An average of 47 people in Thailand die from smoking cigarettes every day, while there has not been a single recorded death here from using e-cigarettes.
Millions of people have successfully used vaping to quit smoking, and many countries actively promote vaping as a means to quit the deadly habit. Yet conventional cigarettes are available in every Thai convenience store, while e-cigarettes are illegal. Government officials and news headlines trumpet the supposed dangers of vaping, but stay silent on smoking even as it kills 71,000 Thais every year – the single biggest preventable cause of death.
Why?
This is the question pondered in the latest Deeper Dive Thailand podcast featuring Asa Saligupta, who became a proponent of vaping after he was diagnosed with spots on his lungs in 2001. He first vaped in 2005, and has done so continuously since quitting cigarettes. “In 2019 I went back and I did like a what is called a lung capacity test,” he said. “The doctor, he was so surprised, he remembered me. He said, ‘So you did quit smoking.’ I said, ‘Yeah, I did quit smoking to do vaping.’ He said, ‘Good for you, man,’ because all the spots were gone.”
Hours of searching through peer-reviewed scientific journals reveal no evidence to support the frequent assertion of Thai officials that vaping is as dangerous as smoking. Britain’s National Health Service said vaping is “far less harmful than cigarettes”, and vaping is actively promoted in the UK as a means to lower the death toll from smoking. In 2015 an independent review published by Public Health England that included the results of animal testing concluded that vaping devices are about 95% safer than smoking cigarettes.
“Vaping has been around for 20 years at least,” Mr Asa, president of End Cigarette Smoking Thailand, told the podcast. “We have hundreds of thousands of testimonials of people saying vaping is safer.
“The main reason for cancer from smoking is because of the combustion,” he continued. “Vaping or even the heated tobacco products, they don't have combustion. Combustion leads to tar and tar is the main item that that coats your lungs and causes cancer. Plus, there are lots and lots and lots of carcinogens in regular tobacco.”
10,000,000:1 ratio
Since the first e-cigarettes appeared about 20 years ago, more than 100 million people have been killed by cigarettes, while fewer than 100 deaths have been attributed to vaping – a ratio of 10,000,000:1 – and most of those fatalities were during the EVALI outbreak of 2019-2020 that was caused by a specific brand of THC-containing vape juice laced with Vitamin E-acetate.
“Specifically there was this one company that … mix it with vitamin E acetate and when it was heated and cooled down, it became so sticky and gooey and covered the lung," explained Mr Asa. “The FDA had come out and accepted that was the main cause.”
So why the anti-vaping hysteria? One motivation appears to be economic. The Bangkok Post quoted an official from the autonomous government agency ThaiHealth as saying, "E-cigarettes will have a widespread effect on tobacco farmers in the country, ... farmers will suffer income loss."
It’s reasonable to question whether it is worth 71,000 lives a year to protect tobacco farmers. If it doesn’t matter that their crop is deadly, why not let them grow opium? It costs an estimated 93 billion baht to treat smoking-related diseases every year, which could be used to compensate farmers for growing something else or rewilding the land to help fight climate change.
In fact, Mr Asa said farmers could continue growing tobacco – the crop could be used partially for heat-not-burn devices, and partially to produce liquid nicotine for vape juice. “I have talked with tobacco farmers,” Mr Asa told the podcast. “Of course…the main concern is for, you know, we have to take our family first. I understand that. But within half an hour or 45 minutes, they completely understood the benefit.”
If vaping is indeed much safer than smoking, as all the evidence suggests it is, then one burning question is: does vaping help smokers quit? A 2021 peer-reviewed found that daily e-cigarette usage among US tobacco smokers can increase the likelihood of quitting smoking eightfold. A 2019 peer-reviewed randomised control study also found that daily e-cigarette use leads to an almost doubled rate of smoking abstinence compared to other nicotine-replacement products after one year.
“Vaping helps people quit smoking,” said Mr Asa. “The British government even handed out vape items to those people who want to quit smoking.”
Cost of Thailand's ban
If vaping is much safer than smoking and does help people quit cigarettes, the inevitable question is: How many lives has Thailand’s ban cost? The question can also be extended to Thailand’s millions of foreign tourists, some of whom will have returned to their deadly smoking habit while in the kingdom.
A final objection to vaping is that it could serve as a gateway to smoking. A 2023 research letter found that exclusive e-cigarette users are unlikely to transition to combustible tobacco. On the other hand, a joint survey by Thailand’s Ministry of Public Health, Ministry of Education and the World Health Organization found that Thai vapers aged 13-15 were up to three times more likely to use tobacco products in the future. What could explain the opposite findings? One explanation could be that because e-cigarettes are illegal in Thailand, they’re harder to obtain; once someone’s hooked on nicotine and they can’t find a vape, they might well smoke a regular cigarette available in every convenience store to get their fix – an argument that e-cigarettes should be at least as widely available as toxic, combustible cigarettes.
However, that study also showed something that people on both sides of the issue find disturbing – that the use of e-cigarettes among those Thai children between the ages of 13 and 15 increased from 3.3% in 2015 to 8.1% in 2021. And everyone agrees that e-cigarettes should not be used by or marketed to children.
“Why don't we say like, let's ban promotion [aimed at] kids and young people, not the product itself,” Mr Asa told the podcast. “And if you want to ban something, let’s ban toy pods.” The additional revenue from taxing vaping devices could be used to strictly enforce the law.
Finally, Mr Asa is adamant that vaping is strictly a way to stop smoking; nobody who does not already smoke should try an e-cigarette and risk getting addicted to nicotine. Because while it’s the delivery system – smoking combustible cigarettes – that causes most of the damage to health, nicotine itself is not entirely harmless: it leads to an increased risk of cardiovascular disease, it can affect brain development, particularly in adolescents, and it affects bone health. So while there’s a strong argument that e-cigarettes should be legalised, controlled and taxed, they should only be used as a way to quit far more dangerous cigarettes, as they are in neighbouring countries like Philippines and Indonesia. Some of the tax and customs revenue could be used to take additional measures to keep all vaping devices out of the hands of children.
“Our main thing,” said Mr Asa, “is that we want some kind of choice for people who have no choice, either vaping or smoking. Those two choices. Then of course I recommend vaping instead of smoking.”
One thing that is clear despite the clouds of anti-vaping propaganda: e-cigarettes are already prevalent in Thailand. “The market is already here,” Mr Asa pointed out. “Just pick up your phone and search Google for prices, a whole list will come out…they deliver to your door. And [they’re available] in flea markets and even in department stores.” In fact, the biggest danger may lie in the fact that unlicensed devices and e-liquid [that could be sourced from Thai farmers] are flowing into the kingdom without inspections and quality control.
What does the future hold for vaping’s legality in the kingdom? Mr Asa said the majority of a committee set up last year to study the issue recommended that vaping be legalised, but he wasn’t sure it would happen because of entrenched interests.
“I could only hope for that,” he said. “That they would at least listen to reason and logic and scientific evidence.”
Click below to watch the full episode, or search for Deeper Dive Thailand wherever you get your podcasts.
