Last updated: January 2019
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; 2019. 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 2016, projected to grow to 55 billion by 2021.3 In 2018, the market for e-cigarettes globally was estimated to be worth more than 13 billion US dollars, and is predicted to continue its rapid growth over the coming years (see estimates here).4 North America is by far the largest e-cigarette market, followed by Western Europe, Eastern Europe, Asia Pacific, and then the rest of the world (see 2018 market size estimates here).4
Although the concept of an electronic cigarette was first patented in the USA in 1965,5 it was not until 2003 that the first commercialised e-cigarette product was developed in China.6 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, 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.7
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.8 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.9 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.10
18B.1.2 Start-up companies
Historically, the e-cigarette market was highly fragmented and largely dominated by small start-up companies.11 NJOY—a company independent of the tobacco industry—was the unrivalled market leader in 2012, but had filed for bankruptcy by the end of 2016.10 In the US, British American Tobacco sales surged in 2014 and led into 2017.12 However, by the end of 2017, JUUL (a sleek, portable e-cigarette that resembles a USB flash drive made by JUUL Labs) rapidly became the largest retail e-cigarette brand in the US,12 and substantially increased sales of the entire e-cigarette category.13 In 2018, JUUL accounted for more than two-thirds of the US e-cigarette market and is reportedly valued at $15 billion.14 JUUL Labs has begun to expand sales to other countries, such as the UK and Canada, where currently some of the top brands such as Logic, Vype, and Blu, are subsidiaries of major tobacco companies.4 In December 2018, it was announced Altria is buying a 35 percent stake in Juul15 (see 18B.1.3, below).
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 quitters16. (see Section 18B.6.5).
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 many of the top e-cigarette brands.10 Acquisitions and investments by the tobacco industry in the past few years include the following:
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 start-up companies to have the resources to go through potentially lengthy and expensive approval processes.20, 21 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.22, 23 Juul Labs has reportedly spent hundreds of thousands of dollars on lobbying firms, as well as hired several former high-profile federal officials and regulators from both the Trump and Obama administrations, in response to the FDA’s proposed new restrictions on e-cigarettes.24, 25
Several commentators have also 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.26 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.27 Johnson & Johnson, which markets the Nicorette line of products, expressed strong support for regulating all non-tobacco nicotine products, including e-cigarettes, as medicines.28 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.26
In Australia, Philip Morris International has reportedly been lobbying federal government MPs to overturn the current ban on the retail sale of e-cigarettes containing nicotine. While third-party lobbyists are required to list themselves on the publicly available lobbyist register, Australia does not require companies to register if they use people from within their own company to lobby government.29 The Australian Tobacco Harm Reduction Association (ATHRA), which has led recent lobbying efforts to legalise nicotine e-cigarettes, reportedly accepted initial funding from e-cigarette companies30 as well as funding from an overseas group that had received money from tobacco companies.31
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. Shapiro H. No fire, no smoke: The global state of tobacco harm reduction 2018. Knowledge-Action-Change, London 2018. Available from: https://gsthr.org/downloads/GSTHR%20Report/Global-State-of-Tobacco-Harm-Reduction-2018.pdf.
5. Gilbert HA. Smokeless non-tobacco cigarette, 1965, Google Patents. Available from: https://www.google.com/patents/US3200819.
6. 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.
7. 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: https://www.amjmed.com/article/S0002-9343(15)00165-5/pdf
8. Cheng T. Chemical evaluation of electronic cigarettes. Tobacco Control, 2014; 23 Suppl 2:ii11–7. Available from: https://tobaccocontrol.bmj.com/content/tobaccocontrol/23/suppl_2/ii11.full.pdf
9. 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.
10. 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.
11. Tobacco Tactics. E-cigarettes. 2015. Available from: http://www.tobaccotactics.org/index.php/E-cigarettes
12. King BA, Gammon DG, Marynak KL, and Rogers T. Electronic cigarette sales in the United States, 2013-2017. Journal of the American Medical Association, 2018; 320(13):1379-80. Available from: https://jamanetwork.com/journals/jama/article-abstract/2705175
13. Huang J, Duan Z, Kwok J, Binns S, Vera LE, et al. Vaping versus juuling: How the extraordinary growth and marketing of juul transformed the US retail e-cigarette market. Tobacco Control, 2018. Available from: http://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2018/05/31/tobaccocontrol-2018-054382.full.pdf
14. Guzman Z. Juul surpasses facebook as fastest startup to reach decacorn status. Yahoo Finance, 2018. Available from: https://finance.yahoo.com/news/juul-surpasses-facebook-fastest-startup-reach-decacorn-status-153728892.html
15. Myers M. Altria-Juul deal is alarming development for public health and shows need for strong FDA regulation, in Campaign for Tobacco-Free Kids,2018: WASHINGTON, D.C. Available from: https://www.tobaccofreekids.org/press-releases/2018_12_20_altria_juul.
16. Hendlin YH, Elias J, and Ling PM. The pharmaceuticalization of the tobacco industry. Annals of Internal Medicine, 2017. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568794/pdf/nihms883981.pdf
17. Mathis W. Bat launches high-tech vape in uk to fend off Juul, IQOS. Bloomberg, 2018. Available from: https://www.bloomberg.com/news/articles/2018-12-11/bat-launches-high-tech-vape-in-the-u-k-to-fend-off-juul-iqos
18. Philip Morris International. E-vapor products. 2018. Available from: https://www.pmi.com/smoke-free-products/mesh-taking-e-cigarettes-further.
19. Kaplan S and Richtel M. Juul closes deal with tobacco giant Altria. The New York Times, 2018. Available from: https://www.nytimes.com/2018/12/20/health/juul-reaches-deal-with-tobacco-giant-altria.html
20. 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
21. Tobacco Tactics. E-cigarettes: Lobbying. 2014. Available from: http://www.tobaccotactics.org/index.php/E-cigarettes:_Lobbying
22. 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/
23. 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
24. Meyer T. Juul hires even more lobbyists Politico, 2018. Available from: https://www.politico.com/newsletters/politico-influence/2018/12/04/juul-hires-even-more-lobbyists-440156
25. Weixel N. Juul boosts lobbying amid FDA scrutiny. The Hill, 2018. Available from: https://thehill.com/policy/healthcare/410671-juul-boosts-lobbying-amid-fda-scrutiny
26. 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/
27. 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/
28. 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
29. Knaus C. Philip morris lobbying on e-cigarettes hidden from Australian public The Guardian, 2018. Available from: https://www.theguardian.com/australia-news/2018/oct/03/philip-morris-lobbying-on-e-cigarettes-hidden-from-australian-public
30. Han E. Secret industry funding of doctor-led vaping lobby group laid bare. The Sydney Morning Herald, 2018. Available from: https://www.smh.com.au/healthcare/secret-industry-funding-of-doctor-led-vaping-lobby-group-laid-bare-20180823-p4zzc5.html
31. Han E. 'Independent' doctor-led vaping group accepts tobacco-tainted funding. Brisbane Times, 2018. Available from: https://www.brisbanetimes.com.au/healthcare/independent-doctor-led-vaping-group-accepts-tobacco-tainted-funding-20181004-p507rq.html?ref=rss&utm_medium=rss&utm_source=rss_feed