Vaping deaths: Are e-cigarettes really safer than smoking tobacco? A complete guide to the facts

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Vaping has been heralded as a healthier alternative to smoking cigarettes, but what do you need to know about the risks attached?

In the US an outbreak of vaping-related illnesses has been linked to 39 deaths and 2,000 cases of lung injury, according to the Centers for Disease Control and Prevention.

Donald Trump is now considering plans to ban all flavoured e-cigarette products following the spike in lung illnesses. Health chiefs in the US are warning people to avoid vaping completely until the cause of the deaths is clear.

It is thought that Vitamin E acetate, an oily chemical added to some THC vaping liquids, could be behind the mystery illness after the substance was found in every lung fluid sample from afflicted patients.

But in the UK, no vaping-related deaths have been confirmed and health officials continue to endorse e-cigarettes as an effective way to quit smoking.

Meanwhile, a number of countries including India, Brazil and Thailand have banned e-cigarettes over growing health concerns. Yet the number of adults who vape around the world is expected to reach almost 55m by 2021, according to market research group Euromonitor.

1. Is vaping better than smoking?

   E-cigarettes, also known as vapourisers or vapes, allow users to inhale nicotine in vapour rather than breathing in smoke.

   Unlike cigarettes, they do not burn tobacco or produce tar or carbon monoxide. However, they do contain nicotine, which is addictive but relatively harmless.

   Vaping is far less harmful than smoking, experts from a number of key bodies including Cancer Research UK, Public Health England and the US National Academies of Sciences, Engineering and Medicine have concluded.

   Both the NHS and Public Health England (PHE) support the use of vaping over smoking. In 2015, a report from PHE estimated vaping was 95 per cent less harmful than smoking.

   Ann McNeill, professor of Tobacco Addiction at King’s College London, told The Independent: “Vaping isn’t risk free, but it’s much less risky than smoking, which kills nearly 100,000 people a year in the UK.

   “If you are a smoker who is struggling to stop smoking, do try vaping and buy your products from a reputable source. And if you are a vaper, it is better to continue to vape than relapse to smoking.”

   Professor John Newton, director for health improvement at PHE, said: “Vaping is not without risks. If you don’t smoke don’t vape.

   “But if you smoke there is no situation where it would be better for your health to continue smoking rather than switching completely to vaping. The sooner you stop smoking completely the better.”

   Cigarette smoking is the leading preventable cause of death in the US, according to the Centers for Disease Control. It kills 480,000 people each year, nearly one in five deaths.

   Tobacco is also one of the major causes of death and disease in India, accounting for nearly 900,000 deaths every year. In the UK it causes nearly 80,000 deaths a year.

   A major UK National Institute Health Research funded clinical trial found e-cigarettes were almost twice as effective at helping smokers to quit compared with other alternatives such as nicotine patches and gum.

2. What are the health risks attached?

   Experts estimate 20,000 smokers who take up e-cigarettes are quitting smoking each year in the UK alone.

   But vaping is not without its risks.

   More than 805 cases of lung disease and 12 deaths in the US have been linked to vaping, according to the Centrer for Disease Control (CDC).

   While the CDC is investigating the causes of this outbreak, they have advised people to avoid using vaping products, particularly those containing cannabis products.

   In the UK, vaping has been linked to 200 health problems including pneumonia and heart disorders over the last five years, according to the Medicines and Healthcare Regulatory Agency (MHRA).

   The MHRA said it is reviewing the information gathered in 74 separate “Yellow Card” reports filed by the public and healthcare professionals. But the watchdog emphasises the reports are not proof the adverse effects were due to e-cigarettes, but a suspicion by people reporting ailments that the device is to blame

   In 2017, MPs began an inquiry into the health effects of vaping to see how the law could address "significant gaps" in existing research.

   It has gone on to note “there is clear evidence that e-cigarettes are substantially less harmful than conventional cigarettes”. It added “there are uncertainties, nevertheless, especially about any long-term health effects of e-cigarettes, because the products have not yet had a history of long use”.

   Public Health England (PHE) said most of the American cases of vaping related-illnesses were linked to people using “illicit vaping fluid” bought on the streets or containing cannabis products.

   A PHE spokesperson said: “Unlike the US, all e-cigarette products in the UK are tightly regulated for quality and safety by the Medicines and Healthcare products Regulatory Agency and they operate the Yellow Card Scheme, encouraging vapers to report any bad experiences.”

   Deborah Arnott, the chief executive of anti-smoking charity Action on Smoking Health (ASH), told The Independent vapers in the UK “should not be scared back to smoking by the news of vaping illness in the US”.

   “Nor should smokers stick to smoking rather than switch to vaping,” she added. “It is essential, however, to only use legal vapes bought from reputable suppliers in the UK and not source illicit unregulated products over the internet.”

