What AVI has actually told India's policymakers

Filed ahead of the Union Budget, this is AVI’s newest submission to government on record: a response to the new “Health Security Cess” on tobacco products, introduced to replace lost revenue once the GST Compensation Cess expired. AVI welcomed the restructuring in principle — but flagged what it called a critical gap: a cess levied explicitly in the name of public health, with no statutory provision actually earmarking any of it for the tobacco users who pay it. The National Tobacco Control Programme, AVI pointed out, currently receives less than ₹20 crore a year — a negligible fraction of what the cess collects — leaving low-income users with effectively no support to quit.

AVI’s request was specific: statutorily earmark a fixed 5-10% of the new Cess revenue for four things — accessible cessation clinics and affordable therapies for the poor; support for switching to lower-harm substitutes like vaping and nicotine pouches for those unable or unwilling to quit outright; direct subsidies for tobacco-related cancer treatment; and an annual, transparent review of how the allocation is spent, with performance-linked incentives for states. The letter closed by framing the ask plainly: that “Health Security” in the cess’s own name should mean something concrete for the tobacco users actually funding it.

Writing to the Union Health Minister ahead of the WHO FCTC’s 10th Conference of Parties in Panama (February 2024), AVI made a case built less on international comparison this time and more on India’s own domestic track record since the ban: illicit vaping devices, AVI wrote, were by then being sold “even in small towns across the country,” with youth access to them, if anything, greater than before — the appeal of an illegal product to that demographic being what regulated ones wouldn’t have carried. The ban had also produced no safety or consumer protection standards and no tax revenue, achieving none of what it set out to prevent.

AVI, as “former smokers who have benefited from risk reduction,” urged the Indian delegation to resist WHO’s hardline anti-THR position at COP10 and instead look to the UK, New Zealand, Japan and Sweden — nations that have allowed or actively promoted switching, and are seeing smoking rates fall sharply as a result — while stopping short of asking India to reverse the ban outright, calling that “an internal matter.” To support the delegation’s preparation, AVI enclosed evidence briefs on vaping’s relative safety, cessation effectiveness, youth impact and regulatory approach, authored by Clive Bates, former director of Action on Smoking and Health (ASH UK) and a longstanding independent THR policy analyst.

By the time the WHO FCTC’s 9th Conference of Parties actually convened — postponed a year by the pandemic from its original Netherlands date — AVI had refined its ask to India’s delegation into three specific requests: transparency and the inclusion of consumers in tobacco-control policymaking, treating risk reduction as a legitimate part of tobacco control rather than something to be excluded from it, and allowing low- and middle-income countries the room to develop solutions suited to their own circumstances rather than importing a one-size-fits-all prohibition.

AVI enclosed a second document alongside its own appeal: an open letter to COP9 delegates signed by 100 specialists in nicotine science, policy and practice from around the world, urging a more constructive stance on tobacco harm reduction. The combined submission was sent to the Health Secretary and India’s delegation ahead of the conference, asking that both documents inform not just India’s COP9 position but its domestic policy as well.

RE: Status of ENDS ban after one year of completion on September 18 — failures and lessons

India was, at the time of writing, reeling under a tobacco epidemic: 26.7 crore Indians (42.4% of men, 14.2% of women, 28.6% of all adults) used tobacco in some form, 10.6 crore of them smokers, per the GATS-2 survey. Only 2.6 lakh had switched to e-cigarettes by 2016-17; that had grown to 6.25 lakh vapers by 2019, when the government banned sale. Meanwhile 13.5 lakh Indians were dying of tobacco-related illness every year, at an annual economic cost approaching ₹2 lakh crore. On the ban’s first anniversary, AVI wrote to every MP with ten specific objections.

1. The haste was never justified. The ban was promulgated by executive ordinance, ahead of Parliament, with no major hauls or busts signalling the acute emergency that would warrant bypassing legislative process for a policy affecting 11 crore people. Tobacco company share prices rose on the news — itself an admission that safer alternatives were a genuine competitive threat.

2. The ban had been ineffective. Thailand, Mexico and Brazil’s comparable e-cigarette bans had each produced a black market with no protections for minors. Bhutan had recently abandoned its own tobacco sale ban for the same reason. India joined an outlier group of nations whose prohibition wasn’t working.

3. Regulation would have served the stated goals better. Almost 100 nations chose to regulate rather than ban, keeping products out of minors’ hands while preserving smokers’ access to a lower-risk alternative — and saw sharp declines in smoking prevalence (UK, US, Canada, France, New Zealand) as a result.

4. The direction of travel was toward regulation, not away from it. Since India’s ban, Hong Kong, New Zealand, the Philippines, South Africa and Russia had each moved to reverse, regulate, or consider regulating e-cigarettes.

