Still at war with the tobacco epidemic, Indonesia must control e-cigarettes too
Several countries are banning e-cigarettes due to revelations of health risks to both users and bystanders.
But in Indonesia, the world's second-largest cigarette market, the government has yet to put in place policies to prevent youths from taking up vaping.
More than 1,000 people were confirmed ill and at least 19 people died from a severe lung disease linked to vaping in the United States (US). The country has recently considered banning flavoured e-cigarettes in response to the deaths and illness associated with vaping.
Twenty countries in South America, the Middle East and Southeast Asia have banned the possession and sale of e-cigarette products.
There has been no research on the prevalence of vaping among youth in Indonesia, but the Indonesian government should be alarmed by the reports of illness and death due to vaping in the US.
The government should take immediate actions to prevent a youth vaping epidemic in Indonesia, especially since Juul, a leading US-based e-cigarette firm, entered the market in early July.
This will further burden Indonesia, which already has the highest rate of youth smokers in the region. A fifth of Indonesians between 13 and 15 years old smoke cigarettes.
Here are some suggestions the government should adopt to control public health risks from e-cigarettes sales:
First, the government should control the safety and quality standards for e-cigarettes, including e-liquid ingredients and e-cigarette components.
Indonesia's existing regulation on vaping is far from adequate.
Currently, the vaping liquid (e-liquid) is taxed as high as 57%, higher than the average of excise tax for combustible cigarettes. However, this policy applies to e-liquid, not the prefilled pods found in Juul products. It is still unclear how Juul will be regulated in Indonesia based on the existing policy.
The Finance Ministry should periodically adjust the tax rate for inflation to keep vape products less affordable for kids. Also, there should be a single excise tax that encompasses all types of e-liquid, regardless of their cartridge model.
BPOM should also set the safety and quality standards for e-cigarettes and continuously monitor adverse effects of the products.
Second, limit access to e-cigarettes for youth and non-smokers.
The government can restrict access to e-cigarettes by limiting the type of selling outlets like kiosks and convenient stores, banning flavoured e-cigarettes, regulating e-cigarette promotion and advertising, and setting up a screening system to prevent non-smokers or young customers from buying the device.
Again, BPOM and the Health Ministry can apply such ban. The government should stop the distribution of misleading and scientifically unproven health claims that promote vaping. This includes messages like vaping helps smokers quit.
Ensuring the efficacy of this measure requires interministerial efforts, involving the Ministry of Communication & Information Technology, Trade Ministry and Health Ministry.
Third, ban vaping in smoke-free areas.
Secondhand vaping may harm the health of bystanders. The World Health Organization (WHO) recommends countries regulate vaping devices in public places.
Indonesian authorities at the regional level may extend current smoke-free laws that forbid smoking in public spaces to e-cigarette users.
Fourth, run a public education campaign about the harms of exposure to e-cigarettes.
The campaign may start in schools. Teachers can play an important role in educating students and parents about the risks of vaping.
The program should also involve health professionals or even youth communities, like in the US.
Again, the campaign should involve multisectoral authorities, like the Ministry of Education and Ministry of Communication & Information Technology.
Why Indonesia needs to control vaping
Vaping is dangerous for health, research has proven.
While it is true that vaping emits fewer chemicals than combustible cigarettes do, it produces other toxic substances. These substances include nicotine, a substance that is as addictive as heroin, and metals in the same or higher levels than combustible cigarettes. It means vaping is not necessarily less harmful than smoking.
E-cigarette's aerosol can also expose users and bystanders to particulate matter and cancer-promoting substances such as formaldehyde.
The e-cigarette has not yet been proven as an effective tool to stop smoking. Instead, vapers might be at risk of being dual users, smoking and vaping, or if they quit smoking, they could not give up vaping for a long term.
Tobacco-related diseases cost Indonesia almost Rp 4.2 trillion (US$295 billion) by 2019. By controlling e-cigarettes and their use, the government can save the young generation from becoming smokers as e-cigarettes tend to attract youth and may turn them into smokers.
E-cigarettes not a solution
The WHO has warned that e-cigarette firms, which are mostly tobacco companies, are trying to re-establish their image as part of the solution to the tobacco epidemic so they can influence governments' tobacco control policies to increase their own profits.
Thus, the WHO Framework Convention on Tobacco Control (FCTC), the global public health treaty to address tobacco use, calls on FCTC countries to prohibit or restrict the production, distribution, sale and consumption of e-cigarettes.
Can Indonesia follow suit to protect its young generation?
It is paramount for the government to regulate and monitor e-cigarettes as part of the country's tobacco control strategy. Indonesia faces an enormous challenge in reducing the number of smokers and preventing young people from becoming addicted to smoking. We should not let e-cigarettes divert our focus on cracking down on tobacco smoking, our long, winding battle to save Indonesians' future.