India’s ban on e-cigarettes may have slowed their uptake, but rising illicit use among youth demands urgent policy and public health attention.
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Electronic cigarettes (e-cigarettes or vapes), formally known as electronic nicotine delivery systems (ENDS), are devices that heat liquids typically containing nicotine, alongside chemical compounds, to produce an inhalable vapour – a process referred to as vaping. Invented in China in 2003 as an alternative to smoking, ENDS began appearing in global markets by 2007, and their uptake has surged in a short span since.
According to estimates, as of 2021, there were 82 million vapers worldwide. Currently, the global vaping industry is valued at approximately US$38 billion, and is projected to reach roughly US$199 billion by 2032. Their uptake is attributed to aggressive marketing, portraying vaping as a healthier alternative to smoking, with multiple flavours, sleek device designs, varying nicotine levels, disposable/refillable e-liquid systems, and rechargeable batteries.
Public Health England (PHE) found that e-cigarettes are at least 95 percent less harmful than smoking.
However, their rise in popularity has been accompanied by controversy. On the one hand, they are promoted as harm-reduction tools for smokers; on the other, the World Health Organization (WHO) warns of their potential harms, particularly for non-smokers and the youth, with the vaping rates of children and young people exceeding those of adults in most nations.
For existing smokers, switching to vaping can reduce health risks. A 2018 review by Public Health England (PHE) found that e-cigarettes are at least 95 percent less harmful than smoking. Despite fears, PHE’s findings also indicate that ENDS do not serve as pathways into smoking for the youth, although vaping addictions are still a concern. Additionally, it was found that a combination of ENDS and behavioural support was most effective in getting people to stop smoking for at least six months among all nicotine replacement therapies (NRTs).
Evidence suggests improvement in physiological and lung functioning for individuals who switch completely or partly from smoking to vaping. This is evidenced by an experiment which showed visible tar deposits from exhaled smoke, but none from e-cigarette vapour. Research also indicates minimal second-hand inhalation risks and lower levels of airborne particulate matter in indoor environments, with 200 times lower nicotine levels found on home-surfaces of vapers – which can turn into a carcinogen.
However, an important consideration is the difference in smoking and vaping behaviours. While smokers usually have longer intervals between nicotine consumption, the clustering of puffs among vapers may increase nicotine addiction and adverse health outcomes with continuous use.
While nicotine alone impacts the nervous system, elevates the risk of cardiovascular diseases, and affects brain development in the youth, the wide range of long-term impacts of ENDS is still being studied.
Most ENDS flavourings are safe for oral consumption as per the US Food and Drug Administration (FDA) standards; however, toxicity via inhalation remains a concern. Upon heating, the liquids change composition, releasing harmful compounds. A study using artificial intelligence to analyse 180 vape flavours predicted that vapes produce 127 acutely toxic, 153 hazardous, and 225 irritant chemicals. However, a research constraint with assessing the impact of e-cigarettes is that most vapers were formerly smokers, or are dual-users of ENDS and tobacco, making it difficult to isolate the impact of ENDS.
Emerging evidence links the chemicals in ENDS with oxidative and cardiovascular stress, lung injury, chronic obstructive pulmonary disease (COPD), asthma, and lung cancer.
Nevertheless, emerging evidence links the chemicals in ENDS with oxidative and cardiovascular stress, lung injury, chronic obstructive pulmonary disease (COPD), asthma, and lung cancer. Aerosols in ENDS contain metals, possibly from the metallic coils that heat the e-liquid and other components of the device, causing kidney disease under chronic exposure.
Chemicals in ENDS can cause ‘popcorn lungs’ (bronchiolitis obliterans), lipoid pneumonia, and collapsed lungs. Vitamin E acetate – an additive in ENDS containing cannabis sourced from informal or illicit sources – has been linked to e-cigarette or vaping use-associated lung injury (EVALI), with 2,807 incidents leading to hospitalisations or death in the US, highlighting the dangers of unregulated markets.
Moreover, there have been 2,035 reported instances (2015-2017) in the US of e-cigarette explosions, causing injuries, with e-liquid exposure resulting in adverse health effects as well. Another concern is the disposal of ENDS. Estimates suggest that in 2023, Americans discarded 5.7 disposable vapes per second. Due to the combination of several metals, including heavy metals, ENDS are not only hard to recycle but also potentially hazardous, posing environmental and waste management challenges.
Additive in ENDS containing cannabis sourced from informal or illicit sources – has been linked to e-cigarette or vaping use-associated lung injury (EVALI), with 2,807 incidents leading to hospitalisations or death in the US, highlighting the dangers of unregulated markets.
As the debate continues, the evidence of the harmful impacts of vaping is still emerging. However, PHE noted that a lot of the claims misrepresented research findings and depended on device characteristics and use.