   There is limited evidence to suggest vaping causes harm to other people around you. According to the NHS, “the available evidence indicates that any risk of harm is extremely low, especially when compared with second-hand tobacco smoke”.

3. Who has died from vaping?

   An outbreak of vaping-related deaths in the US has been described as a public health crisis.

   At least 39 people have died and more than 2,000 have suffered lung injuries from vaping-related illnesses, according to the Centers for Disease Control and Prevention (CDC).

   Currently 46 states and one US territory have reported cases of the illness. Two thirds of those with the illness are 18-34-years-old, while 16 per cent are under 18. Around 69 per cent of the patients are male.

   Most patients have reported a history of using products containing THC, the psychoactive compound in cannabis. But one patient who died in Georgia last month reported only “heavy nicotine vaping”.

   Health researchers believe vitamin E acetate, an chemical added to some THC vaping liquids, could be behind the mystery illness. The substance was found in every lung fluid sample from afflicted patients tested by the CDC.

   A man in Texas was also killed after an e-cigarette he used exploded in his face and tore his carotid artery causing a massive stroke.

   There have been no confirmed deaths linked to vaping in the UK.

   However, some doctors believe the death of 57-year-old British factory worker Terry Miller from lipoid pneumonia was linked to vaping after oil from an e-cigarette was found in his lungs. A coroner returned an open verdict at the inquest after saying he could not be sure whether vaping was a contributory factor.

   Last year after a 34-year-old woman developed lipoid pneumonia, doctors identified the cause as vegetable glycerine found in e-cigarettes, according to a case report in the British Medical Journal.

   But the link between vaping and lipoid pneumonia is disputed. Ann McNeill, professor of Tobacco Addiction at King’s College London, told The Independent that in the case of the 34-year-old woman it “doesn’t really add up” that her illness was caused by vaping a nicotine e-cigarette.

   “The case of lipoid pneumonia was allegedly caused by glycerin in the vape liquid the patient was inhaling - but glycerin is water soluble and an alcohol and not a lipid,” she said. "So the glycerin is unlikely to cause lipoid pneumonia.”

4. Why did the CEO of Juul step down?

   Amid the sudden surge of vaping-related deaths and illnesses in the US, the CEO of tobacco vaping company Juul stepped down in September.

   It came after a 17-year-old who who said vaping gave him lungs “like a 70-year-old” announced he was suing the company for marketing e-cigarettes to young people.

   Former CEO Kevin Burns had previously warned non-smokers against using Juul products, stating they were not the firm’s “target consumer”.

   After launching in 2015, Juul emerged as the largest e-cigarette brand in the US two years later.

   In hundreds of lawsuits filed in federal and local courts across the US, lawyers blame Juul for the rise in youth vaping. They accuse the company of a targeted marketing campaign directed at young adults.

   Just over 20 per cent of US middle and high school students were found to use e-cigarettes in 2018, according to the US surgeon general. This was an increase of 78 per cent from the previous year. Between 2011-2015 e-cigarette use increased by 900 per cent among this age group.

   In the UK, 15 per cent of 11-18 year-olds tried vaping in 2019 compared to 16 per cent in the previous year, according to a study conducted by anti-smoking charity Action on Smoking Health. But there was an increase in the number of current vapers in that age group from 5 per cent in 2019 compared to 3 per cent in 2018.

   Among those surveyed, Juul had the highest brand awareness among 11-18 year-olds but only 7 per cent were able to name it unprompted.

5. Which countries have banned vaping?

   Governments around the world are divided about vaping. Thirty-nine countries have banned the sale of e-cigarettes or nicotine liquids, according to the 2018 Global State of Tobacco Harm Reduction report.

   In the US, Donald Trump said he planned to ban flavoured e-cigarettes in September following a spate of vaping-related deaths. The Food and Drug Administration will develop guidelines to remove from the market all e-cigarette flavours except tobacco.

   Two US states, New York and Michigan, have already imposed bans on flavoured vape products, while Massachusetts has announced a four-month ban on all vaping products.

   In the same month, India’s cabinet approved an emergency order banning the production, import and sale of e-cigarettes.

   Currently Thailand has some of the strictest laws on vaping with the sale and use of all e-cigarettes banned since 2014. People found in possession of a vaping device also face a heavy fine or up to 10 years in jail.

   In Mexico, it is illegal to sell products that mimic tobacco products, including e-cigarettes containing nicotine.

   While in Australia, adults are allowed to buy e-cigarettes that do not contain nicotine but it is illegal to produce or sell vaping devices containing the chemical. Possession of nicotine e-cigarettes is also illegal in some states.

   Although vaping is allowed in most of Europe, in Norway the sale and possession of all vaping products containing nicotine is banned. However, Norwegians can import nicotine e-cigarettes if they have a medical note to prove they need them to quit smoking.