One hundred tobacco harm reduction (THR) experts have published a joint letter challenging the World Health Organization’s (WHO) approach to tobacco science and policy. The group is urging members of the Ninth Session of the Conference of the Parties (COP-9) of the Framework Convention on Tobacco Control (FCTC), a global intergovernmental treaty in which the WHO plays a major role, to encourage the WHO to support and promote the inclusion of tobacco harm reduction into its regulatory advisements.
“Smoke-free nicotine products offer a promising route to reducing the harms arising from smoking. There is compelling evidence that smoke-free products are much less harmful than cigarettes and that they can displace smoking for individuals and at the population level,” the letter states. “Regrettably, [the] WHO has been dismissive of the potential to transform the tobacco market from high-risk to low-risk products. [The] WHO is rejecting a public health strategy that could avoid millions of smoking-related deaths.”
The letter was published on Oct. 18 and will be sent to COP-9 delegates. In a joint statement, Ruth Bonita, former director of WHO Department of NCD Surveillance, and Robert Beaglehole, former director of the WHO Department of Chronic Disease Prevention and Health Promotion, stated that they were “extremely disappointed by WHO’s illogical and perverse approach” to reduced-harm nicotine delivery products, such as vaping.
“A key challenge in global tobacco control is to assist cigarette smokers to transition from burnt tobacco products to much less harmful options that provide the nicotine without the toxic smoke,” the statement reads. “[The] WHO’s continuing disregard of the wealth of evidence on the value of these products is condemning millions of smokers to preventable disease and premature death.”
The letter goes on to make seven points about the current vaping regulatory environment, such as the value of vaping in THR and the unintended consequences of poor regulatory policies. The authors then go on to make six suggestions for the WHO to consider:
- Make tobacco harm reduction a component of the global strategy to meet the Sustainable
Development Goals for health, notably SDG 3.4 on non-communicable diseases. - Insist that any WHO policy analysis makes a proper assessment of benefits to smokers or would-be
smokers, including adolescents, as well as risks to users and non-users of these products. - Require any policy proposals, particularly prohibitions, to reflect the risks of unintended
consequences, including potential increases in smoking and other adverse responses. - Properly apply Article 5.3 of the FCTC to address genuine tobacco industry malpractice, but not to
create a counterproductive barrier to reduced-risk products that have public health benefits or to
prevent critical assessment of industry data strictly on its scientific merits. - Make the FCTC negotiations more open to stakeholders with harm-reduction perspectives, including
consumers, public health experts, and some businesses with significant specialised knowledge not
held within the traditional tobacco control community. - Initiate an independent review of WHO and the FCTC approach to tobacco policy in the context of
the SDGs. Such a review could address the interpretation and use of science, the quality of policy
advice, stakeholder engagement, and accountability and governance. The Independent Panel for
Pandemic Preparedness and Response (IPPPR), initiated to evaluate the response to the COVID-19
pandemic, offers such a model.
Another signatory, David Sweanor, adjunct professor of law, chair of the Advisory Board of the Centre for Health Law, Policy and Ethics University of Ottawa, Canada, in a separate statement, said that effective public health efforts need to be based on science, reason and humanism. Instead, the WHO is aligning itself against all three when dealing with nicotine.
“The result is that one of the greatest opportunities to improve global health, separating nicotine use from smoke inhalation, is being squandered. Global trust in health authorities, and the WHO in particular, has never been so important,” the statement reads. “Yet the WHO is abandoning science, rationality and humanism on nicotine and instead apparently pursuing the moralistic abstinence-only agenda of external funders. This is a public health tragedy that extends well beyond the unnecessary sickening of the billion-plus people who smoke cigarettes.”