DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. Package 2+: e-cigarette tax reform (main presentation) As of 5 September 2019 1
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. Table of contents 1. Ten reasons why we need to raise e-cigarette excise tax 2. Proposed reform on e-cigarette excise tax 3. Cross country comparison 4. Responding to ten concerns of stakeholders 2
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. Ten reasons why we need to raise e-cigarette taxes 30
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. Top 10 reasons why we need to raise e-cigarette excise tax 1. To avoid harmful effects of e-cigarettes on health ; 2. To reduce e-cigarette-related injuries ; 3. To restrict access and availability of e-cigarettes to children and minors; 4. To reduce e-cigarette use among the youth ; 5. To reduce risks to bystanders exposed to second-hand aeroso l; 6. To address the number of vape users; 7. To deter first-time usage of e-cigarette; 8. To prevent the potential use of e-cigarettes as an illicit drug delivery system ; 9. To tax vapor and heated tobacco products (HTPs) the same as regular cigarettes and prevent renormalization of smoking ; and 10. To finance the funding gap of the UHC. 31
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. US - Center for Disease Control Cardiovascular disease 1. E-cigarettes containing nicotine, which is highly addictive, are linked to increased risk of heart attacks and stroke. 2. E-cigarette users were 56 percent more likely to have a heart attack and 30 percent more likely to suffer a stroke than non-users. Source: National Health Interview Survey, Center for Disease Control and Prevention 32
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. “There is conclusive evidence that in addition to nicotine, most e-cigarette products contain and emit numerous potentially toxic substances .” - US National Academies of Sciences, Engineering, and Medicine Source: US National Academies of Sciences, Engineering, and Medicine. 2018. Public health consequences of e-cigarettes. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24952. 33
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. The same chemicals are also found in tobacco cigarettes. “What's coming out of an e -cigarette (aerosol) may look different than secondhand smoke from cigarettes, but it's far from harmless. ” 34
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. 1. The concentrations of nicotine in tobacco fillers and the mainstream smoke of HTP (iQOS) were almost the same as those of conventional combustion cigarettes. 2. Tobacco-specific nitrosamines and carbon monoxide are NOT completely removed from the mainstream smoke of iQOS. 3. It is necessary to consider the health effects and regulation of iQOS. - Department of Environmental Health, National Institute of Public Health, Japan 2017 35
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. Toxic substances E-cigarettes do not emit plain water vapor . They emit aerosols (gas and particulate matter) that contain many harmful substances found in conventional cigarettes, such as, but not limited to: 1. Nicotine 2. Ultrafine particles that can be inhaled deep into the lungs 3. Volatile organic compounds 4. Cancer-causing chemicals such as PAHs, carbonyls 5. Heavy metals such as nickel, tin, chromium lead, copper, and arsenic 6. Tobacco-specific nitrosamines 7. Batter chemicals Source: https://www.centeronaddiction.org/e-cigarettes/tobacco-replacement/are-nicotine-free-e-cigarettes-harmful 36
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. Acute and severe lung illnesses reported in the United States Thomas Haupt, a respiratory disease epidemiologist with Wisconsin's Department of Health Services: "At this particular point, vaping is the only thing that they have in common." 43
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. Acute and Severe Lung Illnesses reported in the United States 44
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. US Center for Disease Control and Prevention 45 Source: CNN (S12:E265 Doctors suspect vaping behind uptick of severe lung disease)
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. US FDA - SEIZURES due to Vaping 46
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. US Center for Disease Control and Prevention 47 Source: The Washington Post published on 16 August 2019
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. Nicotine delivered by e-cigarettes during pregnancy can result in multiple adverse consequences such as Sudden Infant Death Syndrome and Altered Brain Development. - American Academy of Pediatrics (AAP) Source: Center for Disease Control 49
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. Risks of vaping Claims of e-cigarette companies What we know from research A high concentration of cancer-causing “E -cigarettes are 95 percent safer than compounds were found in the urine of cigarettes.” 180 teens who use vapes. (Rubenstein et al., 2018) E-cigarette-using teens are twice as likely “E -cigarettes help smokers quit to smoke conventional cigarettes within cigarettes.” one year. (Watkins, 2018) 52
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 1. To avoid harmful effects of e-cigarettes on health. Risks of vaping Claims of e-cigarette companies What we know from research US Surgeon General: “The harm of cigarettes is in tar. Nicotine, “ Nicotine is a controlled poison and is in itself, is not as harmful.” toxic to developing brains.” European Public Health Association: “E -cigarettes are a viable smoking “Vape users are ⅓ less likely to quit cessation option for people who want to smoking cigarettes.” (Glantz and quit.” Bareham, 2018; European Public Health Association, 2018) 53
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 2. To reduce e-cigarette-related injuries. Regardless of brand, cases of e-cigarette explosions have been reported which have caused severe injuries and sometimes death. 54
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 2. To reduce e-cigarette-related injuries. 1. 82 e-cigarette explosions happened during use. At least 316 2. 92 e-cigarette explosions happened during charging. vape explosions 3. 75 e-cigarette explosions happened during transport, storage or unknown worldwide circumstances. 4. 67 e-cigarette explosions involved spare (August 2009 to March 2019) batteries for removable battery mods. 5. 219 resulted in personal injury or death . Source: e-Cig One 2019 55
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 2. To reduce e-cigarette-related injuries. 56
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 2. To reduce e-cigarette-related injuries. 57 Source: 24 Oras, GMA News Network (video retrieved from Youtube)
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. …on your face and body… 58
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. …in your pockets… 59
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. …in the car or bus… 60
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. …in the car… 61
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. …and in the airport. 62
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. …and even deaths. The first known mortality from an e-cigarette device was when a Florida man was killed by a Philippine-made e-cigarette. Explosion caused by a malfunctioning battery had launched vaporizer fragments into the Florida Man’s brain, killing him instantly. Source: https://www.washingtonpost.com/news/to-your-health/wp/2018/05/16/man-died-after-a-vape-pen-exploded-and-embedded- pieces-into-this-head-autopsy-says/ 63
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. …and even deaths. Source: https://www.washingtonpost.com/health/2019/02/05/vape-pen-kills-man-after-exploding-his-mouth/ 64
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. …and even deaths. 65
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 3. To restrict access and availability of e-cigarettes to children and minors. 1. Kids can order “e - juice” on the internet. 2. E-cigarette juices are sold in flavors like fruit, candy, coffee and chocolate. Most have the addictive ingredient, nicotine. 3. Children are exposed to e-cigarette advertising in the media, and in magazines and billboards. 4. 30 to 50 percent of e-cigarettes sales occur online, where there are poor age verification practices. Source: https://truthinitiative.org/research -resources/emerging-tobacco-products/e-cigarettes-facts-stats-and-regulations 66
DRAFT FOR DISCUSSION. SUBJECT TO CHANGE. 4. To reduce e-cigarette useamong the youth. Source: US FDA and U.S. Center for Disease Control and Prevention (CDC) 67
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