Three quarters of smokers believe vaping is at least as harmful to their health as cigarettes, a global study has found.

The poll of 26,950 tobacco users in 28 countries, conducted by industry analysts Ipsos, aimed to explore views on e-cigarettes as a potentially safer alternative to traditional forms of smoking.

Public health policy towards e-cigarettes, which have become significantly more popular in recent years, varies around the world.

While the UK government has supported vapes as a tool for giving up smoking, claiming they are 95 per cent less harmful than cigarettes, other nations, including many in the Middle East, do not support their use.

The Ipsos study found 74 per cent of respondents believed “vaping is at least as harmful as smoking”.

In Brazil, the Netherlands, Slovenia and Kazakhstan, more than 80 per cent of smokers responding to the Ipsos survey perceived vaping as being equally or more harmful than smoking.

Dr Hassan Razein, a pulmonologist at Zulekha Hospital Dubai, said smoking and vaping should be viewed as equally detrimental to health, and expects legislation on e-cigarette use to tighten further.

“We already knew smoking cigarettes, nicotine and tobacco were dangerous,” he said. “But it was clear we needed to know more about the full profile of vaping and the hazards.

“We knew at the very least there were risks, as nicotine is still addictive and is definitely a harmful substance.”

Impact of vaping on health

Heated nicotine, flavourings and other chemicals used to create an aerosol to inhale are known to be toxic. But most licensed vapes contain significantly fewer toxic chemicals than cigarettes.

But in 2020, the US Centres for Disease Control and Prevention confirmed 2,807 cases of lung damage related to e-cigarettes or vaping, as well as 68 related deaths.

Dr Razein said the medical community was only now seeing the long-term effects of prolonged vaping on people's health.

“We are definitely seeing more people who vape come to us with related health problems,” he said.

“We are still only beginning to understand the full extent of this damage over time. Accessibility for young population is alarming, even more than those smoking in middle age.

“Legislation will become more stringent so vaping has the same stigma as smoking and both are viewed in the same way.”

In Italy, Czech Republic, France and the UK, vaping is perceived to be less harmful than traditional smoking.

Since 2010, there has been a 7 percentage-point drop in the number of smokers in the UK, campaign group Action on Smoking and Health said.

Numbers have fallen from about 20 per cent of the population to 12.9 per cent in 2022.

Although it is well known that smoking causes cancer and heart disease, few long-term studies have assessed the potential damage to health caused by vapes.

Research by University College London found vaping could alter DNA cells in the mouth in a similar way to smoking, leading to cancer.

Long-term use

As more is known about the health effects of the long-term use of vapes, regulations on their use are evolving.

In New Zealand, heath authorities support vapes to help with quitting cigarettes, but disposable vapes are to be withdrawn from sale. Anyone born after 2009 is already unable to legally buy tobacco products in the country.

Dr Derek Yach, a public health expert at Global Health Strategies and a former World Health Organisation cabinet member leading on tobacco and chronic diseases, said attitudes towards vaping were beginning to change in the region, despite the health concerns.

“The Middle East is one part of the world where we are beginning to see a reversal of previous bans on e-cigarettes and tobacco harm reduction products,” he said.

“I’m hopeful this reversal will continue into full thrown support by governments, given the fact that the evidence on the benefits of vapes, nicotine pouches, heated tobacco and e-cigarettes could reverse significant health trends driven by very high male smoking rates across the Middle East.

“This includes increased chronic obstructive pulmonary disorder, a number of cancers, cardio vascular disease and other related conditions. The region is opening up to innovation and technology in this area.”

In the UK, there is a growing black market for unregulated products, with vapes delivering an even greater nicotine hit.

While it is illegal to sell vapes containing more than 2ml of e-liquid – about 600 puffs – products are being sold at almost 15 times that limit.

The UK is due to introduce a new vape tax in 2026, increasing the cost of some products by up to 300 per cent.

Black market

The tax aims to deter non-smokers and young people from vaping, but could potentially push more towards unregulated, dangerous products, critics said.

“Many consumers have no idea that the products they’re buying are untested and potentially unsafe,” said Guy Lawler, managing director of UK online store Vapekit.

“Retailers have a responsibility to adhere to UK vape regulations, but still, there are rogue operators. Vapes are meant to help people quit smoking, but the ever-growing black market is putting people’s health at risk.”

In the UAE, vape products have been subject to a 100 per cent tax since 2019, as part of government strategy to reduce harmful product consumption.

Dr Saakshi Sarin, a cardiologist at Aster Royal Clinic, Arabian Ranches, said smokers had plenty of options to help them quit, other than vapes.

“Unlike cigarettes, vaping products do not produce tar or carbon monoxide, among many other chemicals,” she said.

“However, vapes do include potentially harmful substances such as diacetyl which is a chemical linked to a serious lung disease.

“No tobacco product is safe, and there’s no evidence that they can help you quit smoking. They may be just as addictive and contain dangerous levels of nicotine, chemicals, neurotoxins and metals.

“People trying to quit smoking should try proven tobacco cessation therapies before considering using e-cigarettes, which have not been proven an effective method.

“There are several ways to help one resist the urge to smoke, like nicotine replacement therapy in patches, gums lozenges and nasal sprays.

“Physical activity can also help distract you from tobacco cravings. Remind yourself of the benefits that will help you stick to your goals.”