Last updated: October 2017
Suggested citation: Greenhalgh, EM, & Scollo, MM. InDepth 18B: Electronic cigarettes (e-cigarettes). In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from: http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes
Almost all (90%) e-cigarette products sold globally are made in China, where there are almost 1,000 manufacturers.1 There are over 500 e-cigarette sellers marketing products under varied brand names,1 and it is estimated that 30–50% of sales of global e-cigarettes are conducted online.2 An estimated 35 million people were regular dual or sole users of e-cigarettes and vapour products (including heated tobacco products) in 2015.3 In 2016, the market for e-cigarettes globally was estimated to be worth 7.1 billion US dollars, and is predicted to continue its rapid growth over the coming years to reach 44.55 billion by 2024.4 The US is consistently the market leader, and in 2015 was followed by the UK and other countries in Western Europe.3, 5
Although the concept of an electronic cigarette was first patented in the USA in 1965,6 it was not until 2003 that the first commercialised e-cigarette product was developed in China.7 E-cigarettes generally comprise four parts: the battery, the heating element, the vapourising chamber, and the solution cartridge. The battery supplies the power to the heating element, in order for it to become sufficiently warm to aerosolise the solution. The heating element is housed in a chamber, which also holds the aerosol until the user inhales. Some types of e-cigarettes allow users to control the voltage so they can select the amount of aerosol produced and nicotine concentration.8
There are a growing number of varieties of e-cigarettes and solutions, with evidence of large variability between the labelled content and the actual content and concentrations.9 Differences in battery voltage and unit circuitry can create significant variances in the products’ ability to aerosolise the solution, and consequently the amount of nicotine and other constituents delivered to the user. Individual user behaviour, such as the length, depth, and frequency of puffs might also affect nicotine absorption. Users can also modify many of the products, allowing them to alter delivery of nicotine and/or other drugs.10 First-generation, disposable ‘cig-a-likes’ (which resemble tobacco cigarettes) have increasingly been displaced by later-generation refillable tank systems and e-liquids, which deliver higher doses of nicotine.5
18B.1.2 Start-up companies
Historically, the e-cigarette market was highly fragmented and largely dominated by small start-up companies.11 More recently, large manufacturers and transnational tobacco companies have come to dominate the market (see section 18B.1.3). NJOY—a company independent of the tobacco industry—was the unrivalled market leader in 2012, but had filed for bankruptcy by the end of 2016. A number of other independent e-cigarette companies continue to operate, but comprise only a small share of the global market.1 Some have suggested that the introduction of increasingly stringent regulations, such as in the US and EU, may force the closure of such independent companies, which may not have the means to meet regulatory approval costs5 (see Section 18B.1.4).
18B.1.3 Major international companies
In response to declining smoking prevalence, transnational tobacco companies have increasingly diversified their product lines to include ‘reduced harm’ alternative nicotine products. Some have questioned the ethics and motives of such diversification, with tobacco companies profiting from smokers, new nicotine users, and would-be quitters12.
Although initially slow to enter the market, the major international tobacco companies have invested heavily in e-cigarettes in recent years, and tobacco companies now own all of the top e-cigarette brands.5 Acquisitions and investments by the tobacco industry in the past few years include the following:
Figure 18B.1.1, below, shows the tobacco industry’s entry into the e-cigarette market:
Tobacco industry investment in non-cigarette nicotine products
Source: Tobacco Control Research Group, Tobacco industry investment in non-cigarette products. TobaccoTactics.org, University of Bath. Last updated 9 September 2014.
