he rise of vaping in Pakistan shows a concerning pattern. What began as a social media trend among teenagers posting pictures with colourful devices has evolved into what medical experts are calling a full-blown epidemic among Pakistani youth. Recent studies show that 68.4 per cent of university students now use vaping products, a statistic that should alarm policymakers and parents alike.

While the FDA has reversed course on JUUL approvals and Australia is tightening its prescription-only vaping model, Pakistan finds itself in a regulatory vacuum with legal, unrestricted access to products increasingly recognised as serious health hazards. The contrast couldn’t be more stark: while developed nations implement sophisticated regulatory frameworks, Pakistan’s youth face an uncontrolled market flooding their communities with addictive products.

The epidemic’s scale

The numbers emerging from recent Pakistani studies are devastating. University research reveals that 68.4 per cent of students use vaping products. Separate studies of college students aged 16-19 show 50.4 per cent regular usage rates. Perhaps most concerning, 41.9 per cent of users vape daily, most starting before age 18. These figures represent millions of young Pakistanis, given that the country’s youth population exceeds 60 million.

The accessibility of these products has become shocking in scope. Reports have identified over 1,379 official vape shops nationwide, though the actual number is likely much higher. These outlets cluster strategically near educational institutions, with devices costing between 4,000 and 5,000 rupees and refills at Rs 1,500-2,000, making them affordable for urban youth through illegal imports and online sales offering same-day delivery.

What makes this epidemic particularly insidious is how it has spread beyond traditional tobacco users. Unlike cigarette smoking, which carries social stigma, vaping has been marketed as harmless and trendy. Young people report being able to use devices around family members undetected due to reduced odour and the perception that vaping is safer than traditional smoking.

Age emerges as the most critical risk factor, with the 12-17 year olds facing the highest risk due to peer pressure amplified by social media influence and fundamental misperceptions about safety. The availability of over 50 flavours has made these products particularly appealing to young users. Paradoxically, studies show significant vaping rates even among medical students, highlighting how pervasive the trend has become across all educational demographics.

The mounting health evidence

The health risks associated with vaping continue to accumulate, contradicting industry claims about safety. Medical professionals now identify over 2,000 toxins in each puff of vape. Student health surveys show that 25.6 percent of users report breathing difficulties. Chemical exposure includes formaldehyde, acetaldehyde and diacetyl—substances linked to severe lung conditions including “popcorn lung” disease.

The addiction potential remains perhaps the most significant clinical concern. Research using advanced brain imaging shows that nicotine uptake from e-cigarettes is comparable to traditional cigarettes, creating similar addiction patterns. Youth are especially vulnerable because developing brains are more susceptible to nicotine dependence, with early exposure affecting cognitive development, memory, attention and impulse control.

The most concerning aspect may be what remains unknown about long-term effects. Unlike cigarettes, which have decades of research documenting their health impacts, vaping’s consequences are still being discovered. This uncertainty creates a dangerous situation where an entire generation serves as unwitting test subjects for 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, requires no licensing for sales operations, allows unlimited advertising across all platforms and maintains only a nominal 18-plus age requirement with no enforcement mechanisms.

Pakistan stands at a critical juncture. With youth usage rates exceeding those in countries where vaping is considered epidemic, delaying action risks normalising an entire generation’s addiction. 

These regulatory gaps became apparent when provincial governments attempted to address the crisis through local bans, only to face legal challenges highlighting contradictory approaches. Courts questioned the legal basis for restrictions while allowing the federal government to collect excise duties on e-liquids. This has created an enforcement nightmare where authorities cannot act decisively despite the clear public health threat.

Learning from global leaders

The FDA’s recent evolution offers important lessons. After banning JUUL in 2022, the agency reversed course in 2025, approving products based on evidence showing adult smokers switching from cigarettes. However, this requires extensive scientific infrastructure. From over 25 million applications, only 39 products received authorisation—a 0.0014 percent approval rate demonstrating stringent evidence requirements.

Australia has taken a different approach, treating all nicotine vaping as prescription medicine requiring healthcare oversight. This medical model restricts access to professional supervision, limits products to basic flavours, bans disposables and ensures pharmaceutical standards. Australia’s aggressive enforcement includes seizing over 10 million vapes worth $500 million.

Practical solutions for Pakistan

Pakistan needs immediate emergency measures while building regulatory capacity. Age enforcement represents the most urgent priority, requiring mandatory identification verification, heavy retailer penalties and regular compliance checking. Location restrictions could ban sales near educational institutions and restrict online sales without proper verification.

Economic measures offer powerful tools for reducing accessibility. Increasing taxes on vaping products would raise prices beyond the reach of most young users, following successful tobacco taxation models. Currently, devices cost Rs 4,000-5,000; a substantial tax increases could price out the youth market while generating revenue for healthcare programmes.

Smoke-free policies should be extended to include vaping. Banning vaping in closed spaces such as offices, restaurants, public transport and shopping centres would reduce social normalisation and second hand exposure. Creating comprehensive vape-free zones around schools, hospitals and government buildings—similar to existing tobacco restrictions—would protect vulnerable populations and send clear public health messages.

Primary care physicians, also called general practitioners or family physicians, have a role in patient education, screening for use of e-cigarettes (vapes, JUUL), particularly in adolescents and promoting smoking cessation (pharmacotherapies like nicotine replacement therapy, bupropion and varinecline). Published studies have shown that many GPs are unaware of the role of e-cigarettes in the smoking cessation process, along with their effectiveness and safety. It is therefore important for them to familiarise themselves with guidance and updates available on the use of e-cigarettes. Vapes are not completely harmless or chemical-free. They are associated with serious health problems like cardiovascular and respiratory issues. Public awareness campaigns represent another critical intervention. Most young users believe vaping is harmless, unaware of the 2,000+ toxins in each puff or addiction risks comparable to cigarettes. Evidence-based health education targeting youth, parents and educators could counter industry marketing with scientific facts about respiratory damage, cardiovascular risks and nicotine addiction.

Product controls offer immediate intervention through banning youth-targeted flavours, implementing nicotine concentration limits and requiring plain packaging with prominent health warnings. Pakistan could adapt Australia’s medical framework using existing pharmacy networks rather than requiring doctor prescriptions, building on current tobacco cessation programmes.

Learning from FDA principles, Pakistan could demand basic safety data before allowing new products and require companies to demonstrate products won’t appeal to minors. The key is starting with enforceable restrictions using existing systems rather than complex schemes requiring new infrastructure.

Urgent choice

Pakistan stands at a critical juncture. With youth usage rates exceeding those in some countries where vaping is considered epidemic, delaying action risks normalising an entire generation’s addiction. The window for preventive action is rapidly closing as industry interests become entrenched.

While the FDA and Australia debate sophisticated approaches to established markets, Pakistan faces a choice between prevention and crisis management. The evidence from Pakistani youth studies is clear: this is no longer a future threat but a current emergency affecting hundreds of thousands of young people.

International experience offers lessons, but Pakistan must adapt solutions to its context—one with limited regulatory capacity but also opportunity to prevent industry entrenchment. The country can learn from others’ experiences without repeating their mistakes, provided action comes quickly enough.

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

Dr Tehzeeb Zulfiqar is a research fellow at Australian National University, Canberra

Dr Hina Jawaid is an associate professor in Family Medicine at Health Services Academy, Islamabad