Strengthening e-cigarette enforcement through retailer engagement

In recent years Lao PDR has taken strong action against electronic nicotine delivery systems (ENDS), known as e-cigarettes or vapes, banning their import, export, sale, and distribution, as well as the same for heated tobacco products and shisha.

Unfortunately, these products remain available online and in some locations (i.e. stores, markets, bars) - making it necessary to strengthen enforcement.

"The number of lives lost to tobacco and e-cigarettes must come down," said Dr Timothy Armstrong, WHO Representative to Lao PDR Representative. "While Lao PDR has taken commendable action, these products continue to be sold - we cannot allow health-threatening products to impact health in Lao PDR, especially young people."

To address this issue, a pilot initiative was launched to engage retail stores, bars, entertainment venues, and hotels and guesthouses in high-tourism-volume Luang Prabang Province between July - December 2024.

ENDS for sale in Luang Prabang, along with photos of real products from online purchases - tracking online sellers remains a challenge. Credit: WHO/Will Seal

Led by the Luang Prabang Tobacco Control Committee with support from the Ministry of Health's Department of Hygiene and Health Promotion (DHHP) and WHO, the initiative focused on engaging retailers and other stakeholders to increase awareness of Lao PDR's ENDS ban and ENDS' health risks, as well as monitor availability in physical and online stores, collect much-needed data, and support enforcement efforts.

A combination of industry-briefings and monitoring visits covered 115 locations, identifying ENDS in small number of locations - which were later removed by authorities.

Authorities conducted ENDS monitoring after briefing retailers on Lao PDR's tobacco control laws.
Credit: Luang Prabang PHO Staff.

A survey with retailers indicated high awareness of and support the ENDS ban. 96.8% knew that ENDS are illegal in Lao PDR, and a similar number agreed with the ban - but 41.9% did not know the full details.

The survey also revealed insights into ENDS use and sales. Unfortunately, just over half of respondents felt that the number of locations where ENDS were available had increased, and more than two-thirds of people reported seeing people using ENDS in their community. Most respondents said ENDS are mainly sold online rather than in physical stores, and many observed that children, teenagers and young people were the primary users.

In terms of the harmful effects of ENDS, more than 80% of respondents felt ENDS were particularly harmful.

"We know that ENDS contain harmful substances, including nicotine, which is highly addictive," said Dr Phonepaseuth Xayamongkhoun, DHHP's Director General. "In adolescents and children, nicotine has negative impacts on brain development with long term consequences."

"Non-smokers who start using ENDS may quickly become addicted to nicotine, making it difficult to quit and potentially leading to the use of traditional tobacco products. Additionally, second-hand exposure can also harm non-smokers."

"Sharing information about tobacco, ENDS and related regulations is important, as is working with stakeholders, to help inform the public and retailers about the risks of these products, their effects and the legislation," said Dr Houmphanh Chilasack, Deputy Director General, Luang Prabang Provincial Health Office.

"We have seen an increase in awareness and compliance with the ban - but - these products remain available, particularly online, and particularly used by young people. Addressing these problems is a focus for us, helping to ensure a smoke-free Luang Prabang for everyone."

Unfortunately, while efforts to stop the sale of ENDS continue, tobacco use remains one of the biggest causes of noncommunicable diseases (NCDs) in Lao PDR. Alongside physical inactivity, alcohol use, unhealthy diets, and air pollution, tobacco is one of a major risk factor for serious health conditions. To address this, WHO is taking multiple approaches to safeguard health.

"Despite tobacco control progress, such as banning advertising and the upcoming introduction of plain packaging, Lao PDR still has the lowest tobacco tax rate in ASEAN," said Douangkeo Thochongliachi, WHO Lao PDR's Tobacco Control Officer. "Any effort to increases taxes on tobacco products will save lives, and this has been a significant focus for us, alongside education, policy change, and enforcement support."

To further increase awareness of NCDs and the risks of tobacco and ENDS, WHO Lao PDR facilitated three Lao journalists to participate in a regional "Communicating Noncommunicable Diseases Media Training" in December 2024, bringing together journalists from multiple countries across the region to explore ways to better communicate about NCD-related issues.

One Lao journalist - Senglathsamy Souvath from Lao Youth Radio - was also selected as a Media Fellow, and will explore stories in Lao PDR on rising cases of NCDs among young people, including the increased risk of cardiovascular diseases - particularly from tobacco use. She aims to raise awareness and advocate for stronger NCD prevention and tobacco control policies.

"Witnessing the rise of noncommunicable diseases, particularly cardiovascular issues, among young people in Lao PDR is deeply concerning. Tobacco and other NCD risk factors are stealing years of healthy life. This work isn't just about statistics; it's about the future of our nation. I hope to illuminate the urgency for stronger NCD prevention and tobacco control, so we can protect our youth and build a healthier tomorrow."