In India, hundreds of millions of tobacco users are kept in the dark about safer nicotine products, while the government bans popular alternatives like vaping and stays silent on even basic NRTs. Shot on location at GFN 2025 in Warsaw, Poland, Jagannath Sarangapani exposes how prohibition and the absence of relative risk messaging have shaped the country’s tobacco control strategy.
Transcription:
00:10 - 00:44
[Brent Stafford]
Hi, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV. We're here in Warsaw, Poland for the 12th edition of the Global Forum on Nicotine, the annual conference on safer nicotine products and tobacco harm reduction. In this episode, we're going to be discussing tobacco harm reduction in South Asia, speaking to a very powerful voice, a consumer voice for THR in India. So you're from India and you're a leading tobacco harm reduction advocate there. What does that mean by the way?
00:45 - 01:28
[Jagannath Sarangapani]
Well I guess in a manner of speaking I say when you say leading it's perhaps because I've got a lot of gray hair and I'm getting close to 60 and I guess that means I can't talk about things because when the vast majority of vapers in India are in their 20s and Hardly anyone in their families know that they were smokers and are now vapers and so on. They're very scared to come out and talk about it. I have no such inhibitions. And so I'm quite vocal about what I talk and what I do and what I believe in. And so I guess that's what qualifies me as being one of the leading voices of advocacy in India. Perhaps that's it. Yeah.
01:28 - 01:36
[Brent Stafford]
So for our viewers that are unfamiliar about the state of affairs in India, why do you have to be so careful about talking about it?
01:37 - 02:50
[Jagannath Sarangapani]
Well, for starters, there is a ban on vapes in India. But even prior to that, in India, we are all close-knit communities, close-knit families and so on and so very often children don't tell their parents, the parents don't know that children smoke and so on and so forth and so that's kind of looked at as a taboo and so very little is spoken about it and so you when you have you know 25, 26 year olds who have migrated to vaping They still don't want to talk about it having switched from say a cigarette to something which is definitely Safer they still don't want to talk about it that they were former smokers and our current papers and so we have that as an issue and That's why while you will have a lot of them willing to you know be keyboard warriors and talk about the cause no one's willing to come forward and say it and as to how they have benefited with choosing lesser harm. What's the word?
02:51 - 02:53
[Brent Stafford]
We say safer alternatives.
02:53 - 02:56
[Jagannath Sarangapani]
There you go. Yeah, safer alternatives. So that's what it is.
02:56 - 03:04
[Brent Stafford]
So India banned e-cigarettes back in 2019. What was the government's rationale and how was the decision received?
03:06 - 05:28
[Jagannath Sarangapani]
Yeah, that was such a knee-jerk reaction by the government at that time. They spoke about protecting the teens you see that's a very emotive subject anywhere in the world right when you talk about the youth and so on and so that was predominantly driven as the reason and the rationale for vapes being banned and unfortunate but not a lot of thought went into that there was very little research that was done it was just a knee-jerk reaction lot of us do believe that that's because big tobacco in India which is pretty much 30% plus owned by the government of India they were losing out in the game and there were a lot of people who were migrating to safer alternatives and vaping culture was becoming more prevalent and more seen and so there was a lot of nervousness there and since those companies weren't ready is what we assume that's why they very hurriedly brought in a ban Yeah, it seems that it happened pretty early. Yeah, it was. It was. And it was kind of weird because they did have a debate in Parliament about it. And it's obvious that the parliamentarians, the members of Parliament out there, probably hadn't even seen a wave before in their lives, much less handled it. Because the kind of claims that they were making about it being a narcotic and so on and so forth was so far removed from reality. And that was the kind of justification that was being used. to hurriedly push through this legislation which was very sad they brought it out as an ordinance as if it was an emergency measure and then subsequently ratified in the form of an act and so there was no need for such an ordinance to be brought out It was not something which was so apparent and so dangerous as it was being made out to bring an ordinance and was subsequently passed in the parliament. So that's the funny way in which it happened.
05:28 - 05:34
[Brent Stafford]
Was there much opportunity for harm reduction advocates to have a voice, a consultation? Zero.
