England could be the first country in the world to prescribe medicinally licensed electronic nicotine delivery systems – also known as e-cigarettes – to help reduce smoking rates.
According to the World Health Organisation (WHO), around 80 countries in the world, including India, have taken steps to address the dangers of e-cigarettes, but they still remain unregulated in much of the world.
Why England wants to prescribe e-cigarettes?
There are around 6.1 million smokers in England and almost 64,000 people died from smoking in the country in 2019. Yet, e-cigarettes could be prescribed on the National Health Service (NHS) in a world first.
The Medicines and Healthcare products Regulatory Agency (MHRA), which regulates medicines, medical devices and blood components for transfusion in the UK, is publishing updated guidance that paves the way for medicinally licensed e-cigarette products to be prescribed for tobacco smokers who wish to quit smoking.
If a product receives MHRA approval, clinicians could then decide on a case-by-case basis whether it would be appropriate to prescribe an e-cigarette to NHS patients to help them quit smoking.
E-cigarettes contain nicotine and are not risk free, but UK health authorities are citing expert reviews and data which states that the regulated e-cigarettes are less harmful than smoking.
E-cigarettes were the most popular aid used by smokers trying to quit in England in 2020. E-cigarettes have been shown to be highly effective in supporting those trying to quit, with 27.2% of smokers using them compared with 18.2% using nicotine replacement therapy products such as patches and gum.
A medicinally licensed e-cigarette would thus have to pass even more rigorous safety checks.
UK's Health and Social Care Secretary Sajid Javid welcomed the latest step forward in the licensing process for manufacturers, saying that the Boris Johnson government will soon publish a new Tobacco Control Plan which will set out the roadmap for achieving a smoke-free England by 2030.
"Opening the door to a licensed e-cigarette prescribed on the NHS has the potential to tackle the stark disparities in smoking rates across the country, helping people stop smoking wherever they live and whatever their background," said Javid.
What WHO says about e-cigarettes?
All over the world, whether it is the US Surgeon General's Report or the European Union's Scientific Committee on Health, Environmental and Emerging Risks (SCHEER), the evidence to infer that e-cigarettes, in general, increase smoking cessation has been found inadequate.
As novel tobacco products are promoted as healthier alternatives to smoking by the tobacco industry, the WHO sees e-cigarettes as a major challenge which lies ahead.
It believes that, until independent research shows the real risk profile of these products, governments should be cautious.
"Science-based evidence, not marketing, should guide their actions," says Adriana Blanco Marquizo, head of the WHO Framework Convention on Tobacco Control (FCTC), in organisation's annual report on the global tobacco epidemic released a few months ago.
During the ongoing Covid-19 pandemic, the WHO had launched a campaign to inform people of the risks associated with using tobacco, e-cigarettes, sheesha and smokeless tobacco and betel nut.
The organisation said that while the Covid-19 pandemic highlighted the vulnerability of the world’s population, the tobacco and e-cigarette industries exploited the context for their own commercial ends.
"As cigarette sales have fallen, tobacco companies have been aggressively marketing new products – like e-cigarettes and heated-tobacco products – and lobby governments to limit their regulation. Their goal is simple: to hook another generation on nicotine. We cannot let that happen," said Michael Bloomberg, the WHO Global Ambassador for Noncommunicable Diseases.
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