Electronic Nicotine Delivery Systems Policy Divergence and Surveillance Gaps: A Cancer Prevention Blind Spot in the WHO South-East Asia Region
- 1Kathmandu Model College, Bag Bazar Sadak, Kathmandu, Nepal
- 2Nick Simons Institute, Sanepa, Lalitpur, Nepal
- 3Independent Researcher, Cancer Outcomes, Kathmandu, Nepal
Abstract
The unregulated proliferation of electronic nicotine delivery systems (ENDS) across low- and middle-income countries (LMICs) risks undermining decades of progress in global cancer prevention. Nepal's recent regulatory uncertainty, rooted in a mismatch between primary legislation and subordinate regulation, provides an instructive case for comparative policy analysis across the WHO South-East Asia Region, which already carries a disproportionate oral cancer burden attributable to smokeless tobacco use. Using Nepal, India, and Bangladesh as contrasting policy trajectories, we examine how statutory prohibition, legislative reversal, and contested enforcement intersect with this pre-existing burden. Although ENDS may confer harm reduction benefits among certain adults who smoke, realizing this potential depends on effective product regulation, prevention of youth access, and population-level surveillance; these conditions remain weak or nonexistent in many LMICs. We argue that failure to incorporate ENDS explicitly into primary tobacco control legislation constitutes an actionable governance gap. Explicit legislative coverage of ENDS and harmonization of regional surveillance systems represent minimum safeguards before exposure patterns become entrenched and long-term cancer risks can be reliably assessed.
Related
- The collective effect of non-nicotine constituents on the reinforcing and neuropharmacological effects of comprehensive cigarette smoke and electronic nicotine delivery system (ENDS) aerosol extracts in rats.
- Exposure to Toxicologically Relevant Inorganic Elements and Nicotine Content Variability in Electronic Nicotine Delivery System (ENDS) E-Liquids.
- Community-Level Wastewater Surveillance of Nicotine Biomarkers Tracks Cardiovascular Disease Burden and Myocardial Infarction
- The Physicochemical Principles Governing Nicotine Delivery from Oral Nicotine Pouches.
- Nicotine Equivalence Across Modern Delivery Systems: A Clinical Framework for Perioperative Assessment
BibTeX
@article{pandey2026electronic,
title = {{Electronic Nicotine Delivery Systems Policy Divergence and Surveillance Gaps: A Cancer Prevention Blind Spot in the WHO South-East Asia Region}},
author = {Sneha Pandey and Merina Pandey and Bibek Aryal},
journal = {JCO Global Oncology},
year = {2026},
month = nov,
doi = {10.1200/go-25-00630},
url = {https://doi.org/10.1200/go-25-00630},
note = {CC BY},
}
RIS
TY - JOUR
TI - Electronic Nicotine Delivery Systems Policy Divergence and Surveillance Gaps: A Cancer Prevention Blind Spot in the WHO South-East Asia Region
AU - Sneha Pandey
AU - Merina Pandey
AU - Bibek Aryal
PY - 2026
DA - 2026/11/04
JO - JCO Global Oncology
DO - 10.1200/go-25-00630
UR - https://doi.org/10.1200/go-25-00630
AB - The unregulated proliferation of electronic nicotine delivery systems (ENDS) across low- and middle-income countries (LMICs) risks undermining decades of progress in global cancer prevention. Nepal's recent regulatory uncertainty, rooted in a mismatch between primary legislation and subordinate regulation, provides an instructive case for comparative policy analysis across the WHO South-East Asia Region, which already carries a disproportionate oral cancer burden attributable to smokeless tobacco use. Using Nepal, India, and Bangladesh as contrasting policy trajectories, we examine how statutory prohibition, legislative reversal, and contested enforcement intersect with this pre-existing burden. Although ENDS may confer harm reduction benefits among certain adults who smoke, realizing this potential depends on effective product regulation, prevention of youth access, and population-level surveillance; these conditions remain weak or nonexistent in many LMICs. We argue that failure to incorporate ENDS explicitly into primary tobacco control legislation constitutes an actionable governance gap. Explicit legislative coverage of ENDS and harmonization of regional surveillance systems represent minimum safeguards before exposure patterns become entrenched and long-term cancer risks can be reliably assessed.
SN - 2687-8941
ER -