05:35 - 06:02
[Jagannath Sarangapani]
None whatsoever. We did get a lot of groups together and we did protest these things across the country. We organized a lot of talks and so on. With, say, for example, advocates or users of these safer alternatives, there was absolutely no consultation whatsoever.
06:03 - 06:09
[Brent Stafford]
So when you've been writing about this, you said that it's prohibitionist. Is that the best term?
06:10 - 07:52
[Jagannath Sarangapani]
well i i would say it is prohibitionist is one i would actually uh use a stronger word to say that it says uh what's the word again just give me a sec i'll just yeah okay It's actually discriminatory. It's not just prohibitionist. And the reason why I would say it's discriminatory is because you're not allowing me to have access to safer technologies. You're not allowing people who want to switch to safer alternatives any access to safer technologies or safer methods for me to give me the nicotine which I want in a safer fashion and so that's the problem and again by banning safer alternatives the problem that you're doing is you're making it out into an urban problem because vapes is a replacement for smokers of cigarettes. India, we have a far bigger problem of oral tobacco users and of 375 million tobacco users in India, nearly 200 million of them are oral tobacco users. And so that's a serious issue and that's the serious problem. By shutting off access to any form of safer alternatives, what you're doing is you're shutting off access of improving quality of life for so many people. And the problem is there in the rural areas. Vaping is an urban problem. It's not a rural problem. It never was.
07:52 - 08:00
[Brent Stafford]
And from what I understand, in India, the oral tobacco that's used in the rural areas is particularly nasty.
08:00 - 09:41
[Jagannath Sarangapani]
Yeah, it is, it is. And it's... And it's prevalent. You see, if you look at India, we have far more incidence of oral cancer than lung cancer from related issues. And so you have a lot of toxins that get added into it and it's a particularly aggressive mechanism. the other thing is in the rural India we also have bidis you know as smokers we also have these tiny little bidis that are rolled tobacco leaf with a lot of stuff inside and they are so cheap if you look at the cost of a bidis it's a pack of 20-25 bidis cost less than 20 cents that's how cheap it is and when you actually look at it bulk of rural India smoke BDS or they use oral tobacco, not cigarettes. And so cigarettes is actually an urban issue which very often gets ignored. And so when the government decided to ban any kind of activity, and it's not just banning the sales and marketing and distribution of e-cigarettes and vapes and heat not burns as well, they also banned research. You're not allowed to do research on the subject. On one side, they say there is not enough evidence, India-specific evidence. And on the other side, they say you're not allowed to do any research on the subject. So where are you going to get evidence? If you want India-specific research in India and you ban the research, how is it going to happen?
09:42 - 09:45
[Brent Stafford]
So if you're a university researcher, you cannot?
09:45 - 09:57
[Jagannath Sarangapani]
No, you cannot. No, you cannot. That's bizarre. And that's how closed thinking that the entire thing has been. And so that's the alarming part.
09:58 - 10:23
[Brent Stafford]
So, so many people in North America, because in Canada and the U.S., for decades, you know, cannabis was illegal and the universities weren't allowed to do any research on it. And so that, you know, Catch-22 operated for quite some time. To hear that that just got, you know, in 2019 dropped on India with regard to nicotine, that's crazy.
10:23 - 11:20
[Jagannath Sarangapani]
It is. It is. And it's very regressive in that sense, you know. You pride yourself in being forward-thinking and we are a growing economy. Today we are the fourth largest economy. You would expect your mindsets to also shift and you wouldn't be regressive. Youth is a very emotive subject and so you spring it and then suddenly there is a hush and everybody just buys in, not going into the real problem that exists. And that is education. You need to educate. I'm not going to say if you're not a smoker to pick up a vape. No, I'm not. And certainly not recommended. That's not what I would do. But if you are a smoker and you are looking at improving your quality of life, definitely, you know, you have to have access to these alternative technologies. That's missing. Sad, but it's missing.
11:21 - 11:37
[Brent Stafford]
Are there illicit drug use in India? Of course there is drug use in India. So for the kids, are they getting told to stay away from all these drugs? Is there a moral panic over heroin or over any other drug?
