Chairwoman DeLauro Statement at Hearing on Emerging Public Health Threat of E-Cigarettes

2019-10-16 10:10

Congresswoman Rosa DeLauro (D-CT), Chair of the Labor, Health and Human Services, Education, and Related Agencies Appropriations Subcommittee, delivered the following remarks at the Subcommittee's hearing on the emerging public health threat of e-cigarettes:

Before I begin, I would like to welcome our guests. In the first panel, we have:

  • Dr. Anne Schuchat, Principal Deputy Director for the Centers for Disease Control and Prevention. She is the staff lead for the investigation aspect.

Then, in our second panel, we will have the following witnesses:

  • Renée Coleman-Mitchell, Commissioner of the Connecticut Department of Public Health. It was a pleasure to speak alongside you at an event about vaping that my office hosted at Yale New Haven Hospital. Thank you for your dedication to this issue.
  • We also have, Dr. Sally Satel, Resident Scholar, American Enterprise Institute;
  • Dr. Bonnie Halpern-Felsher, Professor of Pediatrics and Executive Director of Tobacco Prevention Toolkit, at Stanford University;
  • And, Meredith Berkman, co-founder of Parents Against Vaping E-cigarettes (PAVe).

I will introduce them again before their testimony. But, we are glad they could join us.

And, I am pleased that our Full Committee Chair is here this morning, as this has been a signature issue for Ms. Lowey.

This is an important hearing. We are here for several reasons: to hear from the CDC about the ongoing federal response to the public health crisis of e-cigarettes; to identify the public policy remedies we need to be advancing to address this public health crisis; and to highlight the important investments we need to be making through the Labor-HHS appropriations. These investments include tobacco prevention and awareness activities and our national public health data infrastructure.

There are multiple areas of focus because this is a multi-pronged crisis. One track is the rising incidence of lung injuries and deaths from vaping and e-cigarettes. The other is the youth epidemic, which is hooking the next generation on nicotine products.

Of course, the CDC falls under this subcommittee’s jurisdiction. The FDA does not, although I do also sit on the Ag Committee. But, the work of these two agencies is critical and is linked. Yet, while the CDC has routinely warned of the health risks of youth vaping starting back in 2013, the FDA has appeared to have ignored these warning. It has taken no meaningful action to regulate e-cigarette products.

The result of which is that we now have a public health crisis. The Centers for Disease Control and Prevention has confirmed vaping-related lung illnesses have risen to over 1,000 cases and now 26 deaths, with the numbers climbing each week. The FDA is investigating the link between e-cigarettes and seizures. And, the U.S. Surgeon General has warned that e-cigarettes pose risks for brain development, the human respiratory system, and lifelong nicotine addiction.

In Connecticut, we had our first fatality. One fatality is over the line. People should not be dying.

The other part of this crisis is the youth vaping epidemic.

It was on a cover of Time Magazine. The headline read, quote, “The New American Addiction: How Juul Hooked Kids and Ignited A Public Health Crisis.”

According to preliminary results from CDC’s 2019 National Youth Tobacco Survey, 1 out of 4 high school students have used e-cigarettes within the last 30 days. This youth vaping epidemic has nearly tripled since 2017. In my home state, vaping is now the most common form of youth smoking among Connecticut high school students.

The Commissioner of the Connecticut Department of Public Health will reference this, but there is clear data demonstrating that as use of combustible cigarettes among teens is dropping, e-cigarettes are rising.

I spoke to my 14 year-old granddaughter, and I asked her, “What's going on?” She’s in her first year of high school in Washington. She told me, “Babi, everyone—everyone!—is using.”

I recently spoke at event with Dr. Pnina Weiss, medical director for Pediatric Pulmonary Function Laboratory at Yale New Haven Children's Hospital. She ran through the chemicals that are present in these devices:

  • Ethylene glycol, which is used in anti-freeze.
  • Propylene glycol, which is used as toner for laser printers.
  • Vitamin E oil, which is under investigation and implicated in the outbreak of lung illnesses;
  • Fine particles and carcinogens;
  • Fruit flavorings to attract youth;
  • And, then, Nicotine, which is the addictive chemical in cigarettes that hurts children’s brain development. One Juul pod has as much nicotine as one pack of cigarettes.

