WHO Calls for Strict Global Regulation of e-Cigarettes

Pam Harrison

August 27, 2014

The World Health Organization (WHO) is calling for global regulation of electronic nicotine delivery devices — mainly, electronic cigarettes (e-cigarettes) — because current evidence suggests that the potential harms of these devices far outweigh any potential for good.

The WHO report, Electronic Nicotine Delivery Systems, will be presented at the Conference of the Parties to the WHO Framework Convention on Tobacco Control in Moscow, Russian Federation, in mid October.

"In a nutshell, the WHO report shows e-cigarettes and similar devices pose a threat to public health," Douglas Bettcher, MD, PhD, director of the WHO's Department of Prevention of Noncommunicable Diseases, Geneva, Switzerland, told reporters attending a press briefing.

Although e-cigarettes are likely to be less toxic than conventional cigarettes, "their use is a threat to adolescents and to the fetuses of pregnant mothers who use these devices," he added.


Dr. Bettcher also noted that aerosol from e-cigarettes is frequently described in marketing as "water vapor," but that is simply not the case. According to the report, aerosol from e-cigarettes usually contains at least some of the same carcinogenic compounds and other toxicants found in tobacco smoke, although at lower levels than in tobacco smoke.

But for some brands, some of these cancer-causing agents, such as formaldehyde, acrolein, and other toxicants, are as plentiful as they are in the smoke produced by some cigarettes.

Not only are users themselves exposed to these toxicants, but nonsmokers and bystanders are exposed to compounds within the aerosol as well, which is clearly more toxic than being exposed to water vapor, said Dr. Bettcher.

Other adverse health effects cited by the WHO can result from long-term inhalation of toxicants in the aerosol, including eye and respiratory irritation caused by exposure to propylene glycol.

The WHO also points out that the capacity of these delivery systems to deliver nicotine varies widely and depends on how a person inhales with the device. If inhaled vigorously and frequently, the user can be exposed to similar amounts of nicotine as they would get from a cigarette.

Another major concern for the organization is that the tobacco industry is garnering an ever-increasing share of the market. In their view, "the tobacco industry is using the marketing of e- cigarettes to position itself as a public health partner, which it clearly is not," Dr. Bettcher said.

Indeed, by marketing e-cigarettes as a solution to smoking cessation, "the industry is pretending to be part of the solution to the health disaster that they themselves have created," he said. "We don’t accept in any way any potential partnership with the tobacco industry on e-cigarettes."

Need for Regulation

A survey done in preparation for the release of the report shows that worldwide regulation of e-cigarettes is highly uneven. Half of WHO member countries had taken no known measures to regulate the use of e-cigarettes, the survey showed.

"This is why WHO recommends that e-cigarettes need to be regulated," Dr. Bettcher said. As outlined in the report, the WHO would like to see governments adopt 4 basic principles to meet the following goals:

  • Impede e-cigarette promotion to nonsmokers and young people.

  • Minimize potential health risks to e-cigarette users and nonusers.

  • Prohibit unproven health claims about e-cigarettes.

  • Protect existing tobacco control efforts from commercial and other vested interests of the tobacco industry.

The report will be presented to the parties to the WHO Framework Convention on Tobacco Control in Moscow later this year, and it is they who will make the ultimate decision going forward regarding the implementation of the WHO's recommendations.

Ultimately, the WHO would like to see significant restrictions on advertising and sponsorship of e-cigarettes, especially to youth; a ban on their use indoors both in public and work places; and a ban on the sale of any e-cigarette with fruit flavors, candylike flavors, and alcohol drink flavors that are particularly attractive to children and adolescents.


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