11:37 - 12:10
[Jagannath Sarangapani]
Okay. Well, moral panic over heroin and cannabis use and so on and so forth, of course it's there. But is it being talked about? No, it isn't. You're normally kind of just brushing it under the carpet and pretending it doesn't exist. That's the kind of approach that we use towards such issues, which is sad. It shows a lack of maturity, I guess, amongst our policymakers, which you would expect it to be different.
12:10 - 12:29
[Brent Stafford]
So could the focus then on nicotine in youth be a substitute for the fact that they're not doing it in other more dangerous substances? So they're not talking about those, but they can talk about the nicotine. Maybe they're pushing harder on nicotine.
12:29 - 14:02
[Jagannath Sarangapani]
Perhaps that is one way of looking at it, but I guess that would be oversimplifying the issue. Look, as teens everywhere in the world, you're going to be curious. So you have a group of friends, a lot of people pick up smoking due to peer pressure amongst your groups. And so it's easy to talk about a cigarette, it's there, it's visible and so on. But you've got to look at educating, you've got to look at moving beyond it. And so of course kids are going to try. And the minute you say something is banned, there's even more curiosity as to why on earth is it banned? Let me try it out. And so you're actually tweaking a negative response there. Not what you would have intended a ban to be, but that's what you end up driving. And so today you find a lot of people in India vaping, which wasn't the case prior to the ban. So where do they get their vapes? Oh, it's... Everything is now in the gray market. You can't buy a vape legally in India. So, of course, it's all available in the gray market and it's across the country. It's available everywhere. Vapes are available everywhere today. You walk into most convenience stores or whatever? No, no, no, no, no. It's all under the carpet, okay? You know someone who knows someone who knows someone else. You just say, hey, I'm in town. I need a vape. And it all happens. You just get it.
14:02 - 14:11
[Brent Stafford]
So like used to be with say, you know, marijuana, when I show up in a town, I try to get a phone number from somebody or something like that. Absolutely.
14:11 - 14:54
[Jagannath Sarangapani]
And of course, you walk into any pub, you're going to find a lot of people vaping out there. You're going to find a lot of people vaping. You walk on the streets, you're going to find a few people vaping on the streets as well. Though the police is now trying to clamp down and things like that on that, which is actually wrong. There's nothing... to a personal position of a vape is not a crime. That was explicitly spelt out. Now, that being said, the cops are still coming down on people, but then you will still find vapors. It wasn't the case prior to the ban, it's happening now.
14:55 - 14:58
[Brent Stafford]
So it's an invitation for the police to harass citizens.
14:59 - 16:45
[Jagannath Sarangapani]
Absolutely. Absolutely. And you keep hearing about this. You'll hear an incident at least once a week, you know, in Bombay, in Bangalore, in my city, Hyderabad, where I where I am from, you will hear of these incidents where cops harassed a vapor and extracted some money out of it. In Bangalore, when this did happen and somebody actually highlighted the issue, those cops were suspended. But that's because somebody decided to take the fight forward. It's at the end of the day. It's you know He said she said and so if a cop decides to put up some of the charges on you What are you going to do about it? So very often you just pay some money and walk away from it And so it's become kind of an extortionist scenario out there, you know So does India have Somebody to thank for all of these laws and I guess our previous health minister, Dr. Harshvardhan, who seemed all too keen about getting awarded by the WHO for his virulent tanto tobacco stance, I guess. India has a lot to thank him for for this regressive step and I guess in a lot of ways he has been emboldened by you know the Bloomberg Foundation and WHO which seems to have a very weird worldview on vapes you know so I guess amongst these three you could pick and choose any one of them and I would say they are equally to blame yeah
16:46 - 16:57
[Brent Stafford]
In your mind, do you have any doubt that third party, out of country, you know, people, groups, you know, stuck their nose in India's business?
16:57 - 17:49
[Jagannath Sarangapani]
I guess in a lot of ways it is true. You see, now India has come through a lot over the last so many years and so we were dependent very heavily on on WHO's interventions for tuberculosis and so on and so forth. So they have developed this brilliant sounding board because we have been able to progress quite a lot because of agencies like this, including Bloomberg funded philanthropies and so on and so forth in India. And so we have a lot to thank for, but then using that as a leverage to try to influence, I think that's gone wrong. And we are paying the price for that. We're paying the price.
