VAPE: Flaws in law worsening youth ‘vapedemic’

(First part)

MANILA, Philippines—In the Philippines, the vape law that was supposed to curb tobacco smoking among adults and the youth is instead leading to a spike in the use of so-called alternatives, which experts said were as harmful, if not more harmful, than tobacco.

In-depth research is showing that the law is insufficient and leading to a failure to adequately deter some tobacco and related products from ending up at the hands of young people.

This flaw is fueling a growing trend of smoking and vape addiction among Filipino youth, which is being coined “vapedemic” or the widespread use of vape.

Vape law’s promises

After months of heated debate, Republic Act No. 11900, or the Vaporized Nicotine and Non-Nicotine Products Regulation Act, which had been passed by Congress, lapsed into law on July 25, 2022.

Hailed by legislators as one of the most thoroughly researched laws enacted by the 18th Congress, the vape law aims to achieve multiple objectives: protect the health of 16 million smokers, safeguard minors, generate revenue, and stop the illegal trade in inferior vaping devices.

“If we don’t regulate these products, every kind of device will proliferate in the market,” said then-congressman Wes Gatchalian, one of the proponents of RA 11900.

“Without regulating them, there will be no order. It would be difficult to police unwarranted and fly-by-night industries,” he said.

Philippine E-cigarette Industry Association (PECIA) president Joey Dulay had supported the law, saying it was good for the industry and consumers.

“We support the vape law because it provides a comprehensive regulation that will protect consumers and promote responsible trade, ensuring minors and non-smokers are protected,” he had said.

Dr. Lorenzo Mata Jr., president of the advocacy group Quit For Good, said the vape law will help reduce smoking, which is among the world’s leading causes of preventable deaths.

“Ten Filipinos die of smoking-related diseases every hour,” he said.

READ: Vape law to regulate new products, save adult smokers and protect minors — advocates

Controversial, criticized law

But before becoming law, RA 11900 had been opposed by the Department of Health (DOH), Food and Drug Administration (FDA), Department of Education (DepEd), numerous medical associations, and civil society groups.

These agencies and groups had urged President Ferdinand “Bongbong” Marcos Jr. to veto the bill, voicing concerns about the dangers that vapes and e-cigarettes pose to youth. These products are frequently advertised as healthier alternatives to traditional cigarettes and tobacco.

Reacting to the bill’s passage into law, then DOH officer-in-charge Maria Rosario Vergeire remarked, “It’s saddening that it lapsed into law, but we in the Department of Health will continue to inform the public about the dangers of vape and tobacco products.”

Senator Pia Cayetano, a vocal critic of the then-still vape bill, also expressed disappointment..

“Putting at risk the health of our people and of future generations through this law will haunt our collective conscience down the road,” she had said in a privilege speech.

“When we wake up to a generation addicted to vapes, that’s on the 18th Congress that passed the vape bill, and on this administration that allowed it to pass,” she added.

RA 11900 regulates the importation, assembly, manufacture, sale, packaging, distribution, use, advertisement, promotion, and sponsorship of vaporized nicotine and non-nicotine products, their devices, and novel tobacco products. This includes Heated Tobacco Products (HTPs) and Vapor Products, commonly known as vapes and e-cigarettes.

The law also purports to “promote a healthy environment, protect the citizens from any potential hazards of these novel consumer products, reduce the harm caused by smoking, and ensure that the sale to minors and the illicit trade of Vaporized Nicotine and Non-Nicotine Products, and their devices, and Novel Tobacco Products in the country are prevented.”

However, the FDA, echoing the DOH’s stance, has repeatedly stated that the then-vape bill is not a health bill.

“Vapor products and heated tobacco products (HTPs) are currently being marketed by the industry as an alternative to conventional cigarettes, with some claiming or implying that these products are safer or less harmful,” said then FDA officer-in-charge and Director General Dr. Oscar Gutierrez Jr.

“However, these claims are based on opinion rather than empirical evidence, lacking the required studies and substantiations,” he clarified.

“Such statements that vapor products and HTPs are substantially safer than conventional cigarettes are misleading as these products contain harmful and potentially harmful constituents that are hazardous to human health,” he added.

‘A retrogressive bill’

Renowned Filipino tobacco control advocate and Southeast Asia Tobacco Control Alliance (SEATCA) Executive Director Dr. Ulysses Dorotheo had described the then-vape bill as “a retrogressive bill in more ways than one.”

He said two other laws—RA 11346 and 11467—had set the minimum age of access to tobacco at 21 years old and restricted vape flavors to two—tobacco and menthol.

The two laws also kept the products under FDA regulation, he said.

“These public health protections will now be undone by the vape bill,’ he added.

He had warned that then vape bill would lead to a surge in youth consumption and introduction to nicotine addiction.

The then-proposed law, he said, endorses new products that are often marketed as tools for quitting smoking despite substantial evidence to the contrary.

Data from the 2019 Global Youth Tobacco Survey showed that around 11 percent of students in the Philippines use tobacco, 10 percent smoke cigarettes, and 14 percent use e-cigarettes.

