By Pia Rodrigo

In April 2024, a death due to e-cigarette or vape-associated lung injury (EVALI) in the Philippines was reported in the Respirology Case Reports journal of the Asian Pacific Society of Respirology by doctors from Philippine General Hospital (PGH).

A 22-year-old male patient who had no known comorbidities but used e-cigarettes daily for two years presented with sudden severe chest pain and difficulty breathing after a sports activity. Prior to his hospital admission, he experienced cough, vomiting, and fever for a week. The patient did not smoke cigarettes, drink alcohol or use drugs, and had never been infected with COVID-19. He suffered a heart attack due to blockages in his two major arteries, was put on mechanical ventilation, and passed away three days after initial admission.

This tragic case is the sixth recorded EVALI case in the Philippines — other cases of reported EVALI include a 16-year-old from Visayas and a 22-year-old from Alabang, according to the Department of Health.

Although only a few cases of EVALI have been officially recorded in the Philippines, this is already much cause for concern.

Among Filipino teenagers aged 13-15, 14.1% are already using e-cigarettes, as per the 2019 Global Youth Tobacco Survey.

Data on the EVALI epidemic in the United States, where at least 3,000 cases were reported in 2020 alone, are revealing — an observational study by Lanspa et al. comparing EVALI diagnoses before the COVID-19 pandemic and during the pandemic showed that EVALI patients are getting younger.

Tobacco control advocates have been calling on legislators to be concerned over the recent death of the 22-year-old EVALI patient and review policy. The time to act is apropos especially this June, which marks National No Smoking Month. This year, the campaign focuses on protecting the youth from the tobacco industry’s deception and misinformation, including the promotion of e-cigarettes as a “safe alternative” to smoking and the trendy marketing strategies.

Contrary to the industry narrative, vaping is as harmful as cigarette smoking and could even lead to worse health outcomes. In terms of nicotine content, smoking one pod of vape liquid can be the equivalent of smoking three packs or 60 sticks of traditional cigarettes. Inhaling vape chemicals, which include several carcinogens and heavy metals, causes inflammation and swelling in the lungs and airways, and may even alter DNA similarly to cigarette smoking.

Weak legislation has only expanded the youth’s access to these harmful products. Republic Act 11900 or the Vaporized Nicotine and Non-Nicotine Products Regulation Act, which was touted as a law strengthening regulation against e-cigarettes, actually watered down existing regulation by lowering the age limit of access to e-cigarettes from 21 years old to 18 years old, removing the ban on e-cigarette flavors aside from tobacco and menthol, and shifting regulatory purview from the Food and Drug Administration (FDA) to the Department of Trade and Industry.

Even the good provisions in the law have huge gaps in implementation. Section 12 of RA 11900 states that “Manufacturers, importers, and sellers in their product advertisements are prohibited from contracting celebrities or health professionals to promote or encourage the use of Vaporized Nicotine and Non-Nicotine Products or Novel Tobacco Products.”

However, influencer marketing for e-cigarette products is still rampant. Just recently, on May 30, a day before World No Tobacco Day, more than 50 top social media influencers like Rosmar Tan (who has 20 million followers on TikTok) and Boss Toyo (with 8.7 million followers on Facebook) attended the first ever VapeFest in Pasig City for the brands SHFT and Chillax.

When asked if she was worried about potential criticism from parents for endorsing these products, Rosmar responded that she was not endorsing these products: “Nasa kanila pa din naman po kung [g]usto nilang gumamit o hindi (It’s still up to them if they want to use these products).” But the mere presence of these influencers at VapeFest is cause for concern, and we need to have more conversations on holding our influencers, or key opinion leaders, to account. For all the clout that they have, the least we can expect from our influencers is that they avoid peddling products that have been proven to cause serious illness and death, and not spreading misinformation to their vulnerable young audience.

In recent months, the gaps in implementation of vape regulations have caught the attention of both the executive and legislative branches of government.

The Bureau of Internal Revenue (BIR), for one, has been carrying out a campaign combating the sale of illicit vape products, especially for online sales, which tend to escape regulatory requirements. As of June 1, the BIR will presume that any vape product not bearing BIR stamps has not paid the required excise tax. According to the BIR, violation will result in the seizure of the illicit vape products and criminal cases against the businessmen and possessors of these products.

Among legislators, Senators Joel Villanueva and Pia Cayetano have been expressing deep concern over the rising number of cases of EVALI, especially among the youth. Senator Villanueva believes that RA 11900 should be amended, and that the responsibility of regulating vape products should return to the FDA.

If our policies enable the youth to become addicted to nicotine through e-cigarettes and vape devices, the tobacco epidemic will be replaced with a potentially more insidious one. We can only hope that our policymakers, especially our legislators, act urgently to prevent the “vapedemic,” because the youth will remember for years to come who protected their interests when they needed them the most.

Pia Rodrigo is strategic communications officer at Action for Economic Reforms.