Overview

This call to action on e-cigarettes notes that urgent and strong decisive action to prevent uptake of e-cigarettes, which are harmful to health, should be taken to protect children, as well as non-smokers and minimize health harms to the population.

The promotion of e-cigarettes has led to marked increases in e-cigarette use by children and adolescents, with rates exceeding adult use in many countries.  Further, to date, the commercialization (sale, importation, distribution or manufacture) of e-cigarettes as consumer products has not been proven to have had a net benefit for public health. Instead, alarming evidence on their adverse population health effects is mounting. Therefore, based on WHO’s assessment of available evidence, particularly the growing body of evidence on uptake by children, adolescents and non-smokers, the statement recommends that:

• Where countries ban the sale of e-cigarettes, they should strengthen implementation of the ban and continue monitoring and surveillance to support public health interventions and ensure strong enforcement.
• Where countries permit commercialization (sale, importation, distribution and manufacture) of e-cigarettes as consumer products, they should ensure strong regulations to reduce their appeal and their harm to the population, including by banning all flavours, limiting the concentration and quality of nicotine, and taxing them.
• Irrespective of whether countries ban sale of e-cigarettes or permit commercialization as consumer products, these actions should be taken in conjunction with measures to motivate and assist existing users of tobacco products to quit tobacco use using proven methods, including advice from healthcare workers, toll-free quit lines, mobile and digital cessation services, and approved therapies.
• Countries do not pursue a smoking cessation strategy that permits commercialization of e-cigarettes as consumer products. Any cessation objective utilizing these products should carefully weigh national circumstances and the risk of uptake, and exhaust other proven cessation strategies. The conditions under which the products are accessed for cessation should be controlled to ensure appropriate clinical conditions, and the products should be regulated as medicines, rather than their sale being permitted as consumer products.

The call to action is accompanied by a technical note which provides detailed information on the evidence underpinning the guidance provided.