That is the cocktail. It is a recipe for disaster.

Further compounding the risks to youth, is the fact there is no approved nicotine replacement therapy for children under the age of eighteen, and that we do not know what will happen to kids who turn teen vaping into a lifelong addiction.

A lack of data and a lack of FDA approvals is an important factor in this discussion, that I want to touch on now. Despite the anecdotal claims that some business have made, there is no data demonstrating the long-term safety of vaping. There is no evidence that e-cigarettes are successful as a cessation tool, which experts including the NIH Director Dr. Francis Collins have confirmed. And, there is no e-cigarette that has been FDA approved as a smoking cessation device.

Anecdotes and company claims must not be stymieing the bipartisan push to protect our communities, especially when the science is so clearly on our science.

House Democrats are launching into action. Today, the Energy and Commerce Committee is also holding a hearing on a comprehensive legislative package that, among other things, would ban kid-friendly flavors. The Judiciary Committee is marking up my bill—the Preventing Online Sales of E-cigarettes to Children Act. This bipartisan bill, which I first introduced in 2015, will close an existing loophole in federal law by mandating age verification of online sales and deliveries of e-cigarette and vapor products.

As important is that the Trump administration stop dragging its feet and get to work. Despite announcing a proposal to ban flavored e-cigarettes well over a month ago, we have yet to see anything. And, we are now seeing industry pressure this administration into exempting Mint & Menthol flavored e-cigarettes from its flavor ban, when they are among the most popular flavors among youth.

Such action is necessary because, clearly, industry self-regulation is not working. So, it is past time for FDA to uphold is mission as a regulatory agency and use their authority to protect people from these harmful products. This goes back to 2009 when the Congress gave the Food and Drug Administration the authority to regulate all tobacco products, including e-cigarettes. The bipartisan Family Smoking Prevention and Tobacco Control Act, or TCA, gave FDA the authority to regulate new tobacco products before they enter the market, and that includes e-cigarettes.

However, the FDA has not. Instead, it allowed dangerous products to come to market by exempting e-cigarettes from the pre-market review process—which would have required manufacturers to prove the safety of their products prior to their sale. The FDA made the express decision to skip this review in what they call quote “enforcement discretion,” and allowed these devices to be sold.

What a pre-market review would have done is looked at the totality of the science surrounding e-cigarettes. It would have determined the safety of the devices themselves, as well as the safety of the ingredients and additives in flavor pods. Additionally, FDA would have evaluated any theoretical benefits from e-cigarettes against the impact on youth vaping initiation.

But, none of this happened, not under the current or under the prior administration. Instead, the FDA repeatedly delayed implementing their authority over vaping products. Most recently, they tried to delay until August 2022, before a federal judge overruled that and set the timeline for 2020. Of course, industry is now seeking to delay that timeline.

So, instead of the FDA following the lawful process and providing the public the safety data they need, we have thousands of e-cigarette products on the market without independent, science-based assessments of their long-term health risks, their ingredients, or their impact on youth tobacco initiation.

Here, in the Labor-HHS subcommittee, we have been advancing funds that could be a crucial part of the response.

In the House-passed, fiscal year 2020 Labor-HHS appropriations bill, we include a $40 million increase for the CDC’s Tobacco Prevention and Cessation Efforts. Its Office on Smoking and Health is committed to a world free from tobacco-related death and disease.

I also believe this crisis has demonstrated the need for the $100 million we provide in the fiscal year 2020 appropriations bill for a new initiative to begin addressing the gaps in our nation’s public health data infrastructure.

This epidemic has really spotlighted the gaps in our public health data infrastructure.

When it emerged, CDC had to create entirely new databases and systems. That process was neither speedy, nor seamless. The first iteration crashed and burned in less than week, with system errors and bugs. The second iteration required states to enter data by hand, in a cumbersome, fragmented, and non-automated file submission processes.

It is further evidence that our public health data systems are too antiquated and in grave need of upgrades. Our systems still rely on obsolete technologies like faxes and compact discs.

To me, it is clear evidence as to why we need the $100 million in the House-passed bill.

But, as I said, this is a crisis demanding more immediate action than fiscal year 2020 funding. I know many of our witnesses today have recommendations for what the Congress can do and should do. Please share those suggestions. We need your help. We must act.

116th Congress