Over five million Indians have died of smoking-related causes since their government banned the sale of vapes and heated tobacco products in late 2019. Instead of being swayed into offering low-risk, effective alternatives to millions of people who smoke, the government has intensified its war on them.
Cheered on by the World Health Organization and allied groups, India’s government has now obstructed research on tobacco harm reduction (THR) products and gagged the media from discussing adoption of THR strategies.
India is home to 120 million adults who smoke, the majority of whom are poor with strained health-care access. Cancer is projected to increase in India in the coming years, and 27 percent of cancers are attributed to tobacco use (which includes smoked bidi rolls and traditional chewable forms, as well as cigarettes).
Risk reduction can play a vital role in these conditions, and has been identified by Dr. Balram Bhargava, former director of the Indian Council for Medical Research, as a key approach to reducing the country’s cancer burden.
The directives amount to a de facto ban on investigating the risk continuum of nicotine products, and their health impacts among Indian populations.
Yet despite the enormous costs of tobacco use in India—1.35 million deaths a year, economic losses of over 1 percent of GDP—Indian doctors receive no training on preventive interventions or mitigating tobacco-related harms.
The WHO’s campaign against lower-risk nicotine alternatives, propagated aggressively by anti-tobacco groups funded by Bloomberg Philanthropies, has led to further hardening of official positions in India.
On December 15, the day after WHO issued its latest dire warning against vaping, the National Medical Commission, a constitutional body that lays down policies for medical education in India, directed all doctors to refrain from conducting or participating in research on vapes and heated tobacco without seeking its approval and that of the health ministry. A similar instruction, issued to state-funded educational institutions in 2019, had already driven ethics panels to blindly reject THR research proposals.
Together, these directives amount to a de facto ban on investigating the risk continuum of nicotine products, their varying impacts on health, and the viability and effectiveness of switching strategies among Indian populations.
The latest restriction, ostensibly to promote “responsible research,” is being viewed as an attack on both academic freedoms and public health.
“The possibility of turning India from a cancer capital into one where millions of adult smokers can lead healthier lives has gone up in flames.”
“Research is an integral part and the backbone of a progressive nation,” Dr. Aparajeet Kar, an interventional pulmonologist in Assam, told Filter. “With a ban on ENDS [electronic nicotine delivery systems] and now an effective ban on research, the possibility of turning India from a cancer capital into one where millions of adult smokers can lead healthier lives has gone up in flames.”
Vaping nicotine is demonstrably safer than smoking conventional cigarettes or bidis, and many countries have seen dramatic declines in smoking after its introduction. In contrast to India, these nations have adopted a scientific approach in tackling tobacco-related health burdens, said Dr. Kar, who is the director of the Association for Harm Reduction Education and Research (AHRER), a pan-India body of medical professionals seeking integration of THR in tobacco control.
Researchers working in the THR field say tobacco use in India is a complex issue, which cannot adequately be addressed with boilerplate measures such as tax hikes and bans. While over 40 percent of adult Indian men consume tobacco, with prevalence particularly high in poor and rural communities, smoking is also rising sharply among urban women—situations that require pragmatic and differentiated policy responses.
It’s notable, too, how research into cannabis and opium is permitted and funded, when tobacco use severely impacts far more Indians.
“The wide spectrum and high tobacco use in India is both a health and social concern, depriving many families of breadwinners and contributing to inequalities,” Professor Debjani Banerjee, a social science researcher at VES Business School in Mumbai who has conducted studies on vaping and oral nicotine, told Filter.
“Studies have identified a significant desire to quit among tobacco consumers and e-cigarettes have emerged as an effective alternative support,” she continued. “Then why are policymakers imposing a ban on such research which can help validate the truth, especially as it could prove its worth in reducing tobacco mortality and morbidity?”
Speak No Harm Reduction
The new research clampdown came just months after a comparable attack on media freedoms. In May 2023, the ministry of information and broadcasting, in an unprecedented move, barred print and digital media from publishing anything that “directly or indirectly promotes the use of electronic cigarettes.”
The diktat was prompted by a high-profile panel discussion on THR. This included, among eminent Indian and international experts, a member of Niti Aayog, the top policy think tank of the Indian government. The 35-minute discussion highlighted various perspectives on THR, including opposition to it. It made no mention of any specific products. But because some panelists were critical of the vape ban, the health ministry branded the event as vaping “promotion.”
In response to the ensuing media gag, panelist Dr. Nimesh Desai, a psychologist and former director of the Institute of Human Behaviour and Allied Sciences in New Delhi, told Filter, “As far as I saw it then and see it now, that session was one of the science-industry dialogues at a business summit, so clearly had shades of opinions on possible future course of actions [in tobacco policy].”
With no discernible media resistance, the circular has succeeded in wiping out THR debate. Media houses now relegate reporting on vaping and THR developments to junior staff. Their articles are peppered with quotes from medical professionals with no exposure to THR, nor any understanding that vaping, heated tobacco and modern oral nicotine products fall low on the risk spectrum. Instead, these “experts” echo the Bloomberg line by portraying such interventions as an industry tactic to hook young people.
“I worry about the chilling effect this will have on public discourse around safer nicotine alternatives which can save many lives.”
Another participant in the panel debate, Dr. Kiran Melkote, orthopedic surgeon at Fortis Hospitals in Gurgaon and also an AHRER director, said the idea that talking about evidence-based solutions and reducing harm from tobacco use undermines public health—especially when current approaches are failing—is “deeply offensive.”
“I worry about the chilling effect this will have on public discourse around safer nicotine alternatives which can save many lives,” he told Filter.
The reason cited for the gag was that discussing vapes in a positive light amounts to promotion, which violates the ban. But can a law carry within it a penalty for criticizing it?
“The freedom to analyze and criticize legislative and executive actions is inherent to the rule of law,” legal counsel Pingal Khan, a partner at Ashlar Law in Bangalore who has been involved in vaping litigation, told Filter.
“Making a law or interpreting it to mean it cannot be questioned is an attack on Article 19 [the right to freedom of speech] as well as the fundamental principles on which our Constitution stands,” he continued. “The government’s position is absurd and is likely to result in executive overreach and arbitrary application of the directive, causing harm to the evolution of dialogue and policies in the health and harm reduction policy space.”
International experts have also responded with dismay to India’s backsliding on academic and media freedoms, which appears to be timed for showcasing at the upcoming COP10 international tobacco control meeting in Panama.
As if in a parallel universe, many Indians are voting for their health by switching from combustible tobacco to unregulated vaping products.
“There is a vast difference between violating a law and questioning its basis,” David Sweanor, law professor and chair of the Advisory Board of the Centre for Health Law, Policy and Ethics at the University of Ottawa, Canada, told Filter. Sweanor was an international invitee on the panel that prompted the media directive.
“There is no question there are huge differences in risk between different nicotine products,” he continued. “Whether it is good public health policy to enact a ban on the least hazardous ones is clearly worth discussing. All the more so when the policy is associated with a vast increase in the market value of cigarette makers, and millions of lives could end tragically prematurely if the law is indeed misguided.”
India’s government, it’s worth remembering, holds a large stake in ITC Limited, a tobacco company that dominates the Indian cigarette market.
Meanwhile, as if in a parallel universe and despite the ban and growing censorship, India’s illicit vape market continues to mushroom. Many Indians are voting for their health by switching from combustible tobacco to unregulated vaping products. These have become available in small towns across the country. They’re sold in defiance of the government, the WHO and Bloomberg, but without age verification or consumer protections.
Photograph by Santeri Viinamäki via Wikimedia Commons/Creative Commons 4.0
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