Under the Framework Convention on Tobacco Control (FCTC), in 2014, the WHO called on all countries to consider either prohibiting or regulating ENDS. As a signatory, India undertook a precautionary approach to prevent future vaping-related public-health crises, imposing a nationwide ban in 2019 – based on a white paper published by the Indian Council of Medical Research (ICMR).
However, despite the ban, consumption via illicit channels continues, particularly in urban India. In 2024, the Indian e-cigarette market was valued at approximately US$2.20 billion and is estimated to reach US$3.40 billion by 2033. According to a 2022 survey, among tertiary-educated Indians of ages 18-30, 23 percent reported having used e-cigarettes. Another study of vapers over 18 in Indian metropolitan cities found that their first exposure to nicotine came from smoking for 71.4 percent of those surveyed. The majority were dual-users; however, there was a reduction in smoking prevalence from 78.3 to 58.4 percent due to vaping, while 30 percent had quit tobacco entirely.
Despite the ban, consumption via illicit channels continues, particularly in urban India. In 2024, the Indian e-cigarette market was valued at approximately US$2.20 billion and is estimated to reach US$3.40 billion by 2033.
While the effectiveness and public health impacts of this ban are yet to be fully understood, initial analyses suggest that it has averted the rapid uptake seen globally, with 33 percent of the population in a sample study unaware of ENDS.
As India continues to manage its tobacco burden, the emerging trends in ENDS use – particularly among the youth and non-smokers – raise concerns, requiring strategic intervention.
Addressing the Tobacco Burden
As of 2022, over 267 million adults (ages 15+) in India used tobacco, causing over 1.35 million deaths annually, costing the country US$27.5 billion in health costs in 2017-18 alone, accounting for 5.3 percent of the total health expenditure. Meanwhile, excise tax from tobacco amounts to only 12.2 percent of its economic cost. Reducing the tobacco burden is therefore a national priority. While quitting all forms of tobacco and nicotine is the ideal, many continue to struggle with addiction. In cases where other NRTs remain unsuccessful, relatively safer alternatives, along with behavioural change support, may be explored for aiding smoking cessation.
Support for Vaping Cessation
The correlation between tobacco smoking and e-cigarette initiation indicates the need for incorporating vaping cessation in national tobacco control efforts. For instance, the National Tobacco Quitline Services — a toll-free helpline — had a one-year abstinence rate of 21.62 percent according to a 2024 study. Conducting gap analyses to strengthen existing interventions, while including support for quitting ENDS, can increase their effectiveness.
Mitigating the Risks from Illegal ENDS
Given India’s ongoing challenges with the illegal ENDS market, policy may need to evolve — tightening enforcement, or considering a regulated framework — to mitigate the risks posed by poor quality products with harmful additives.
Investing in Research
Compared to combustible tobacco, e-cigarette aerosols contain fewer and lower levels of toxicants. However, without a well-outlined strategy, they may undermine decades of progress in combating smoking. A cost-benefit analysis may help assess the trade-offs: weighing the potential for reducing the tobacco burden against the supply of dangerous ENDS through illegal channels, the risk to youth, and long-term ENDS dependence.
There is limited research available on the use of ENDS in India, particularly among students. Moreover, the cultural sensitivity surrounding smoking, coupled with discreet vape designs, may encourage usage. With significantly cheaper tobacco alternatives, ENDS usage also depends on affordability, further highlighting the need for investments in research on vaping behaviour, addiction patterns, and socio-economic drivers to inform policy.
Following Global Research and Response
As evidence emerges globally, India must adapt its response in line with domestic realities. In countries like the US and the UK, vaping is legal, but heavily regulated. The UK is working towards regulating and licensing ENDS as medicinal quit aids, while the US FDA provides authorisation to ENDS based on rigorous toxicology studies. Despite recognition that vaping is not 100 percent safe, it is believed that with effective regulation and quality benchmarks, risks can be minimised. In contrast, the WHO stands firmly against ENDS, with 34 countries having banned ENDS.
In the Indian context, at the time of the ban, neither the potential benefits nor the full extent of harms associated with vaping were well understood or evidenced — as acknowledged in the ICMR White Paper. The relevance of different approaches in the current Indian scenario requires further evaluation.
While ENDS may be the lesser evil, they are not harmless. Dual and continuous use of ENDS raises serious public-health concerns. India’s strategy must address the increase in consumption of ENDS, especially among non-smokers, who face health risks without benefitting from smoking reduction. Illicit and unregulated products exacerbate these risks. Simultaneously, India must also explore pathways to support smokers who may benefit from relatively safer alternatives, requiring evidence-informed policy to protect population health in an evolving landscape of nicotine consumption.
Nimisha Chadha is a Research Assistant with the Health Initiative at the Observer Research Foundation.
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Nimisha Chadha was a Research Assistant with ORF’s Centre for New Economic Diplomacy. She was previously an Associate at PATH (2023) and has a MSc ...
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