Everyone’s been talking about vaping recently because of the situation in the US, with several e-cigarette users dying and more in hospitals with severe lung injuries. Public opinion about vaping has always been divided, but the situation in the US has intensified the debate on how safe vaping really is.

Aside from the inevitable alarmist headlines, it doesn’t help that information about vaping isn’t that widespread yet. For one thing, many people tend to assume that vaping is similar to smoking when the two actually have different effects. 

Let’s step back a bit and analyse what’s really happening and why these cases are arising in the US.

The US Vaping Outbreak

By File:Blank US Map With Labels.svg: Hedgefighter derivative work Begoon - This file was derived from: Blank US Map With Labels.svg: , CC BY-SA 3.0, Link

Only this year in the US, more than 1000 people were reported to have received lung injuries, and at least 30 people have now died. Many of those affected are young and otherwise healthy, but all were vapers or had vaped before.

Considering that around 9% of US adults vape, the number of people affected is considerably small, but has caused significant concern due to the unusual symptoms, which have been described as resembling a rare form of pneumonia. The number of young people affected isn’t surprising when you consider that, there are far more young people vaping in the US than adults and compared to the UK, vaping has a far more cool and trendy reputation,

There’s a lot of confusion because health centers can’t trace the exact chemical that triggered it. The predominant view so far is that the injuries and deaths are linked to THC, which is the psychoactive compound in marijuana. Vitamin E acetate might also be a factor. Given that high THC content is illegal in the US—and the UK—many of the e-liquids and mods used by those affected seemed to be coming from the black market. 

Undoubtedly these unregulated products are extremely unsafe to use. As with anything that’s ingested into the body, a slight mistake in the manufacturing process can have hugely dangerous consequences. Put the wrong type of wire in a mod, and it can end up spewing out toxic chemicals. To make it more complicated, vaping isn’t really regulated at all in the US, unlike the UK (where there has been no such outbreak of lung related injuries or deaths). As a result, investigations are slowed down because it’s uncertain if the ingredient lists of the involved products are correct.

As expected, the reaction to this has been inflammatory. The most vocal critics have pinned the blame on vaping as a whole, recommending that people drop e-cigarettes completely. President Trump has given a predictable knee jerk reaction, entirely devoid of the evidence, saying that he’s considering having flavored e-cigs banned throughout the whole country. Although it might not push through completely, this would be a huge blow to vaping in the US. Worse still, it could drive vapers to turn to the black market or to concoct their own flavored e-liquids at home. This would create more hospital cases and deaths because the problem isn’t vaping per se—rather, it’s unregulated e-cigarettes.

What about the UK?

What’s often neglected in these headlines is that the US vaping crisis is unique. If vaping is dangerous enough to warrant a ban, then how come no similar situation has occurred in the UK? 

After all, vaping has been around in this country for many years now and, as of 2019, there are around 3.6 million British people vaping. The vaping community isn’t really a fringe subculture anymore and public awareness of vaping is gradually changing.

Vaping in the UK is actively backed by several medical experts and government institutions, including Public Health England and the NHS, with campaigns to make e-cigarettes more accessible. Despite all this activity, the UK only has 74 reports of negative health reactions linked to vaping over the past three years, and none of them resulted in death. 

Considering that vaping is relatively established in the UK and many of the same e-liquid flavours are available, to conclude that vaping is universally dangerous because of the cases coming out of the US just doesn’t stack up. If vaping isn’t bringing about a similar outbreak in the UK (and other countries), then we instead need to look into what makes the UK different.

Vaping as a Public Health Tool

For one, there’s stronger support in the UK for vaping. Several studies have been done on the health consequences of vaping, and one landmark report that made waves throughout the global community was the 2015 PHE e-cigarette evidence review, which stated that vaping is a least 95% less harmful than cigarettes. The report pointed out that the harmful compound in cigarette smoke isn’t nicotine but rather tar particles and thousands of toxic gases, which are hardly present in e-cigarettes. This has been backed by other studies commissioned by organisations like Cancer Research UK and the Royal College of Physicians.

Beyond this, vaping has taken on a more active role in public health. Surprisingly, vaping is twice as effective as conventional nicotine therapy for helping smokers quit. The Royal College of Physicians has gone as far as to declare that vaping should be promoted as widely as possible as a smoking substitute, and the National Health Service (NHS) is encouraging smokers to switch to vaping.

This is in line with the UK’s goal of becoming smoke-free by 2030. So far, progress is significant, and vaping has contributed to this. Most vapers in the UK get into it to stop smoking, and more than half of them are already ex-smokers. Smoking has plummeted since vaping was introduced in 2011, and a recent study by University College London states that vaping might be helping 50,000 to 70,000 smokers quit per year in England.

Strict Regulations

Another reason why the UK isn’t seeing similar cases to those in the US is because it has strict regulations for vaping under the EU’s Tobacco Products Directive. There are specific laws that monitor advertising and promotion and vaping isn’t targeted towards kids—as a result, only 1.6% of teenagers in the UK use e-cigarettes weekly, as opposed to the youth vaping prevalence in the US.

More to the point, all vaping products sold in the UK are also carefully inspected and registered with the Medicines and Healthcare products Regulatory Agency. In addition, e-liquids can only have a maximum nicotine content of 20 mg/mL, in contrast with the US where some pods by Juul reach as high as 59 mg/mL.

Verdict

Although there is still more evidence to be collected and analysed, it appears self evident that, thanks to an organised regulatory system, the UK has not experienced cases similar to those now coming out of the US. E-cigarettes in the UK are screened for safety, and vapers have little incentive to turn to the black market because e-cigarettes are widely available anyway, not to mention promoted by recognised health bodies.

Rather than the generalised knee jerk conclusion that vaping is unsafe, what the US crisis implies is that non-standard vaping products must be avoided because these can be life-threatening. In many ways then, the US cases have only reinforced the argument for a healthy regulated vaping market. To focus on banning vaping completely—or removing flavored e-liquids—misses the root of the situation and undermines vaping’s potential as a smoking cessation tool.

While vaping isn’t 100% risk-free, it’s far far safer than smoking and unlikely to cause such severe consequences as long as you stick to buying your vaping devices and e-liquids form recognised trustworthy suppliers and manufacturers.