It’s Time to Fix the “EVALI” Narrative

Back in 2019, there was a serious lung injury outbreak that put thousands of people in the hospital and made national headlines almost overnight. 

It was quickly labeled: 

EVALI — “E-cigarette, or Vaping, Product Use-Associated Lung Injury.” 

At the time, everything was moving fast. People were trying to figure out what was going on in real time, and the name stuck. 

But here we are years later—and the science has caught up. 

The problem is… the name hasn’t. 

Now, Dr. Michael Pesko is asking the CDC to do something that honestly should’ve happened a long time ago: 

Update the name so it actually reflects what caused the outbreak. 

 

What We Know Now 

 

Early on, there was a lot of uncertainty. That’s fair. 

But over time, the evidence became clear: 

The 2019–2020 cases were linked to illicit THC vape products, not standard nicotine products. 

More specifically, they were tied to vitamin E acetate contamination—something found in illegal, unregulated products. 

Not something used in nicotine e-liquids.  

That distinction matters. A lot. 

 

So Why Does the Name Still Say “E-Cigarette”? 

 

That’s the issue. 

Even though the cause is better understood, the name still includes “e-cigarette.” And that’s continuing to shape how people think about what happened. 

If you ask the average person what caused the outbreak, a lot of them will still point to nicotine vaping. 

Not illicit THC products. 

That confusion didn’t just disappear when the outbreak ended—it stuck around. 

 

And That Confusion Has Real Consequences 

 

This isn’t just about wording. 

The way something is labeled influences: 

• What people believe  
• What they avoid  
• What policymakers focus on  

When the name itself is misleading, it creates a ripple effect. 

Even now, you still see: 

• Media stories getting it wrong  
• People lumping completely different products together  
• Ongoing confusion in both public conversations and policy discussions  

And that all traces back, at least in part, to how this was originally framed. 

 

This Isn’t About Rewriting History 

 

No one is saying the outbreak wasn’t serious. It absolutely was. 

But public health is supposed to evolve as we learn more. 

We update guidance. 
We refine recommendations. 
We correct things when new evidence comes in. 

That’s how it’s supposed to work. 

So when the cause becomes clear, the language should follow. 

 

What’s Being Asked 

 

Dr. Pesko—and a number of others—aren’t asking for anything extreme. 

Just: 

• Remove “e-cigarette” from the name  
• Make a clear distinction between nicotine and THC products  
• Update how this is communicated going forward  

That’s it. 

 

Why This Actually Matters 

 

At the end of the day, this comes down to credibility. 

If public health messaging doesn’t match the evidence, people notice. 

And once trust starts to slip, it’s hard to get back. 

Fixing the name won’t change what happened in 2019. 

But it will help make sure people understand what actually caused it—and what didn’t. 

 

So What Now? 

 

We’re not in 2019 anymore. 

The evidence is clearer; the cause is understood—and the way we talk about it should reflect that.