Pakistan’s vaping crisis | Political Economy

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He said the rise of vaping in Pakistan shows a pattern. What started as a social media trend of teenagers posting photos with colorful devices has evolved into what medical experts are calling a full-blown epidemic among Pakistani youth. Recent studies show that 68.4 percent of university students now use vaping products, a statistic that should alarm policymakers and parents alike.

Even as the FDA reverses Joule approvals and Australia tightens its prescription-only vaping model, Pakistan will find itself in a regulatory vacuum with legal, unrestricted access to products recognized as serious health risks. The contrast could not be starker: while developed countries implement sophisticated regulatory frameworks, Pakistan’s youth face an unregulated market that floods their communities with addictive products.

Epidemic scale

The numbers emerging from recent Pakistani studies are devastating. University research shows that 68.4 percent of students use vaping products. Separate studies of college students ages 16-19 show a 50.4 percent regular use rate. Perhaps most notably, 41.9 percent of users vape daily, most starting before the age of 18. These figures represent millions of young Pakistanis, given that the country’s youth population is over 60 million.

The reach of these products has become staggering in scope. Reports indicate more than 1,379 official vape shops across the country, although the actual number is much higher. These outlets strategically cluster near educational institutions, with devices priced between Rs 4,000-5,000 and refills between Rs 1,500-2,000, making them affordable for urban youth through illegal imports and online sales that provide a day’s supply.

What makes this epidemic particularly insidious is how it has spread beyond traditional tobacco users. Unlike cigarette smoking, which carries a social stigma, vaping is marketed as harmless and trendy. Young people report smoking because of the reduced odor and the perception that it is safer than traditional smoking.

Age has emerged as the most important risk factor, with 12-17 year olds most at risk due to peer pressure through social media influence and basic misconceptions about safety. The availability of more than 50 flavors makes these products especially appealing to young consumers. Surprisingly, studies also show significant vaping rates among medical students, even highlighting how widespread the trend has become across all academic demographics.

Evidence of growing health

Health risks associated with vaping continue to accumulate, contradicting industry claims about safety. Medical professionals now identify more than 2,000 toxins in each puff of vape. The Student Health Survey found that 25.6 percent of users report breathing problems. Chemical exposures include formaldehyde, acetaldehyde, and diacetyl—accumulators linked to severe lung conditions, including “popcorn lung” disease.

Addiction potential remains perhaps the most important clinical concern. Research using advanced brain imaging has shown that nicotine uptake from e-cigarettes is comparable to traditional cigarettes, producing similar patterns of addiction. Young people are particularly vulnerable because developing brains are more susceptible to nicotine dependence, with early exposure affecting cognitive development, memory, attention and impulse control.

The most important aspect may be what remains unknown about the long-term effects. Unlike cigarettes, which have decades of research documenting their health effects, the consequences of vaping are still being explored. This uncertainty creates a dangerous situation where an entire generation serves as unwilling test subjects for a relatively new technology.

Regulatory vacuum

Pakistan currently operates with virtually no meaningful vaping regulations. The country allows unrestricted import and trade of devices and nicotine products, does not require licensing for sales operations, allows unlimited advertising across all platforms and maintains only an age requirement of over 18 without enforcement mechanisms.

Pakistan stands at a critical juncture. With youth use rates higher than those in countries where vaping is considered an epidemic, delaying action risks normalizing addiction for an entire generation.

These regulatory gaps became apparent when provincial governments tried to address the crisis through local bans, only to face legal challenges highlighting the conflicting approach. Courts have questioned the legal basis of the bans while allowing the federal government to collect excise duty on e-liquids. This has created an enforcement nightmare where authorities cannot act decisively despite the obvious threat to public health.

Learning from world leaders

The FDA’s recent evolution offers important lessons. After banning Joule in 2022, the agency reversed course in 2025, and approved the product on the basis that it had been shown to switch adult smokers from cigarettes. However, this requires extensive scientific infrastructure. From more than 25 million applications, only 39 products received authorisation—an approval rate of 0.0014 percent that demonstrates the stringent evidence requirements.

Australia has taken a different approach, treating all nicotine vaping as a prescription drug requiring healthcare. This medical model limits access to professional supervision, limits products to basic flavors, bans disposables and ensures pharmaceutical quality. Australia’s aggressive enforcement includes seizing more than $10 million worth of $500 million.

A practical solution for Pakistan

Pakistan urgently needs emergency measures while building regulatory capacity. Age enforcement represents the most pressing priority, requiring mandatory identity verification, heavy retailer fines and regular compliance checks. Location restrictions may prohibit sales near educational institutions and online sales without proper authentication.

Economic measures offer powerful tools for reducing access. Increasing taxes on vaping products will increase prices by reaching more young consumers after the successful model of tobacco taxation. Currently, the device costs Rs 4,000-5,000. A substantial increase in taxes while receiving revenue for health care programs could cost the youth market.

Smoke-free policies should be expanded to include vaping. Banning vaping in closed spaces such as offices, restaurants, public transport and shopping centers will reduce social norms and second-hand exposure. Creating vape-free zones around schools, hospitals, and government buildings—consistent with existing tobacco restrictions—will protect vulnerable populations and send clear public health messages.

Primary care physicians, also known as general practitioners or family physicians, have a role in patient education, screening for e-cigarette use (Back, Joule), especially in adolescents, and in promoting smoking cessation (pharmaceuticals such as nicotine replacement therapy, bipropion and varenicline). Published studies show that many GPs are unaware of their effectiveness and safety, as well as the role of e-cigarettes in the smoking cessation process. It is therefore important for them to familiarize themselves with available guidance and updates on the use of e-cigarettes. Backs are not completely harmless or chemical free. They are associated with serious health problems such as cardiovascular and respiratory problems. Public awareness campaigns represent another important intervention. Most young users believe that vaping is harmless, unaware of the 2,000+ toxins in each puff or the addictive dangers of cigarettes. Evidence-based health education targeting youth, parents, and teachers can counter industry marketing with scientific facts about respiratory harm, cardiovascular risks, and nicotine addiction.

Product controls offer immediate intervention by banning youth-targeted flavors, enforcing nicotine concentration limits and requiring plain packaging with prominent health warnings. Pakistan could adopt the Australian medical framework by using existing pharmacy networks instead of requiring doctor’s prescriptions, building on existing tobacco cessation programs.

Learning from the FDA’s principles, Pakistan can demand basic safety data before allowing new products and require companies to demonstrate products will not appeal to minors. The key is starting with workable restrictions using existing systems rather than complex schemes that require new infrastructure.

Quick selection

Pakistan stands at a critical juncture. Rates of youth use are higher than those in some countries where vaping is considered an epidemic, delaying the process that threatens to normalize addiction for an entire generation. The window for preventive action is closing fast as industry interests enter.

While the FDA and Australia discuss sophisticated approaches to established markets, Pakistan faces a choice between prevention and crisis management. The evidence from the Pakistani Youth Studies is clear: it is no longer a future threat, but the present emergency affects hundreds of thousands of young people.

International experience offers lessons, but Pakistan must adapt solutions to its own context. A country can learn from the experiences of others without repeating its own mistakes, provided action is taken quickly enough.

The health of future generations of Pakistan hangs in the balance. With studies now showing most students using these products, comprehensive regulatory action has become a national priority. The choice is now between learning from international experience or allowing Pakistan’s vaping crisis to become a permanent feature of its public health landscape.

Dr Tehzeeb Zulfar is a Research Fellow at the Australian National University, Canberra

Dr. Hina is Associate Professor in Family Medicine at Javaid Health Services Academy, Islamabad