Analysis

Israel’s Strategy for E-cigarettes: Sell First, Worry About Health Later

The Health Ministry is waiting for the U.S. Food and Drug Administration to take a position. Until then, Philip Morris’ IQOS product can enjoy the market.

An IQOS  e-cigarette.
Akio Kon/Bloomberg

The upshot of the deceptively laconic announcement last week by the Health Ministry is that Health Minister Yaakov Litzman is shirking his duty to protect Israelis’ health. According to Litzman, pending a ruling by the U.S. Food and Drug Administration, no restrictions will be placed on IQOS, Philip Morris’ new e-cigarette now being sold in Israel.

This goes against the position of the attorney general, the Health Ministry’s own legal adviser, the Israel Medical Association and the Israel Cancer Association. It also contradicts recent statements by the Health Ministry itself.

According to the first part of last week’s statement, the restrictions governing tobacco products – regarding advertising, sales, use in public places and the reporting of ingredients – will also apply to e-cigarettes. It’s the second part of the statement that’s a problem: IQOS, which is based on tobacco vaping rather than burning, won’t be subject to regulation.

“In this area there is as yet no clear regulation around the world, in particular from the FDA, which is currently discussing the issue,” the ministry said. “We will wait to see the FDA decision.”

Meaning: Philip Morris, the world’s second-largest tobacco company, has just received a tremendous gift from the Health Ministry – the ability to market its cigarette without any restrictions on advertising, use in public places, and possibly without any tax as well. That’s a warm welcome to the Israeli market – courtesy of the Health Ministry.

“The ministry’s policy poses an immediate danger to public health in Israel,” was the Israel Medical Association’s response.

With good reason. Philip Morris is now entitled to sell its new toxic product however and to whomever it wants, even to children. And it can be used in any public place, whether on a bus or train, in a movie theater or at a restaurant. The company’s huge lobbying and PR investments in Israel appear to have paid off royally.

Deputy Health Minister Yaakov Litzman
Tali Meyer

The Health Ministry’s policy on the issue has been far from consistent. Just a month and a half ago at a hearing in the Knesset, Prof. Itamar Grotto, the Health Ministry’s public health chief, said the ministry considered IQOS a tobacco product.

“The current law could be immediately applied to it,” Grotto said. Another time, in response to an article by TheMarker on the subject, the ministry said that it "supports the classification of the product as a tobacco product and for tobacco regulations to apply, as well as a tax payment. The matter is currently under examination in conjunction with the Justice Ministry.”

Other health officials are angry

So what happened between January and last week that made the ministry so drastically alter its policy? Did the Justice Ministry throw a wrench in the works?

On the contrary. Top legal officials say that all the rules, taxes and restrictions that apply to regular cigarettes should apply to IQOS.

In a letter to Deputy Attorney General Raz Nizri a month ago, Health Ministry legal adviser Mira Hibner-Harel wrote that IQOS is “very similar to a regular cigarette in terms of all the ingredients that justify regulation including proven harm to health, potential for addiction due to nicotine exposure, the harmful impact on the health of people around the smoker, and the impeding of efforts to curb smoking.”

Nizri found the Health Ministry’s arguments “worthy and reasonable” and said the attorney general also believed that the restrictions applying to regular cigarettes should apply to IQOS.

Doctors who treat the damage caused by smoking are also unanimous about what must be done. In recent months Israeli medical organizations have put out strong statements against letting IQOS enter Israel without restrictions or regulation, going so far as to call it “experimentation on human beings.”

In a series of letters in recent weeks, public health experts and the Israel Medical Association have cautioned that “Philip Morris, whose products have killed millions of people, has launched a substantial overt and covert PR campaign to introduce its new cigarettes into Israel . The introduction of a new product into Israel that is being aggressively marketed by the tobacco companies is a public health emergency.”

The doctors added that it wasn’t clear how toxic the e-cigarette was. “There is very little research on the product, and some of what research there is was carried out or funded by the tobacco companies, and thus is of dubious value,” they wrote.

Litzman says he's basing his decision not to classify the new cigarette as a tobacco product on the fact that the FDA has yet to rule on the matter, but he’s ignoring one important thing: In the United States, IQOS is completely prohibited until the FDA reaches its decision. The Israeli Health Ministry’s approach is the opposite: Sell first, then think about regulation.

Israel alone in the West

This week the Israel Medical Association and the Israel Cancer Association ramped up their protests, calling the decision “a wanton policy for an absence of regulation on a new and dangerous tobacco product.”

“As we previously warned, the product is being aggressively marketed with no oversight or regulation whatsoever, especially regarding the Internet and cellphones – where mainly young people are reached,” the associations said. “The ostensible restriction to those 18 and older only makes the product more enticing to young people attracted by labels that are for adults only.”

By not subjecting IQOS to regulation, Israel is unique among Western countries. It can’t be sold in the United States, while in Japan, the first country where IQOS was sold, it is classified as a tobacco product, as it is in Hong Kong. New Zealand has completely banned the sale of IQOS and Australia may adopt a similar policy. The European Union requires that all new smoking products be subject to a number of restrictions.

At the moment, Israel appears to be the only Western country where legislators aren’t putting any restrictions on the sale of the product. One can’t help but speculate about whether this situation is linked to the meetings that Litzman and other Health Ministry people had with officials from Philip Morris International, as revealed by Channel 2 reporter Haim Rivlin. The Philip Morris executives were out to ensure that IQOS received a soft landing in Israel. They probably never imagined it would be this easy.

The Health Ministry adds: “Unlike regulation in Israel, American regulation requires approval for every new product. In America there is also an FDA approval mechanism for regular cigarettes, something that does not exist in Israel. The minister therefore decided that the decision on the matter would be made following, and in accordance with, the FDA decision.”

As for the opposition by the Health Ministry’s legal adviser and the deputy attorney general, the ministry says: “The minister’s decision is clear: When the FDA makes its decision, we will adapt to that. As of now, no decision has been made.”

Regarding the complaints by the medical organizations, the ministry adds: “Their voice is definitely being heard. But a final decision will only be made in tandem with the FDA decision.”

Philip Morris says: “IQOS is meant exclusively for adult smokers and not for someone who does not smoke or wants to quit. Scientific studies show that IQOS leads, on average, to a 90 percent decrease in levels of toxic and potentially toxic chemicals in tobacco vapor compared to cigarette smoke. Based on the cumulative scientific evidence, a full transition to IQOS could present less risk of harm than continued cigarette smoking.

“However, in keeping with the company’s responsible approach, the product’s packaging clearly states that it is addictive and harmful to one’s health. IQOS has already been sold in 20 countries, and more than a million adult smokers have switched to using it. Philip Morris will continue to abide by the law and sell the product responsibly.”