Shortly before the 11th WHO Framework Convention On Tobacco Control Conference of the Parties in November 2025, Vitoria Borges Spinola, Lucas Porto Santos, Hamilton Roschel, Bruno Gualano, and Megan E. Roberts published “Weak enforcement of Brazil’s E-cigarette ban and the expansion of a dangerous illicit market” in The Lancet Regional Health – Americas arguing that Brazil’s ban on importation and sale of e-cigarettes has been a failure based on their estimated 600% increase in adult e-cigarette use between 2018 and 2023. Spinola et al’s paper was mentioned in the industry’s effort to head off other countries following Brazil’s lead in banning e-cigarettes at the COP, including this letter from a Brazilian Congressman to the Health Minister pressing the Ministry to support the industry’s harm reduction agenda.
Andre Luiz Oliveira da Silva and I just published “Reassessing Spinola et al.: data, sources, and the case for Brazil’s E‑cigarette ban” in Lancet Regional Health – Americas raising several issues with Spinola et al’s analysis:
- The data they used in their analysis was from a survey funded indirectly by the tobacco industry that has systematically overstated the size of Brazil’s illicit tobacco market as part of industry efforts to oppose a variety of tobacco control policies (a point made in an earlier response by André Salem Szklo and Vera da Costa e Silva)
- In contrast, data from ongoing Ministry of Health surveys has shown stable e-cigarette use
- They overstated e-cigarette use in several other ways
- They misrepresented the findings of several papers on the characteristics and risks of e-cigarettes used in Brazil
- While they acknowledge some of the Brazilian government’s efforts to block illegal sales, they understate the magnitude and success of these efforts
- They do not present evidence that countries that have legalized and attempted to regulate e-cigarettes had lower use than Brazil
Indeed, the limited available evidence indicates that e-cigarette use is much lower in Brazil (and several other countries with bans) than the United States, which tries to regulate them.
Spinola et al responded to the our and the other commentary by defending their interpretation of the surveys, but offered this important clarification: “we are not (and have never been) calling for or endorsing a repeal of the e-cigarette ban. Industry-sponsored use of our work to argue for a repeal is inappropriate and inconsistent with our intent.”
Later, they amplify this point: “At present, we clarify that a ban lift is not, in our view, the most appropriate strategy for e-cigarettes in Brazil, in a context in which a widespread and erroneous perception persists that these devices are substantially less harmful than conventional cigarettes. This distorted perception is likely fueled by easy access, misinformation circulating on social media, and insufficient public education and risk communication—all components of what we describe as weak regulatory enforcement.”
Hopefully, this clarification will offer an antidote to any continued use of the original Spinola et al paper to support industry efforts in Brazil or elsewhere against bans.
The full citation for our commentary is: Olivera da Silva A, Glantz SA. Reassessing Spinola et al.: data, sources, and the case for Brazil’s E‑cigarette ban. Lancet Regional Health – Americas) 2026;56:101387. https://doi.org/10.1016/j.lana.2026.101387. It is available here.
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