Letter to Health Commissioner Varhelyi regarding vapes and 'popcorn lung'

I write on behalf of the European Tobacco Harm Reduction Advocates (ETHRA). ETHRA is the voice of 27 million EU consumers of safer nicotine products (SNPs). The safer nicotine products we use include vapes, nicotine pouches, snus and heated tobacco products.  ETHRA is a consortium of 24 grassroots consumer associations in 17 European countries, supported by experts in tobacco control and nicotine research. We are a voluntary operation with no industry funding or conflicts of interest. Our transparency registration number is 354946837243-73.

We listened with interest to the exchange of views in the ENVI Committee on 13 May and we are dismayed by your factually incorrect and baseless assertion that vaping causes popcorn lung. 

As the UK Health Security Agency explains in its document on Clearing up some myths around e-cigarettes:

MYTH 1 -  E-cigarettes give you ‘popcorn lung’

“One of the most commonly held concerns is that e-cigarettes might cause ‘popcorn lung’. This came about because some flavourings used in e-liquids to provide a buttery flavour contain the chemical diacetyl, which at very high levels of exposure has been associated with the serious lung disease bronchiolitis obliterans.

The condition gained its popular name because it was initially observed among workers in a popcorn factory.”

“However, diacetyl is banned as an ingredient from e-cigarettes and e-liquids in the UK. It had been detected in some e-liquid flavourings in the past, but at levels hundreds of times lower than in cigarette smoke. Even at these levels, smoking is not a major risk factor for this rare disease.”

This is confirmed by Cancer research UK who state:
"There have been no confirmed cases of popcorn lung linked to e-cigarettes. Some of the liquids in e-cigarettes used to contain diacetyl. This led to the idea that e-cigarettes might cause popcorn lung.”

“In Britain, the ban on diacetyl is implemented through guidance from the e-cigarette regulator, the MHRA: Advice on ingredients in nicotine-containing liquids in electronic cigarettes and refill containers (updated August 2024)”

The legal basis for the ban is derived from the Tobacco Products Directive 2014/40/EU Article 20 3(e): "except for nicotine, only ingredients are used in the nicotine-containing liquid that do not pose a risk to human health in heated or unheated form;". It is the responsibility of member states to implement the ban in national law, and the responsibility of the Commission to ensure the member states comply. All member states should ban diacetyl in vapes because the substance is listed in the European Chemicals Agency database as follows: Butanedione (Diacetyl): toxic if inhaled, causes damage to organs through prolonged or repeated exposure [...].  So if the problem is in the EU, it is with the Commission and its oversight of European Union legislation.

The most likely way for diacetyl to emerge in vapes in the EU is through unregulated illicit trade, not legally available nicotine vapes. The growth in illicit products will be driven by excessive and counterproductive EU regulations, such as flavour bans, that deny adult consumers the products they wish to use. So, the main responsibility for diacetyl exposure in the European Union today rests with the Commission, and the main risks of future increases in diacetyl exposure arise from the Commission promoting excessive regulation and nurturing illicit trade. 

It seems that the Commission is out of touch with basic science on Safer Nicotine Products and we therefore request a meeting so you can hear from people who use these products and scientists who have spent years researching them.