5. Smokers had fewer options, not more. Cold-turkey quitting succeeds about 5% of the time; NRTs (largely inaccessible and unsubsidised in India) push that to roughly 7%; vaping had shown roughly double the effectiveness of NRTs, at price points within reach of bidi smokers — while bidis themselves remained lightly taxed and exempt from pictorial warnings.

6. The ban was perpetuating smoking, not reducing it. Tobacco use fell only 6% between GATS-1 and GATS-2. Fewer quit options meant more current smokers stayed smokers — plausibly connected to the same rise in tobacco-company share prices noted above.

7. The public reasons given for the ban had since been refuted. US vaping deaths cited during the Parliamentary debate were later attributed to illegal cannabis vaping, not nicotine vaping; US teen vaping had fallen 34% by 2020; nearly 100 FCTC signatory nations had chosen regulation over the ban the government cited FCTC alignment for; and government counsel in a Kolkata court had stated the ban was partly meant to keep Juul out of the market.

8. The science had only strengthened since the ban. A January 2020 Journal of Hazardous Materials study compared toxicity on bronchial epithelial cells across cigarettes, heat-not-burn products and e-cigarettes, and found e-cigarettes the least toxic of the three; a September 2020 UK COT report reaffirmed Public Health England’s 95%-safer finding; and an April 2020 study found e-cigarettes producing dramatically less carbon monoxide, acetaldehyde and formaldehyde than combustible cigarettes.

9. The ban followed a pattern of pressure on low- and middle-income countries. A Bloomberg Philanthropies–funded NGO had published a position paper that year arguing THR products should be banned specifically in LMICs like India, citing weak regulatory capacity — a position AVI called discriminatory, and urged India to resist in favour of independent, evidence-led policy.

10. It was a bad economic decision. A legitimate e-cigarette industry could have generated tax revenue, created an alternative income stream for India’s tobacco farmers, and reduced the downstream healthcare cost of tobacco-related disease — instead the ban handed that economic activity to smuggling networks and a $5 billion industry booming next door in China.

AVI asked Parliament and the government to reconsider the ban and institute an unbiased review, drawing on regulatory frameworks already in use elsewhere — the EU’s Tobacco Products Directive, the US FDA’s deeming regulations, and approaches from China, New Zealand, the Philippines and South Africa — and offered its own expertise in shaping a policy that would serve India’s 27 crore tobacco users with accurate information and safer choices.

India has the second-largest smoking population in the world, with over a million tobacco-related deaths annually. AVI argued that this alone should have put the country at the forefront of promoting cessation therapies and safer nicotine delivery systems — e-cigarettes, snus and other harm reduction products — rather than banning their sale and distribution while still permitting personal use, a policy AVI called “the grave mistake” at the heart of India’s current approach.

The letter — sent directly to Dr Harsh Vardhan, then Union Health Minister, and the Health Secretary, in both English and Hindi — argued that traditional cessation methods alone cannot address India’s tobacco burden without a progressive stance on harm reduction, and asked the Minister to carry that position into COP9, then scheduled for November 2020 in the Netherlands (later postponed to 2021), and to withdraw the ban on sale, production, distribution, advertising and transport of e-cigarettes at home.

Filed with the Tobacco Control Division on November 8, 2019 as formal “public comments/views” on the bill that would ratify September’s ordinance into permanent law, this is the most detailed submission AVI has put on the record — a fully referenced, section-by-section response, later emailed individually to every sitting MP in both houses so the debate wouldn’t proceed without it. The full document is archived above; the core of its argument:

The three state-sanctioned interventions aren’t enough. Cold-turkey quitting, cessation counselling and NRT were, AVI argued, failing at scale: just 19 functional cessation clinics existed nationally for a 27-crore tobacco-using population, NRT effectiveness hovers near 7%, and most Indian medical professionals report insufficient training to offer cessation help at all. Raising taxes has its own ceiling — push the price of a cigarette too high and smokers shift to loose, unbranded ones sold even more cheaply, with no net harm reduction.

Harm reduction has a track record everywhere except tobacco. India already runs free methadone distribution — including mobile clinics — for opioid dependence, an approach AVI called well-integrated and uncontroversial. The submission asked why the same non-judgmental principle, of meeting people where they are rather than demanding abstinence, had found “stiff resistance” only in tobacco, despite tobacco affecting far more people: 1.1 billion smokers worldwide, 7 million deaths a year.

Teen use doesn’t hold up as a rationale for a blanket ban. AVI cited a UK study of 60,000 teens finding no evidence of a “gateway” effect, and a November 2019 US study of 12,000 teens concluding that e-cigarette use and smoking correlate through shared risk factors rather than one causing the other. In a market where loose cigarettes are cheap and freely sold while e-cigarette devices cost roughly ten times more, AVI argued a ban would if anything push risk-prone teens toward the more accessible, deadlier product.

