Navigating the path towards universal healthcare

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The passage of Republic Act No. 11223, or the Universal Healthcare Law, was hailed as a landmark for the Philippines, as it sought to reform the country’s healthcare sector in pursuit of health coverage for all.

To fund the law, legislators are considering increasing excise taxes on e-cigarettes, or products categorized as Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS). Under the Comprehensive Tax Reform Program (CTRP) Package 2+, the excise tax on ENDS/ENNDS products will be at par with traditional tobacco products.

The rationale for the equal taxation of the two product categories is that government health officials, as well as some legislators in Congress, believe that vape products are not the safe alternatives to tobacco products as they claim to be.

In fact, the Department of Health issued Administrative Order (AO) 2019-0007 in June, calling for the registration and licensing of ENDS/ENNDS sellers, distributors, and manufacturers. And in the face of a supposedly growing number of minors using vape products, the AO also called for the prohibition of product sales to anyone under 18 years of age.

At a recent briefing, the Senate Ways and Means Committee announced that it remains unconvinced that ENDS should be taxed lower than traditional tobacco products. Senator Pia Cayetano, chairperson of the said committee, cited a lack of sufficient scientific studies supporting the category’s reduced risk claims.

“What I’m very vocal about is that there clearly are health risks. It’s not correct to say that there are no health risks. If there are health risks, would it be correct to lower the tax?,” Cayetano told BusinessWorld. “I do agree that more research needs to be done, so if I have to veer on the side of caution, then it’s not so simple to say — reduced harm (warrants) lower taxes.”

Advocates supporting the reduced taxation of ENDS versus combustible cigarettes, including leading US vapor brand JUUL Labs, maintain that ENDS must be taxed lower than tobacco products relative to their risks.

Dr. Tikki Pang, a former Director for Research Policy & Cooperation for the World Health Organization (WHO) headquarters in Geneva, Switzerland, recently spoke to select members of the media to state that ENDS offer an opportunity for smokers to wean themselves from harmful tobacco products, thereby lessening their risk of developing tobacco-related illnesses such as lung cancer, hypertension, and heart disease.

Based on the 2015 Global Adult Tobacco Survey, 75% of the country’s 16 million adult smokers have expressed their desire to quit smoking – however only 4% are successful in doing so.

Dr. Pang pointed out that a large portion of these smokers belong to the middle to lower economic brackets. He believes that this segment will be most affected by the price increase of ENDS, as it will render less harmful alternatives to cigarette smoking, such as ENDS, even more unattainable to them.

“The whole idea of making these products (ENDS) available and affordable is to encourage current smokers to cease the use of combustible cigarettes, especially as it is costing the country a steep amount in healthcare costs and productivity losses.  If prices for ENDS are increased, these smokers will choose to continue using cigarettes, instead of switching to the use of less harmful smoking alternatives,” Dr. Pang said. “If they can’t afford it, smokers will only continue smoking. The ENDS category needs to be taxed in such a way that it becomes affordable to those who need it the most.”

Dr. Pang encouraged local regulators and policy makers to be more open to the growing body of scientific evidence citing the reduced risk potential of ENDS. He cited a study published in the New England Journal of Medicine, a highly respected peer-reviewed medical journal, which found that ENDS users have a higher success rate in quitting cigarette smoking, compared to users of the Department of Health-prescribed nicotine replacement therapies (NRTs) such as gums, patches, and nose sprays.

Similarly, the UK’s Public Health England (PHE) reviewed British and international studies on ENDS in 2014 and 2018, concluding that e-cigarettes are 95% less harmful than their traditional counterparts due to the absence of tar, carbon monoxide and other toxic substances involved in the burning of tobacco such as benzene, arsenic, and formaldehyde.

Dr. Pang also shared that in countries like Canada and New Zealand, the number of smokers have significantly dropped after their local Ministries of Health have actively advocated for the use of ENDS, in recognition of their harm reduction capacity.

“The Philippines government should give the category a chance, and smokers the opportunity to use less harmful smoking alternatives,” he said.

And while he agrees with the proposed government campaign to restrict minors from accessing and purchasing ENDS, Dr. Pang proposed that excise taxes on ENDS/ENNDS should reflect their reduced risks compared with tobacco.

“As with any new technology, such as ENDS, there is always a lot of confusion and ambiguity at the beginning. However, universal healthcare is about collaboration, inclusion, and prevention, about reducing the harm for everyone, not about discouraging a specific product. That will only burden your healthcare system,” he said. “To deny smokers of a product that can improve their health, to me, is a human rights violation.” — Bjorn Biel M. Beltran