17:49 - 18:16
[Brent Stafford]
Yeah, it's interesting because tuberculosis, of course, was the main raison d'etre for the union, which is obviously one of the organizations that's very powerful when it comes to pushing these anti-nicotine laws. Michelle Minton, some years ago, a writer from the U.S., termed this as philanthropic colonialism. And in a way, is that the case?
18:16 - 18:57
[Jagannath Sarangapani]
It absolutely is. I mean, if you look at the WHO's most, well, not the most recent, but one of the, you know, publications or statements from them that said that well as far as the first world is concerned vapes are fine but as when it comes to the third world vapes are a no-no I mean what logic is that there is no logic to saying that you know vapes are safer for for one class and there's no logic to that and to actually believe that they are allowed to make such a statement stinks You know, and that's where we are.
18:57 - 19:07
[Brent Stafford]
Well, so some critics do say that the government has effectively outsourced health policy to international activist groups. Is that a fair assessment?
19:08 - 19:51
[Jagannath Sarangapani]
I would say, yeah, perhaps it is, because even if you look at, for example, the government white paper from the ICMR, the Indian Council for Medical Research, that effectively said that vapes are bad and e-cigarettes are bad, they cherry-picked research papers and very, no independent research, Nothing. They just cherry-picked papers. A lot of those papers that have been subsequently redacted, they use those as findings and publish it and that's the government of India's white paper? No logic. No logic whatsoever, but hey, that's the official stance now.
19:54 - 20:00
[Brent Stafford]
So what's the impact then when it comes to the term sovereignty? Are you sovereign? Is the nation sovereign?
20:02 - 20:25
[Jagannath Sarangapani]
Well, We would like to believe we are, except I guess we outsource. when things get a little difficult and we kind of say, well, we're taking the decision because of this. And so I guess that's unfortunate, but reality of life there.
20:26 - 20:32
[Brent Stafford]
So from what you've seen, is the term relative risk used in any discourse in India?
20:34 - 21:47
[Jagannath Sarangapani]
No, it isn't. nobody talks of you know safer products no it isn't we do have some NRTs that have come into the market I mean you have nicotine lozenges that have made it into the market you do have some nicotine sprays that have come out and so on but those are highly you know restricted they're available only in a few dispensaries and so on but they're not widely available the government of India doesn't promote these and for anyone looking for it you have to have that interest to look for such information to be able to find it otherwise you're not going to find it what do you think has been the human cost in India with regard to the ban so for People in the bracket of 35 and above, considered adults, the economic cost was 27.5 billion. That's been the economic cost from tobacco use and that's a staggering number.
21:48 - 21:54
[Brent Stafford]
So we're here at the Global Forum on Nicotine 2025. What do you think of the conference so far?
21:54 - 22:44
[Jagannath Sarangapani]
I think it's good. It's always refreshing to come here because A, you definitely recharge. And you realize that in your country you're sounding off and throwing things back and forth and it's your own voice you're hearing. Here you get other perspectives, you look at challenges that are there and then there you realize that there are a lot of common points and then discuss with people as to how they have overcome certain challenges and that is rewarding. It gives you hope, it recharges and then you say, yes, perhaps there is something that I can pick up from here. Maybe this is an approach we need to try. And that's brilliant and that's very, very helpful.
22:46 - 22:52
[Brent Stafford]
So what would you say to policymakers in India if they said, Juggie, come on in and sit down and let's have a chat?
22:53 - 23:48
[Jagannath Sarangapani]
I would say let's re-look at what started off in your mode to ban harm reduction as a significant first step in making people's lives healthier. I think we should be looking at oral tobacco very, very seriously. Vapes is addressing only 8-10% of the tobacco users in India. We should be talking of making, you know, even snus or pouches and so on and so forth far more affordable. You should have government programs. And I would encourage quality research if you want to take it India specific. It's all out there. I would invite experts to talk about this and reverse this ban which is actually hurting the cause, not helping.