The US has seen nearly 40 deaths linked to e-cigarettes, but should vapers in Malta be concerned? Are bystanders at risk? Sarah Carabott asks the experts.
E-cigarettes could impact bystanders, public health chief Charmaine Gauci has warned, as some doctors call for a ban in places where traditional cigarette smoking is not allowed.
There have been no deaths or hospital admissions related to vaping in Malta but this ‘alternative’ way of smoking is not worry-free for health practitioners.
Contacted following reports of tens of deaths in the US, the Superintendent of Public Health, Prof Gauci, said vaping aerosols could contain toxic substances such as nicotine, formaldehyde, acetone, heavy metals, volatile organic compounds and particulate matter that could impact the health of those exposed to second-hand vapour.
Her claims were supported by respiratory physician Martin Balzan, who said that aerosol chemicals inhaled by bystanders could affect their health.
E-cigarettes work by heating up chemicals, and while the levels of toxins vary between different cigarettes, they could at times even be higher than those found in tobacco smoke, he said.
Vaping aerosols could contain toxic substances
But apart from the toxins, non-smokers who are exposed to e-cigarette vapour may absorb as much nicotine as they would from traditional cigarettes. Nicotine does not only trigger dependence but is also detrimental to cardiovascular systems and the development of foetuses, he added.
Dr Balzan said some doctors were calling for the ban of e-cigarettes and heated tobacco products in places where traditional cigarette smoking is banned. E-cigarettes are legally considered a tobacco-related product and, according to the World Health Organisation, such novel tobacco and nicotine products are not risk free.
The long-term effects on health and mortality of e-cigarettes has not yet been studied and remains unknown, he added.
Prof. Gauci noted that although, so far, no deaths or hospital admissions associated with vaping have been reported in Malta, there were still long-term effects.
She said the health authorities were concerned about the promotion of e-cigarettes especially among younger people, for whom such products would be particularly attractive because of their sweet flavours and for being innovative.
Why have there been so many death reports in the US but not in the EU?
Among others, nicotine concentration in e-cigarettes, unlike in the US, is regulated in the EU, Prof. Gauci said.
In Europe – including Malta – all e-cigarette products are tightly regulated through the Tobacco Products Directive. Transposed locally in 2016, it lays down rules for cross-border distance sales, including registration of all retail outlets planning on engaging in such sales.
Vape shops are not licensed or registered yet, however, the authorities need to be notified about any products placed on the market.
Meanwhile, Malta is considering banning cross-border distance sales, something member states have the option to do, Prof Gauci said.
What does EU legislation say?
A maximum nicotine concentration and volume is allowed for cartridges, tanks and nicotine liquid containers. The ingredients must be of high purity and e-cigarettes should deliver nicotine doses at consistent levels so as to avoid the risk of accidental consumption of high doses.
Health warnings are mandatory – consumers must be advised that e-cigarettes contain nicotine and should not be used by non-smokers. Packaging should include the product’s nicotine content. Promotional elements are not allowed on e-cigarette packaging and cross-border advertising and promotion are prohibited.
E-cigarette manufacturers must notify the EU member states of all products they place on the market and report annually to them on sales volumes, consumer preferences and trends.