READ: Tobacco packaging: Getting PH youth hooked on smoking, vaping

The Philippine Pediatric Society also found that 11 percent of students between 10 and 15 years old had already tried vapes. The DepEd reported that 6.7 percent of Grades 7-9 students had tried and are using e-cigarettes.

Among the top reasons for vape use by students were online accessibility (32 percent), flavor (22 percent), and the belief that e-cigarettes are safer than cigarettes (17 percent).

A study published online in the National Library of Medicine (NLM) summarized some of the warnings and worries aired by vape law critics in past years.

The law, the researchers said, “not only legitimizes the use of vaping products but also lowers the age at which these can be accessed.” The vape law allows access to tobacco, vapes, and e-cigarettes to 18-year-olds from 21.

It also removed regulatory authority from the DOH and transferred it to the Department of Trade and Industry, the researchers said.

Calls for a veto fell flat, and the bill became law “with most politicians favoring pro-industry policies,” they said.

“With these in place, it will be even easier for an average teenage Filipino to pick up the habit of vaping,” they continued.

“This is a grim reminder to all that possible repercussions in health choices due to political decisions may be seen in the next few years,” they added.

Cigarettes, e-cigarettes, HTPs sold near schools

RA 11900 sets several age-related regulations for the sale, distribution, and use of vapor and heated tobacco products. Among these were:

• Section 6 (Minimum Age Sales and Purchase): Purchase, sale, and use of these products are restricted to individuals 18 years and older. Ignorance of the buyer’s age is not a valid defense for sellers.
• Section 7 (Proof-of-Age Verification): Retailers must verify the age of buyers using government-issued IDs. Direct delivery is limited to individuals over 18.
• Section 8 (Online Trade): Online sales are permitted with measures to prevent access by those under 18. Websites must display age restriction signage and require an age declaration on the opening page.
• Section 9 (Sales and Promotion near Schools): Sales, promotion, and advertising within 100 meters of schools or minors’ facilities are prohibited.
• Section 10 (Point-of-Sale Signage): Retailers must display warnings about the illegality of selling these products to minors and their potential harm.
• Section 11 (Display of Products): These products should not be displayed next to items appealing to minors.
• Section 12 (Product Communication Restrictions): Advertisements should not target or appeal to those under 18, prohibiting youth-centric imagery.
• Section 15 (Use in Public Places): Use of these products is banned in indoor public places except designated vaping areas.

Despite regulations, a separate study by the Institute for Global Tobacco Control (IGTC) at Johns Hopkins Bloomberg School of Health found ongoing sales and advertising of tobacco products near many schools in the Philippines.

The study revealed that over 2,000 cigarette vendors were operating within 100 meters of 276 schools in violation the law.

Additionally, it identified at least 43 e-cigarette and 33 Heated Tobacco Product (HTP) retailers near various schools in selected cities and regions.

Read more about IGTC’s study here: As vaping ‘epidemic’ grips PH youth, tobacco sellers flout law vs targeting kids

E-cigarettes were mainly available in convenience stores and vape shops, while Heated Tobacco Products (HTPs) were typically sold in neighborhood and convenience stores around schools.

IGTC researchers pointed out that marketing strategies at points of sale, like displays and advertisements for cigarettes, e-cigarettes, and HTPs, are aimed at Filipino youth.

The study found that less than half of the 6,617 retailers surveyed across the country had signs indicating the ban on sales to individuals under 21. The most prevalent forms of advertising near schools were indoor and outdoor print ads, often featuring vivid imagery and brand specifics.

Jennifer L. Brown, PhD, from the IGTC, stated in an exclusive email interview with INQUIRER.net, “Filipino law forbids the sale and advertising of cigarettes, e-cigarettes, and heated tobacco products within 100 meters of schools and mandates clear signage about age restrictions.”

“Adhering to these regulations is essential to shield young people from the dangers of tobacco,” she added.

Brown also proposed that retailers could choose to cease selling tobacco and nicotine products, mirroring the actions of global establishments that have implemented smoke-free policies for health reasons even before legal mandates were in place.

Contrary to the law, advertisements and promotional materials were also observed within 100 meters of schools, showcasing youth-targeted marketing techniques by cigarette, e-cigarette, and HTP retailers, often prominently placed near areas frequented by children.

Notably, 12 percent of cigarette retailers positioned their advertisements at the eye level of children, and 264 retailers displayed ads or products close to snack items.

Push for stricter enforcement of policies

Elizabeth Crespi, MPH, from the IGTC, pointed out the numerous tactics tobacco companies use to attract children and young individuals.

“There is ample evidence showing that tobacco companies employ various strategies to promote their products, aiming to attract the attention of children and young individuals,” she said.

In her conversation with INQUIRER.net, Crespi emphasized, “The findings of this study, along with the prevalent violations, underscore the need for stringent enforcement of laws.”

Brown expressed hope that making the study’s findings public could spur meaningful action from all sectors.

(Next: Vape and e-cigarette packaging, online marketing tactics target Filipino youth.)