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Doctors, advocates demand e-cigarette regulation
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octors and health groups have urged the government to put a stricter regulation against electronic cigarettes in the proposed omnibus bill on health amid growing numbers of users, particularly among young people.
Roughly 10 years after e-cigarettes or vapes were first introduced to the Indonesian market, their sale and distribution remain largely unregulated.
Indonesia is the only country in the Southeast Asia region that does not implement a specific regulation on the distribution and marketing of e-cigarettes, in marked contrast to Singapore, Cambodia, Brunei and Thailand, which have imposed a complete ban on the products.
The only form of e-cigarette control that was implemented by the Indonesian government is a 2017 ministerial regulation stipulating a maximum 57-percent tax excise for e-liquid used in e-cigarette devices.
Health advocates urged lawmakers and the government to finally regulate e-cigarette sales in the omnibus bill on health that is currently being deliberated by House of Representatives Commission IX, overseeing healthcare and manpower.
However, in the current draft of the omnibus bill on health available for the public, there are still no provisions that specifically regulate e-cigarette sales.
Head of the Tobacco Control National Committee, Tubagus Haryo Karbianto, said regulating the sale and marketing of e-cigarettes remained crucial to protecting the public from their harmful effects.
"I hope lawmakers could add provisions that strictly regulate e-cigarette distribution based on best practices in other countries, including banning its advertising, especially toward young people, and banning the sale of flavored e-cigarettes," he said.
Pulmonologist from the Indonesian Society of Respirology (PDPI) Feni Fitriani Taufik said the association hoped authorities could impose the same restrictions for e-cigarettes as with conventional cigarettes.
"Both e-cigarettes and conventional cigarettes have the same potential for harm to the human body, so we hope they could be regulated similarly. Although some e-cigarettes have lower levels of nicotine compared to conventional cigarettes, that does not mean they are less dangerous," Feni said.
The current law stipulates the advertising and promotion of conventional cigarettes on TV and radio may only take place between 9:30 p.m. and 5 a.m., with advertisements being prohibited from showing cigarettes, the shape of cigarettes, tobacco product branding or smoking.
The law also requires producers to put pictorial health warnings that cover 40 percent of cigarette packaging and ban the sales of tobacco products to children under 18 years old.
Rising vaping problem
Indonesia has seen an exponential increase in the number of e-cigarette users in recent years, with prevalence increasing tenfold from 0.3 percent in 2011 to 3 percent in 2021, according to data from the Global Adult Tobacco Survey (GATS).
As per 2021, roughly 6.3 million Indonesians are estimated to use e-cigarettes, GATS data suggest.
A 2021 study in the International Journal of Health Policy and Management suggested the e-cigarette market in Indonesia started growing steadily in 2015 with the country being projected to become Southeast Asia’s largest due to its massive population.
The research also observed e-cigarette marketing in Southeast Asia heavily targeted the youth with trendy vape pen designs, a wide variety of e-liquid flavors, point-of-sale promotions and adverts featuring young female models.
The targeting of young people, particularly females, the study stated, is inconsistent with the claim e-cigarettes are intended to help current smokers quit, especially given the low female smoking prevalence in Southeast Asia.
Making matters worse, recently, e-cigarettes have been used as a new way to abuse drugs. Earlier this year, Jakarta Police raided a home industry in West Jakarta producing e-liquid mixed with methamphetamine.
Health concerns
Vaping has been widely endorsed as an alternative to smoking tobacco cigarettes with claims it produces no hazardous carbon monoxide and tar, unlike conventional smoking.
However, Feni of the PDPI highlighted both the association and the World Health Organization (WHO) did not recommend the use of e-cigarettes as aids for smoking cessation because vapes and conventional cigarettes both cause harm to human health.
"We often find young patients suffering from chronic coughs after using electronic cigarettes. Some pulmonologists also saw an increased risk of pneumothorax in patients who regularly use vapes," Feni said.
She also cited a study that found e-cigarette users have an increased risk of bronchitis, pneumonia and lung inflammation and another study that found a substance that could cause urethral cancer in the urine of e-cigarette users.
"Most importantly, e-cigarettes contain nicotine, which can cause addiction just like conventional cigarettes," Feni added.
Teenagers and adolescents, the main targets for e-cigarette marketing, are more vulnerable to nicotine dependency than adults. Studies have found chronic nicotine exposure can impact brain development and can contribute to cognitive and attention deficit conditions and worsen mood disorders, including depression and suicidal thoughts.
Increasing evidence shows youth who use e-cigarettes, who have never smoked, and would have been considered low-risk for later taking up smoking, increase their chance of smoking traditional cigarettes later in life by two to fourfold.
The effectiveness of e-cigarettes as a tool to help people quit smoking also remains in question, with a 2019 socioeconomic survey by Statistics Indonesia finding that a staggering 96.3 percent of vape users also smoke conventional cigarettes.
