WATCH | Bhekisisa: What’s 95% safer than tobacco? Not vapes, say experts

Last week the Australian government tabled a bill in parliament to ban e-cigarettes from being sold in public shops, and allow people to get a vape only on prescription from a health worker to help them quit tobacco.

And in a sudden about-turn from its 2015 stance, the UK has now made it illegal for shops to sell e-cigarettes that come prefilled with a vaping liquid and can be used only once, mostly because they want to stop children from picking up the habit. The UK’s announcement comes off the back of a 2015 announcement by the British government that vaping is “around 95% safer than smoking”.

An e-cigarette is a battery-operated device that heats a nicotine-containing liquid, often flavoured, to form a mist that you inhale, for a kick similar to when you smoke traditional tobacco products.

Moreover, a large analysis of many studies published in The New England Journal of Medicine in February showed that vaping is as bad for you as smoking traditional cigarettes when it comes to the chance of getting heart disease, having a stroke or developing conditions that interfere with the biochemical reactions in your body.

Concerns like these, together with the rise of vaping among teenagers and not knowing what the long-term health effects of vaping are, are prompting legislators to be cautious — also here at home.

If South Africa’s Tobacco Products and Electronic Delivery Systems Control Bill that’s before parliament comes through, the sale of e-cigarettes will be controlled in the same way as tobacco products in South Africa.

Richard van Zyl-Smith, a lung specialist at the University of Cape Town’s Lung Institute, says it’s a prickly issue. “Vaping is not without risk. It may be safer than smoking tobacco, but it’s not safe compared with [inhaling] fresh air.”

Mia Malan spoke to Van Zyl-Smith in the latest episode of Bhekisisa’s monthly TV programme Health Beat to find out why there’s so much huffing and puffing around vapes.

Mia Malan (MM): In a pilot study among pupils in high-income high schools, you found that teens tend to vape because of stress. Tell us more about that.

Richard van Zyl-Smit (RvZ-S): We used high-income schools just as a convenience sample. We asked how many [pupils] are vaping and why do they continue to vape. [Reasons like] anxiety, stress and coping came out very strongly. It’s not the only reason; for others, there was a clear nicotine addiction.

MM: Supporters of vaping often quote a statistic that e-cigarettes are around 95% less harmful than tobacco, which comes from the British government's review of evidence. How did they come to this conclusion?

RvZ-S: “The 95% safer” paper is a paper that was published in a reasonably obscure journal and put together by a group of individuals that don't have the cleanest record, from a scientific point of view, in relation to their affiliations with tobacco industries and harm reduction industries. So there are a couple of red flags in terms of how [the study] was done and who was involved. What they did was, essentially, [to] sit in a room, look at the evidence and come up with a conclusion to say that vaping appears to be 95% safer. There's only one paper, and it's only that paper. Many of us in the [research] space say 95% is not the correct number. Just given the number of chemicals and the dangers of tobacco, it is likely to be safer [than smoking]. But 95% is a very tenuous estimation. [Such reduced harm] also applies only to people who are smoking and have a 50% chance of dying from smoking-related illness.

MM: Why would a government take that information and base an entire policy on that, as in the UK?

RvZ-S: The UK is an outlier. Most other countries consider smoking cessation to be fresh air, whereas the UK considered it to be vaping. But the UK has recently announced they're going to ban disposable vaping devices, because they've seen an alarming rise in vaping among adolescents. Clearly there’s something afoot in the UK where [their] saying it's safe has caused problems. 

MM: Is there any data to show that [tobacco] smokers who want to quit turn to vapes?

RvZ-S: There is a Cochrane review that looks at all the evidence and makes recommendations, and it’s not a good option [the analysis shows]. It doesn't mean it [vaping] doesn't work for the individual. But if you asked me what the best way to stop smoking is, vaping wouldn't be top of my list.

MM: What, then, works best to stop smoking?

RvZ-S: Behavioural modification is the buzzword. [We want] to understand why someone smokes. What's triggering [the behaviour]? How do you change your behaviour? Are you stressed? Are you anxious? Are you bored? Are you angry? What is it that triggers you [to smoke]? Behavioural modification tries to break the habit in addition to pharmacotherapy [using drugs to treat a condition], so using either a [nicotine] patch or one of the oral medications to help with nicotine withdrawal. In combination they are the best option. 

MM: Is vaping a safe option to try if you want to quit smoking? Are there any harms involved?

RvZ-S: It would be considered a safe option to use, but we would always advocate it as a stepping stone. You're still exposing yourself to chemicals, as well as remaining addicted to nicotine and spending the money. So, the best option is fresh air.

MM: Is nicotine, from tobacco or vaping products, bad for you? Or is it OK to have a little bit of nicotine?

RvZ-S: Nicotine is not a harmless substance. Taken in large doses it causes a significant problem. [In addition to it being addictive], it has impacts on the immune system, on your blood pressure and the lining of your arteries. It can also impact on the growth of blood vessels. There's [some] discussion around whether it’s a cancer-causing drug itself — most people would agree that it doesn't cause cancer, but it may promote the growth of cancers because it promotes the growth of blood vessels. 

MM: Nicotine is a scheduled substance, so it gets regulated. Are the ingredients in vapes, including nicotine, regulated? How does that work?

RvZ-S: The problem with vaping is that it doesn't fit into any standard [form of] regulation. It's not a foodstuff [and] it's not a health product. It's nothing. So the government has not had the ability to regulate it. The regulation currently before parliament has been seven years in the making [and it] will finally regulate vaping, [with] the proposal [being that it] will regulate vaping exactly like it does tobacco, following the US, for example, [where] tobacco and vaping are legislated in the same format.

MM: Why is it a good thing that the new proposed legislation will treat traditional smoking and e-cigarettes the same way?

RvZ-S: It's a good thing because you need to restrict access, particularly among adolescents. There is no reason to be marketing an addictive product like tobacco or vaping. [In this way] you're protecting the public, not enticing young people to it.

MM: What do you think of the philosophy of organisations like “Vaping saved my life”, who argue that vapes should be made more available and cheaper, so that more people can quit smoking?

RvZ-S: I have many issues with [an idea like] “vaping saved my life”, first, because you don't know that it has saved your life. That is only in the future. I don't think vaping needs to be freely available. It needs to be cheap for those that need to use it because they want to stop smoking. But if you make it cheap and freely available, it's going to get [both] used and abused, which is going to cause problems. It's not without risk: vaping may be safer than tobacco, but it’s not safe compared with [inhaling] fresh air.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.