aping is inundating the Pakistani market especially targeted towards the youth. E-cigarettes (often called vape pens) are battery-operated vaping devices that heat a liquid until it becomes an aerosol (mist) that is inhaled. The aerosol is not just a water vapour. It usually contains nicotine, other harmful chemicals and flavourings. Even e-cigarettes that claim to have no nicotine have been found to contain nicotine. Some might contain marijuana, herbs or oils. Nicotine, a catecholamine with sympathomimetic effects, rapidly enters the bloodstream when inhaled and crosses the blood-brain barrier within seconds.

Some e-cigarettes are disposable and designed for one-time use. When the liquid is used up or the battery dies, the user throws the device away. Others can be refilled with liquid, recharged, and used over and over. Some people buy pre-filled cartridges for the e-cigarette. Others buy a bottle of liquid and refill the e-cigarette as needed.

The vape device was initially manufactured in Beijing in 2003. Its introduction to the US market followed in 2007. Initially vaping was promoted as a safer alternative to conventional cigarettes. It was marketed as counteracting the harmful effects of cigarette smoking, while also providing mood enhancement and a sense of euphoria. Pakistan is currently seeing a surge of fancy stores selling vaping to the youth. The traditional Paan Khokha shops continue to sell hazardous cigarettes; on top of that have arrived the fancy stores selling vaping devices.

There are no statuary warnings on the use and sale of vaping materials in these stores. The government of Pakistan should impose sanctions on opening of such stores.

The global e-cigarette and vape market size was valued at $22.45 billion in 2022. It is expected to grow at a compound annual growth rate of 30.6 per cent from 2023 to 2030. It is experiencing tremendous growth in the West and Southeast Asian countries such as Bangladesh, Nepal, India and Pakistan, Pakistan is emerging as a major vaping business hub. It is believed that many are using vaping devices without fully understanding their contents and harmful effects.

Tobacco companies once reassured the public that cigarettes were harmless; it took years for the dangers to be acknowledged. A similar trend is now emerging with vaping. By the time its toxic effects are understood, it may have already become an outbreak in Pakistan.

Recent studies have revealed that the additive chemicals in e-liquids have potential deleterious effects on the body, its aerosols induce DNA damage, curtail antioxidant defences and negatively affect cell viability and proliferation. Acrolein, also a component, exhibits cytotoxicity, cross-links DNA and inhibits enzymes. Reactive aldehydes induce oxidative stress, contributing to cardiovascular, respiratory, pulmonary and oral diseases. E-liquid constituents, irrespective of nicotine, affect gingival fibroblasts and oropharyngeal mucosa and induce oxidative stress. Components like cinnamaldehyde in e-cig liquids are immunosuppressive. Vaping use poses significant health concerns for oral tissues as well as the immune system.

The prevalence of vaping in Pakistan has the potential to lead to a devastating situation, similar to the past acceptance and substantial advertisement of cigarettes. Tobacco companies once reassured the public that cigarettes were harmless. It took years for the dangers to be acknowledged. A similar trend is now emerging with vaping. By the time its toxic effects are understood, it may have already become an outbreak in Pakistan. Few restrictions on vaping, including its sale, use, advertisement, promotion, sponsorship and packaging, make it readily available to a wider population. The availability of several flavoured options among vaping products in Pakistan makes it especially appealing to the youth, who are considered to be the primary target market. Other factors such as peer pressure, the absence of social stigma and easy accessibility contribute to its acceptance among youth. Efforts are being made globally to tackle the vaping crisis. China has imposed a complete ban on the sale of flavoured e-cigarettes as part of a comprehensive crackdown on the industry. In 2019, India imposed a complete ban on vape smoking. According to World Health Organisation, 34 countries have banned the sale of e-cigarettes. However, 88 countries do not have a minimum age for purchasing e-cigarettes and 74 countries have no regulations in place for these harmful products. Pakistan falls in the latter group of countries. It could learn from the actions of countries like India and China.

The government should launch awareness-raising campaigns and review and revise policies to enforce a ban on vaping in public places, including imposing higher taxes on such products to decrease accessibility to the youth, especially teenagers. Since social media appeals to the youth, effective social media campaigns need to be initiated to educate them about the side effects of vaping, the risks associated with it and provide assistance to those who are already addicted.

Since there are limited studies on this matter, there also needs to be greater emphasis on longitudinal studies to determine the long-term effects of vaping.

The writer is a senior public health leader in Pakistan with international experience of design and management of health systems strengthening initiatives.