The research gag, not a lack of evidence, was the actual problem. AVI pointed to two 2019 health ministry circulars barring ENDS research and even consultation on the subject at centrally funded and NBE-accredited medical institutions — and to an RTI-obtained internal note in which Vikas Sheel, then Joint Secretary at MoHFW, wrote months before the ban that “the issue does not appear to have proceeded in a scientific and objective manner.” ICMR’s own white paper recommending a ban, AVI argued, was published weeks after that research gag took effect and cited no research from any country that had itself banned e-cigarettes.

Courts had already ruled against prohibition, repeatedly. By AVI’s count: the Delhi High Court held the 2018 central advisory non-binding on states; the Delhi and Bombay High Courts had separately stayed state-level ENDS bans; and the Calcutta High Court had granted relief against the ordinance itself, with the matter then sub judice — a consistent judicial signal, AVI argued, that caution should have preceded the ban rather than followed a court challenge to it.

A conflict of interest AVI called out directly. Tobacco company share prices rose immediately after the ban was announced. The submission noted the Indian government’s 28% stake in ITC (maker of roughly 80% of cigarettes sold in India) and a stake in VST, arguing this direct commercial interest in cigarette sales sat uneasily against a stated public-health rationale for banning a lower-risk alternative — and against Article 5.3 of the FCTC, which bars tobacco-industry influence over tobacco control policy, a treaty India was itself a signatory to.

Specific drafting problems. AVI flagged Section 3(d)’s definition of “electronic cigarette” — any “device that heats a substance to create an aerosol for inhalation” — as broad enough to sweep in steam inhalers and wearable air purifiers, and noted the bill nowhere defined what quantity of devices or e-liquid constituted personal use (not banned) versus commercial possession (banned), leaving existing users with no clear, lawful way to keep the devices they already owned.

The submission closed by asking the ministry to create a specific carve-out allowing adult e-cigarette users to continue accessing devices and components, rather than being pushed back toward smoking. It was signed by Samrat Chowdhery, Director, Association of Vapers India.

Respected Sir,

We are writing on behalf of Association of Vapers India (AVI), an advocacy group created to spread awareness about safer alternatives to tobacco and cigarettes, and to work with government on policy guidelines that protect the lives of Indian smokers. We have no business or individuals with vested interests involved in our operations.

We have seen media reports on Electronic Nicotine Delivery Systems (ENDS) regulation and the views of the Ministry’s own expert committees. Several state governments have already moved to prohibit e-cigarette sale without, we believe, evaluating the consequences.

The case for harm reduction. ENDS carry real potential to help the 11.2% of the world’s smokers who are Indian — around 900,000 annual deaths — switch away from combustible tobacco. Regulators elsewhere have largely chosen to regulate the category rather than prohibit it. The UK’s Royal College of Physicians found long-term vapour inhalation unlikely to exceed 5% of the harm from smoking; e-cigarettes have shown effectiveness upwards of 50% as a cessation tool, against roughly 7% for patches and gums; and a US study in the British Medical Journal, drawing on the largest representative sample of e-cigarette users to date, found e-cigarette use associated with increased smoking cessation at the population level.

How other regulators have approached it. The UK’s 2017 Tobacco Control Plan committed to “permitting innovative technologies that minimise the risk of harm” and “maximis[ing] the availability of safer alternatives to smoking.” The US FDA extended its e-cigarette regulation deadline by up to four years that same July, with then-Commissioner Scott Gottlieb explicitly framing the shift as encouraging smokers toward e-cigarettes. The WHO’s own August 2016 FCTC COP7 report acknowledged that if the great majority of smokers unable or unwilling to quit were to switch to a lower-risk nicotine source, “this would result [in] a significant public health achievement” — and the COP7 decision left ENDS regulation to individual Parties’ national laws and public health objectives, rather than prescribing prohibition.

The illicit-trade risk. Restricting legal availability, we argued, would not eliminate demand — it would push it into illegal trade, with no assurance of source, quality or compliance, and a direct loss of government revenue. The WHO’s own COP6 report had already acknowledged illicit trade and cross-border online sales of these products as a live concern.

Our request. We asked the Ministry to reconsider any prohibition on these grounds: that it would subvert the harm-reduction potential of the category, ignore mounting international scientific evidence, hand a boost to smuggling, and remove a choice from millions of Indian smokers and vapers — and we asked for a more consultative process before any policy guideline was finalised, along with the opportunity to introduce the Minister to people for whom switching to ENDS had been the difference between life and continued smoking.