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ot long ago, Trade Minister Enggartiasto Lukita sparked controversy for encouraging electronic cigarette users to switch to smoking tobacco, saying vaping did not benefit tobacco farmers. In doing so, he acted contrary to last year’s WHO and Human Rights Watch reports that found that farmers suffered, although tobacco firms profited.

Did the minister not realize that his statement could undermine our fight against tobacco-related diseases? Or did his statement reflect the strong lobbying of the tobacco industry? His remarks followed his signing of Ministerial Regulation No. 86/2017 governing the import of e-cigarettes.

Many insist that vaping is safe, while others doubt it. Neither is right nor wrong, because current scientific evidence apparently cannot determine the safety of the product.

An e-cigarettes is a battery-powered device designed to vaporize a solution of the commonly addictive nicotine and other chemical additives into an aerosol, which is then inhaled by its user. However, unlike conventional cigarettes, vaping does not generate smoke from burning tobacco, which typically contains hundreds of deadly toxic chemicals.

The rampant use of e-cigarettes has been driven by the common belief that they serve as “harm reduction” to conventional cigarettes, and can thus be used as a smoking cessation aid. This assumption has been recently backed by a report commissioned by Public Health England, which shows that e-cigarettes are 95 percent safer than combustible cigarettes.

However, conventional cigarettes have long been deemed as the most harmful legal product on the market, so anything else could easily be seen as safer than smoking. One would guess that inhaling chemicals into our lungs for a long period would be far from entirely harmless. Another major public health concern is that vaping could potentially become a gateway to smoking tobacco among youths, which may threaten decades of tobacco control efforts.

The evolving debate may reflect disagreement regarding e-cigarettes. Indonesia, too, seems to remain undecided where to put its feet. The National Drug and Food Control Agency (BPOM) and the Ministry of Health are investigating the safety of e-cigarettes.

The BPOM states it has never licensed e-cigarettes sales; it only monitors the chemical content of the product, especially nicotine. The Finance Ministry, in treating e-liquid as a tobacco product, intends to impose a 57 percent per milliliter excise tax on the retail price of e-liquid by 2018.

Unlike other parts of the world, where smoking has been significantly reduced, Indonesia still grapples with tobacco control, as a high percentage of its adults still smoke.

With their constant aim to increase profits, tobacco giants inundate Indonesia with their products, offering cheap conventional cigarettes. They are reluctant to shift to the smaller vaping market segment, although this might change in the future, especially with increasing public awareness on the harms of smoking, as seen in the United Kingdom.

Although no study has been made on e-cigarettes in Indonesia, we should be vigilant before it is too late given the rising popularity of vape. The future might see a double burden if many tobacco smokers are also vaping, instead of quitting smoking altogether.

Furthermore, vaping may lead to experimenting with tobacco cigarettes among youths and those who have never smoked. This might not be the case in the UK, but we are speaking about a nation where one conventional cigarette is as affordable as candy. When users become addicted to the nicotine in e-cigarettes, they might seek a more affordable and widely available source of nicotine, that is, tobacco cigarettes.

Restrictions on e-cigarette products will be meaningless if strong measures to sharply reduce tobacco smoking remain unenforced.

It may take decades to clearly understand the real health impacts of e-cigarettes. If they are found to be harmful, the world would come to an agreement to eliminate the products, Indonesia would then be in trouble, given its long history of slow implementation of regulations and resistance from central and local institutions that rely on tobacco excise revenues.

So, it is still too soon to answer whether vaping is a threat or an opportunity for Indonesia. But integrated precautionary measures are warranted to protect public health from the potential risks of e-cigarettes.

First, regulations should be in place to control the safety and quality standards for e-cigarettes, including, but not limited to, the volume of the refill container, nicotine content and e-cigarette product design.

Second, e-cigarette manufacturers, importers and retailers must also make their products transparent by notifying relevant authorities through an established monitoring and reporting system on aspects such as ingredients and emissions, description of the device and sales; all information that should be accessible for the general public.

Third, to thwart unforeseen hazards of secondhand exposure to e-cigarette byproducts and to prevent youths from taking up this practice, vaping-free zones must be established in public places (i.e. schools).

Fourth, rules are needed to regulate the packaging, labeling and promotional elements of e-cigarettes. For instance, e-cigarettes advertisements targeting minors and non-smokers should not be allowed.

Lastly, Indonesia should start investing in independent e-cigarette research to inform its vaping-related policies. We must also keep our minds open to innovation, because e-cigarettes may in fact turn out to be a transitionary means for smokers who want to quit.

After all, e-cigarette regulations should not be misleading, based on the inaccurate assumption that smoking tobacco is profitable for the nation and thus better than vaping. If we seriously aspire to curtail the burden of tobacco smoking in Indonesia, we must ratify the WHO Framework Convention on Tobacco Control immediately.

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Beladenta Amalia is a physician and predoctoral fellow in The Tobacco Control Unit at the Catalan Institute of Oncology (TCU-CIO) in Barcelona, Spain. Citta Widagdo is a doctoral researcher in public health law at the University of Birmingham, UK.