A debate has started on the future of tobacco alternatives regulation in Brazil, where many products such as e-cigarettes and heated tobacco are fully prohibited.
The public hearing on the regulatory status and future of tobacco alternatives, held on 28th September and presided over by senator Soraya Thronicke from the opposition party Podemos, gathered together industry stakeholders, parliamentarians and representatives of health sector non-governmental organisations (NGOs).
Support was expressed for reversing Brazil’s prohibitionist approach to tobacco alternatives – though with some caveats.
‘We have to watch and learn’
Although the debate focused largely on the future of vaping, other products such as heated tobacco were also covered. Some, such as Thronicke, were of the opinion that while the passing of RDC 46/2009, which bans electronic smoking devices including heated tobacco devices, based on the information available was valid at the time, new information subsequently coming to light demonstrated that products such as e-cigarettes and heated tobacco could be less harmful alternatives to smoking.
Prohibition as a policy “stops Brazil from earning BRL5bn ($1bn) of taxes per year and generating new jobs,” Thronicke argued, stressing that, in recent years, scientists have released updated information. “Health systems from Canada, Sweden and the UK have been using ENDS [electronic nicotine delivery systems] in policies for tobacco control,” she said.
Others agreed that the situation had changed significantly since Anvisa had issued resolution RDC 46/2009. Dirceu Barbano, a former director at Anvisa (in office from 2008 to 2014), said the choice was right at the time but that things had changed.
“It was a decision taken 14 years ago. They were allowed in only a few countries, and there was little information on what role ENDS could play in the context of tobacco control policies,” Barbano said. “Experience and information [have subsequently] showed that these products may be less harm than conventional cigarettes.”
Reflecting on public health, Lauro Anhezini Junior of the Brazilian Association of Tobacco Industries (Abifumo) mentioned the experiences of countries like New Zealand, which formally regulated ENDS during the pandemic as a potential aid to help with tobacco-related diseases, and Sweden, which has decreased cancer incidence after adopting lower-risk tobacco alternatives (primarily snus but also including vapes and nicotine pouches).
Based on a US National Academy of Sciences study, Anhezini said that conventional cigarettes present 100 to 150 toxic substances, heated tobacco products (HTPs) present fewer than 20, and e-cigarettes, on the other hand, less than five.
“We have to watch and learn from what went wrong and right in these international experiences,” he said.
Economically, Anhenzini agreed that, as the Federation of Industries of the State of Minas Gerais (FIEMG) estimated, the legalisation of ENDS would bring BRL132m ($25m) in additional income to Brazil.
‘A decrease in consumption’
Vera Luisa da Costa e Silva, head of the Secretariat at the National Commission for World Health Organization Framework Convention on Tobacco Control (WHO FCTC) Implementation in Brazil (Conicq), said that many countries that had permitted alternative nicotine products were now reconsidering their position. This included, for example, bans on flavours and disposables for vaping as well as prohibitions on flavours in HTPs like those issued by the European Union (EU).
“The EU’s issued a decree to ban flavour and additives in all HTPs from its territories from 23rd October this year,” she said, arguing that Brazil’s longstanding prohibition instead showed concrete positive results.
“Research released by Vigitel in 2023 shows a decrease in consumption. The ban is working and must continue,” she added.
The director of Alliance for Tobacco Control (ACT) Promoção da Saúde, Monica Andreis, pointed out that 79% of Brazil’s population supported the continued ban (data from Datafolha, August 2023) and praised their sensibility in doing so.
Meanwhile, Alcindo Cerci Neto, a spokesperson for Brazil’s Federal Council of Medicine (CFM), warned that permitting ENDS would lead to increased “dual use” by consumers.
“Studies show that people who start using ENDS will likely use conventional cigarettes or recreational cannabis. What’s more, the younger you start, the harder it gets to quit smoking,” Neto said.
Parliamentarians that participated in the hearing also took a stand on the matter. President of the Parliamentarian Front of Medicine senator Hiran Gonçalves, from the opposition party Progressistas, stood for the legalisation of tobacco alternatives in some form, although he condemned flavours and additives as he said they attract teenage consumers.
Senator Styvenson Valentim from the oppostion party Podemos showed reservations: “To regulate these products, there must be enough evidence that they won’t cause damage to people’s health, especially to youngsters, who use them inconsequently.”
Understanding why ENDS became a trend was a concern raised by Senator Rodrigo Cunha: “Influencers are using vapes on social media, which is inducing youngsters to smoke these devices. Traditional advertising doesn’t work anymore with this generation”.
The second session of this public hearing will include the participation of a current Anvisa representative, but still has no confirmed date.
– Beatriz Miranda TobaccoIntelligence contributing writer
Photo: Lucas Santos