E-Cigarette Use and Regulation: A Comparative Analysis between the United States, the UK, and China.

Abstract

Svirsky, Howard, and Berman (2022) have enumerated a variety of U.S. FDA (Food and Drug Administration) roles, arguing that although the public possess a “right to information” about health risks, the FDA should be hesitant about endorsing e-cigarette use given scientific uncertainty. In the authors’ view, as a knowledge purveyor, the FDA has a responsibility to inform the public about the harms and benefits of e-cigarettes; however, its roles as information producer, advisor, and market agent require that FDA be cautious in the way it interprets and communicates available evidence. Compared with disseminating information regarding the health risks and benefits of e-cigarettes, the FDA can make its most important contribution to public health by reducing combustible tobacco use, making such products less appealing while simultaneously making e-cigarette products safer. In this commentary, we aim to supplement the authors’ opinion by comparing the trends in e-cigarette use and governmental regulation in the U.S., the UK, and China. We selected these three typical countries because the U.S. is the world’s biggest vaping market (Knowledge Action Change 2020), China has the world’s largest smoking population (China Briefing 2022), and no country in the world other than the UK has announced support for medicinal licensing of e-cigarettes (Hopkinson et al. 2022). Although the e-cigarette was first invented by H. A. Gilbert in 1963, the subsequent commercially viable design was patented in 2003 by Chinese pharmacist, Hon Lik, who brought it to the Chinese domestic market the next year. Subsequently, e-cigarettes entered the U.S. and European markets in 2006 and 2007, respectively (Gupta et al. 2020). Governments generally categorize e-cigarettes as tobacco, imitation tobacco, medicinal, pharmaceutical, or consumer products, poisons, or electronic nicotine delivery systems (ENDS), and how e-cigarettes are defined affects its policies and regulations. Currently, there is no global standard for e-cigarette regulation, which varies from one country or region to another (Bianco et al. 2021). Thus far, different approaches to regulating e-cigarettes have been adopted internationally. First, we analyze the regulation of e-cigarettes in the U.S., the UK, and China. In mainland China, since e-cigarettes first emerged in 2004, their regulations have gone from relaxed to strict. Back then, with little international regulatory experience, the classification of e-cigarettes had not yet been determined. E-cigarette companies marketed their products as a safer alternative to tobacco and as a tool to facilitate quitting smoking. Since there is little evidence of health effects, government agencies started to pay attention to the regulation of e-cigarettes and gradually tightened it (Xu et al. 2016). In August 2018, the State Administration for Market Regulation (SAMR) and the State Tobacco Monopoly Administration (STMA) released a notice banning the sale of e-cigarettes to minors and online sales of e-cigarettes in November 2019 (Zhao et al. 2020). In November 2021, China’s State Council announced it had revised Regulations for the Implementation of the Tobacco Monopoly Law to include e-cigarettes and related products, making them subject to the same rules as tobacco products. In March 2022, the STMA released the