Vape issue heats up: will health lose out to revenue?

 

Incidents of vape poisoning have been on the rise – and the country may have to foot a huge bill for the treatment of victims.

PETALING JAYA: It’s said that there’s no smoke without fire – and word on the street is that the government is planning to allow e-cigarettes with nicotine to be sold in the open market, just like cigarettes.

According to two sources, the government is planning to impose taxes on e-cigarettes containing nicotine in the 2022 federal budget.

Financially hard-pressed from the prolonged Covid-19 pandemic, the government imposed an excise duty on vape liquids (RM0.40 per ml) from January this year.

Currently, nicotine is classified as a Group C poison under the Poisons Act 1952. It is illegal to put nicotine in e-liquid but the industry wants the provision to be removed so that vape liquids containing nicotine can be sold freely.

Vape Consumer Association of Malaysia president Aslahuddin Ja’afar said the association had been working hard to get vaping legalised.

“I think we’re almost there because our new health minister is more ‘progressive.’ Hopefully, things will pass through,” he said while speaking in a podcast recently.

A message posted on the Facebook page of the Malaysian Organisation of Vape Entity recently had claimed that one vaping company would monopolise the vape industry in Malaysia.

Public health experts and health-related NGOs had, for many years, asked the government to ban e-cigarettes as vaping was a continuation of nicotine addiction. Many chemicals used in the e-liquid are still unknown while the sweet-smelling aroma attracts the young to pick up vaping,

However, strong lobbying by tobacco companies and the local vape industry has persisted and the tax to be imposed on e-cigarettes with nicotine had been decided by the previous government, said a source.

The World Health Organization’s framework convention on tobacco control stipulated that government dealings with the tobacco industry should be minimal, transparent and accountable but little has been disclosed to concerned NGOs and the public.

For some politicians and those in the economic sector, e-cigarettes can be tapped for revenue.

For instance, Kapar MP Abdullah Sani Abdul Hamid had asked the health minister to state his commitment to “helping” the vape industry which is worth RM500 million a year, which he said has the potential to create jobs for more than 50,000 Malaysians.

Hardcore smokers also argue that vaping enables them to move away from unhealthy cigarette smoking to a “less harmful” product.

Local health experts, however, said a full ban was required because people could add other substances in e-cigarettes which can be harmful. Hence, vaping does not result in harm reduction.

National Poison Centre (NPC) pharmacist Sulastri Samsudin said the centre had received an increasing number of calls on e-cigarette or vaping product use-associated lung injury (EVALI) and this corresponded with the increase in vape users in the country.

“In some vape or e-liquid exposure cases, patients experienced seizures and exhibited aggressive behaviour after inhaling e-liquid suspected to contain illicit drug constituents,” she told FMT.

From the 47 cases NPC received from 2015 to October this year, based on calls from doctors nationwide who sought advice on handling vape-poisoning related cases, 64% (30) were accidental ingestion or inhalation of e-liquid involving children aged below five.

Many vape poisoning incidents go unreported since it is not mandatory to report poisoning incidents to the centre.

One child who ingested her father’s e-liquid suspected to contain harmful substances, had difficulty walking and her skin turned reddish while a nine-year-old vaper developed a severe allergic reaction such as shortness of breath, rashes and fever, said Sulastri.

In more than 80% of cases, she said victims experienced vomiting symptoms, indicating nicotine poisoning.

Children and teenagers constantly exposed to nicotine could suffer from impaired brain development which can have an effect on thinking and learning processes, while adult vapers risk having heart problems and hypertension, said Sulastri.

Kuantan-based International Islamic University Malaysia pharmacist Mohamad Haniki Nik Mohamed said the number of e-cigarette users increased from 600,000 in 2016 to reportedly 1.2 million in 2019.

Currently, at least 600,000 e-cigarette users are teenagers, he said in a webinar on Smoking Harm Reduction: Pintu Kemudaratan (Doorway to Danger) recently.

“Vaping with or without nicotine is harmful to health,” he said.

Malaysian Green Lung Association president Ho Rhu Yann pointed out that the Johns Hopkins University researchers had on Oct 6 reported that vaping aerosols contain nearly 2,000 chemicals, most of which were unidentified and the health risks not known yet.

The current health minister and Cabinet should be reminded that in the health ministry’s written reply to the Kapar MP, two EVALI cases involving teenagers were reported and they needed breathing assistance in the intensive care unit.

A report in the US showed that the cost of treating an EVALI patient hospitalised for 11 days was US$18,938 (RM78,497). With the high treatment cost and additional cost needed for more complex enforcement activities, the government may not get the return it expects, it said.

It also said that e-cigarette users generally failed to stop smoking and some became dual users (cigarette and e-cigarette). There was also an increase in teenage users.

With such concerns, Ho said the government should not legalise e-cigarettes as an excuse to get more revenue but increase taxes on cigarettes which are already regulated.

Interestingly, the government could gain more by increasing taxes on cigarettes than on e-cigarettes.

TAR University College Economics senior lecturer Wency Bui said using the optimal tax projection strategy, the government could gain RM771 million if it increases cigarette excise duty from 40 sen to 77 sen per stick (45.7% to 61.8% of its retail price).

“With the tax increase, an estimated total cigarette tax of RM3.36 billion can be collected, more than the health ministry’s estimation of RM108 million to RM300 million from one million vapers,” she told FMT.

At the webinar in which Haniki spoke, moderator Mohd Afiq Mohd Nor said neighbouring countries such as Singapore, Thailand, Brunei, Vietnam, Cambodia and the Philippines had banned vaping and Malaysia should do likewise.

If the industry and vapers are still insistent, the government could approve one type of e-cigarette -­ one that allows air inhalation only. Nothing else.

Gaining taxe revenue should not come at the expense of the nation’s health. The government could well end up shooting itself in the foot. - FMT