Electronic cigarettes and health outcomes: umbrella and systematic review of the global evidence.

OBJECTIVE: To review and synthesise the global evidence regarding the health effects of electronic cigarettes (e-cigarettes, vapes). STUDY DESIGN: Umbrella review (based on major independent reviews, including the 2018 United States National Academies of Sciences, Engineering, and Medicine [NASEM] report) and top-up systematic review of published, peer-reviewed studies in humans examining the relationship of e-cigarette use to health outcomes published since the NASEM report. DATA SOURCES: Umbrella review: eight major independent reviews published 2017-2021. Systematic review: PubMed, MEDLINE, Scopus, Web of Science, the Cochrane Library, and PsycINFO (articles published July 2017 - July 2020 and not included in NASEM review). DATA SYNTHESIS: Four hundred eligible publications were included in our synthesis: 112 from the NASEM review, 189 from our top-up review search, and 99 further publications cited by other reviews. There is conclusive evidence linking e-cigarette use with poisoning, immediate inhalation toxicity (including seizures), and e-cigarette or vaping product use-associated lung injury (EVALI; largely but not exclusively for e-liquids containing tetrahydrocannabinol and vitamin E acetate), as well as for malfunctioning devices causing injuries and burns. Environmental effects include waste, fires, and generation of indoor airborne particulate matter (substantial to conclusive evidence). There is substantial evidence that nicotine e-cigarettes can cause dependence or addiction in non-smokers, and strong evidence that young non-smokers who use e-cigarettes are more likely than non-users to initiate smoking and to become regular smokers. There is limited evidence that freebase nicotine e-cigarettes used with clinical support are efficacious aids for smoking cessation. Evidence regarding effects on other clinical outcomes, including cardiovascular disease, cancer, development, and mental and reproductive health, is insufficient or unavailable. CONCLUSION: E-cigarettes can be harmful to health, particularly for non-smokers and children, adolescents, and young adults. Their effects on many important health outcomes are uncertain. E-cigarettes may be beneficial for smokers who use them to completely and promptly quit smoking, but they are not currently approved smoking cessation aids. Better quality evidence is needed regarding the health impact of e-cigarette use, their safety and efficacy for smoking cessation, and effective regulation. REGISTRATION: Systematic review: PROSPERO, CRD42020200673 (prospective).

Outbreak response capacity of the Global Outbreak Alert and Response Network across WHO's South-East Asia and Western Pacific regions.

Objective: The COVID-19 pandemic challenged the Global Outbreak Alert and Response Network's (GOARN) mechanism used to rapidly deploy technical support for international responses and highlighted areas that require strengthened capacity within the Network. GOARN's partners in the World Health Organization's (WHO) South-East Asia and Western Pacific regions were engaged to explore their levels of preparedness, readiness and ability to respond to international public health emergencies. Methods: Consultative discussions were held and a survey was conducted with GOARN's partners from the two WHO regions. Discussion topics included partners' capacity to support and participate in a GOARN deployment, training, research and collaboration. Descriptive and content analyses were conducted. Results: Barriers to engaging in GOARN's international outbreak response efforts included limited numbers of personnel trained to respond to outbreaks; institutional, financial and administrative hurdles; and limited collaboration opportunities. Partners identified innovative solutions that could strengthen their engagement with deployment, such as financial subsidies, mentorship for less experienced staff, and the ability to provide remote support. Discussion: GOARN plays an important role in enabling WHO to fulfil its international alert and response duties during disease outbreaks and humanitarian crises that have the potential to spark disease outbreaks. Yet without systematic improvement to strengthen national outbreak capacity and regional connectedness, support for international outbreak responses may remain limited. Thus, it is necessary to integrate novel approaches to support international deployments, as identified in this study.