiency of electronic cigarettes as a substitute for smoking.

This must also be taken into account in a recent, rather heated debate regarding electronic cigarette flavours. Flavours are known to play a crucial role in replacing smoking with the use of electronic cigarettes, and non-tobacco flavours are the most popular option among the switchers. By contrast, the concerns about flavours attracting the non-smoking youth to regular use of electronic cigarettes have proved to be unjustified — in other words regular use among never-smokers has remained negligible in spite of the wide range of flavour options available.


Vapers Finland

Päivi Arffman, PhD

Vapers Finland is a non-governmental organization aiming at reducing the health risks from smoking, with focus particularly on the public health potential of electronic cigarettes as a substitute for smoking. The association is taken into account by the Finnish Ministry of Social Affairs and Health and the Parliament’s Social and Health Committee in the consultation on regulation of electronic cigarettes.



1. Farsalinos, KE (et al.): Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries. Addiction, August 2016.
2. ASH: Use of electronic cigarettes (vapourisers) among adults in Great Britain. May 2017.
3. Bauld, Linda (et al.): Young People’s Use of E-Cigarettes across the United Kingdom: Findings from Five Surveys 2015–2017. Int. J. Environ. Res. Public Health. 2017 August 29.
4.  Villanti, AC (et al.): Frequency of youth e-cigarette and tobacco use patterns in the U.S.: Measurement precision is critical to inform public health. Nicotine & Tobacco Research. 24 December 2016.
5. UK Centre for Tobacco & Alcohol Studies: Vaping may help explain the record fall in UK smoking rates — Press Release with comments from UKCTAS Directors. 15 June 2017.
6. Public Health England: Highest smoking quit success rates on record. Press release. 27 September 2017.
7. Zhu, Shu-Hong (et al.): E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys. BMJ 26 July 2017.
8. CDC: Youth and Tobacco Use.
9. McNeill, Ann (et al.): Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. February 2018.
10. Royal College of Physicians: Nicotine without smoke: Tobacco harm reduction. April 2016.

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