The introduction of increasingly strict regulations on e-cigarettes, such as in the US and EU, led to fierce lobbying, both in favour of and against proposed new laws. Smaller e-cigarette companies have tended to fight new restrictions, while big tobacco companies have pushed for a range of controls on e-cigarettes, including detailed health warnings, reduced product ranges, restricted sales, and onerous and costly testing requirements. The tobacco companies argue that these restrictions ensure product safety, but others have suggested that the industry’s support for the laws comes from a desire to maintain dominance and minimise competition. Strict regulations might give large companies an advantage in the e-cigarette market, as they are much more likely than small start-up companies to have the resources to go through potentially lengthy and expensive approval processes.13, 14 For example, the FDA’s process to gain approval for a new product is time-consuming and expensive, potentially favouring the tobacco industry’s products.15, 16
Similarly, several commentators have claimed that the initial move to classify e-cigarettes as medicinal products under early drafts of the EU Tobacco Products Directive (since changed, see 18B.9) was influenced by lobbyists from both the pharmaceutical and tobacco industries.17 GlaxoSmithKline, one of the major providers of pharmaceutical smoking cessation aids and thus a competitor of e-cigarettes, lobbied vigorously for stringent e-cigarette regulation in the EU.18 Johnson & Johnson, which markets the Nicorette line of products, expressed strong support for regulating all non-tobacco nicotine products, including e-cigarettes, as medicines.19 Tobacco and e-cigarette lobbyists reportedly sent gifts and offers of hospitality to members of the European Parliament. While the extent to which these were accepted is not known, all member states are signatory to article 5.3 of the World Health Organization’s Framework Convention on Tobacco Control, which obliges parties to protect the processes of development and implementation of tobacco control policies from interference by the tobacco industry and associated interests.17
1. Technavio. Global e-cigarette market 2016-2020. 2016. Available from: https://www.technavio.com/report/global-health-and-wellness-e-cigarette-market
2. Zhu S-H, Sun JY, Bonnevie E, Cummins SE, Gamst A, et al. Four hundred and sixty brands of e-cigarettes and counting: Implications for product regulation. Tobacco Control, 2014; 23(suppl 3):iii3–iii9. Available from: http://tobaccocontrol.bmj.com/content/23/suppl_3/iii3.abstract
3. Euromonitor International. Global tobacco: Key findings part ii: Vapour products. 2017. Available from: http://www.euromonitor.com/global-tobacco-key-findings-part-ii-vapour-products/report
4. Hexa Research. E-cigarette market analysis by product (disposable, rechargeable, modular), and segment forecasts, 2014–2024. 2017. Available from: https://www.hexaresearch.com/research-report/e-cigarette-market
5. Bauld L, Angus K, de Andrade M, and Ford A, Electronic cigarette marketing: Current research and policy. Cancer Research UK; 2016. Available from: https://www.cancerresearchuk.org/sites/default/files/electronic_cigarette_marketing_report_final.pdf
6. Gilbert HA. Smokeless non-tobacco cigarette, 1965, Google Patents. Available from: https://www.google.com/patents/US3200819.
7. Grana R, Benowitz N, and Glantz SA. Background paper on e-cigarettes (electronic nicotine delivery systems), 2013. Available from: http://www.escholarship.org/uc/item/13p2b72n.
8. Orellana-Barrios MA, Payne D, Mulkey Z, and Nugent K. Electronic cigarettes—a narrative review for clinicians. American Journal of Medicine, 2015; 128(7):674–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25731134
9. Cheng T. Chemical evaluation of electronic cigarettes. Tobacco Control, 2014; 23 Suppl 2:ii11–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24732157
10. World Health Organization (WHO), Electronic nicotine delivery systems. Conference of the parties to the who framework convention on tobacco control Moscow, Russian Federation 2014. Available from: http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf?ua=1.
11. Tobacco Tactics. E-cigarettes. 2015. Available from: http://www.tobaccotactics.org/index.php/E-cigarettes
12. Hendlin Y, Elias J, and Ling PM. The pharmaceuticalization of the tobacco industry. Annals of Internal Medicine, 2017; 167(4):278–80. Available from: http://dx.doi.org/10.7326/M17-0759
13. No authors listed. When it comes to e-cigs, big tobacco is concerned for your health. Daily Mail, 2015. Available from: http://www.mailonsunday.co.uk/wires/reuters/article-3007278/When-comes-e-cigs-Big-Tobacco-concerned-health.html
14. Tobacco Tactics. E-cigarettes: Lobbying. 2014. Available from: http://www.tobaccotactics.org/index.php/E-cigarettes:_Lobbying
15. Bandyk M. Big tobacco stubs out e-cigarette competitors. The Daily Caller, 2013. Available from: http://dailycaller.com/2013/04/06/big-tobacco-stubs-out-e-cigarette-competitors/
16. Neal M. The maker of vuse e-cigs is lobbying to ban vaping. Gizmodo, 2014. Available from: http://gizmodo.com/the-maker-of-blu-e-cigs-is-lobbying-to-ban-vaping-1633442788
17. No authors listed. Anger over tobacco lobbyists as europe nears new rules on e-cigarettes. Euro News, 2013. Available from: http://www.euronews.com/2013/07/10/new-tobacco-products-directive-adopted-regulations-on-e-cigarettes-announced/
18. Siegel M. It’s official: Big pharma is lobbying against electronic cigarettes. Tobacco Today, 2014. Available from: http://www.tobaccotoday.info/2014/06/16/its-official-big-pharma-is-lobbying-against-electronic-cigarettes-dr-michael-siegel/
19. Kitamura M. Glaxo memo shows drug industry lobbying on e-cigarettes. Bloomberg Business, 2014. Available from: http://www.bloomberg.com/news/articles/2014-02-19/glaxo-memo-shows-drug-industry-lobbying-on-e-cigarettes