Tag: WHO

COP Ends With Pledges to Health, Environment

Photo: Maksym Yemelyanov
The 10th session of the Conference of the Parties (COP10) to the World Health Organization Framework Convention on Tobacco Control (FCTC) concluded on Feb. 10 with a commitment to strengthen protections against the impact of tobacco on the environment and health.
“We have taken a historic decision on Article 18,” said Adriana Blanco Marquizo, head of the FCTC Secretariat, in a statement, describing action to strengthen the article of the FCTC focused on the protection of the environment and the health of all people.
“The decision urges parties to take account of the environmental impacts from the cultivation, manufacture, consumption and waste disposal of tobacco products and to strengthen the implementation of this article, including through national policies related to tobacco and protection of the environment,” Blanco Marquizo said.
Representatives from 142 parties gathered in Panama City Feb. 5–10 to tackle a range of issues from progress on implementation of the treaty to the regulation of tobacco advertising, promotion and sponsorship.
According to the WHO, some 200,000 hectares of land are cleared every year for tobacco cultivation, accounting for up to 20 percent of the annual increase in greenhouse gases.
The decision also addresses the issue of cigarette filters. According to the WHO, an estimated 4.5 trillion cigarette butts are thrown away annually worldwide, representing 1.69 billion pounds of toxic trash containing plastics.
“Under specific circumstances—such as sunlight and moisture—cigarette filters break down into smaller plastic pieces, eventually leaching out some of the 7,000 chemicals contained in a single cigarette,” the WHO wrote on its website. “Many of those chemicals are environmentally toxic. The decision on Article 18 is very timely given the ongoing intergovernmental negotiation committees working to develop an international legally binding instrument on plastic pollution, including in the marine environment.”
COP10 delegates also agreed to strengthen guidelines on cross-border tobacco advertising, promotion and sponsorship and the depiction of tobacco in entertainment media.
In addition, two expert groups were established—one to work on forward-looking tobacco control measures under Article 2.1 of the FCTC and the other to focus on Article 19, which concerns liability.
Other decisions adopted by COP10 relate to the promotion of human rights through the WHO FCTC as well as strengthening the FCTC Investment Fund.
The parties also agreed to extend by five years the mandate of the Global Strategy to Accelerate Tobacco Control 2019–2025: Advancing Sustainable Development Through the Implementation of the WHO FCTC 2019–2025 so that it fully aligns with the 2030 Agenda for Sustainable Development.
COP10 also adopted the Panama Declaration, which draws attention to the “fundamental and irreconcilable conflict” between the interests of the tobacco industry and the interests of public health. The declaration also makes clear the need for policy coherence within governments to comply with the requirements of Article 5.3 of the WHO FCTC, which aims to protect public health policies from commercial and other vested interests of the tobacco industry.
Contradicting the observation of tobacco grower and consumer groups that traveled to Panama, the WHO insisted that COP10 was open to the media, which it said had the opportunity to observe all public and open sessions.
COP10 is followed by the Meeting of the Parties to the Protocol to Eliminate Illicit Trade in Tobacco Products, which will meet in Panama City Feb. 12–15.
February 12, 2024
World Medical Association Applauds WHO Anti-Vape View

The World Medical Association (WMA) has joined the World Health Organization (WHO) in warning about the dangers of electronic cigarettes and other electronic nicotine delivery systems (ENDS).
“This warning comes amidst rising global popularity of e-cigarettes, particularly among young people, and a lack of adequate regulation in many countries,” a press release states.
The Italian publication Formiche recently published a report raising concerns about the WHO’s tobacco control policies and strategies in combating smoking-related diseases.
Titled, “Framework Convention on Tobacco Control: Challenges and Prospects for WHO,” the report provides a comprehensive overview of the smoking crisis, the limitations of current tobacco control policies, and the role of harm reduction and non-combustion products. Additionally, it emphasizes the need for innovative strategies and a re-evaluation of the WHO’s approach to effectively combat the global smoking epidemic.
The report highlights how the FCTC has not considered harm reduction efforts which led to a deviation from the original stance of the WHO. Despite the FCTC’s efforts, the number of smokers have remained stable over the last 20 years, with the decrease in smoking rates being countered by the effects of population growth.
Lujain Alqodmani, president of the WMA, said there is an urgent need for government action to safeguard children and adolescents, and the WMA supports the WHO’s efforts to eliminate nicotine products. She highlighted the “alarming situation” reported by the WHO, where 88 countries have no minimum age restriction for purchasing e-cigarettes, and 74 countries lack regulations for these harmful products.
The Formiche report’s author also worries about the tobacco control policies pursued by many low- and middle-income countries, which are home to 18 percent of the world’s smokers and where policies either ban alternative nicotine solutions entirely or treat them like cigarettes.
The effect of these approaches, according to the report, is that smokers who do not quit are not supported in changing to options that could present less risk to them. “The hope is that the forthcoming Conference of the Parties can represent an opportunity for public health but also, in the spirit of the United Nations, a moment of confrontation to guide policy choices based on established scientific evidence,” the report states.
December 18, 2023
Postponed COP10 Expected to Prioritize ENDS Rules

Image: Tobacco Reporter archive
The regulation of new and emerging e-cigarette, heated-tobacco and nicotine products will be one of the central topics of discussion at the COP10-MOP3 international tobacco control conferences next year, said Adriana Blanco, head of the World Health Organization Framework Convention on Tobacco Control (FCTC), in a virtual press conference on Nov. 14, reported ECigIntelligence.
Speaking from the WHO headquarters in Geneva, Switzerland, Blanco said that proposals to create more stringent rules and health guidelines to govern new tobacco and nicotine product use will be prioritized at the COP10 (10th Conference of the Parties to the WHO FCTC) and the MOP3 (third session of the Meeting of the Parties to the Protocol to Eliminate Illicit Trade in Tobacco Products), which will now take place in Panama next year.
Last week, the WHO postponed COP10 to 2024 due to security issues for attendees and no new date has been announced.
November 16, 2023
2023 WHO Report Wrongly Details Malaysia Policy

Media has reported that the recent World Health Organization (WHO) 2023 report on the global tobacco epidemic wrongly claims Malaysia doesn’t have or barely has smoking bans in public places. Malaysia is marked as having “zero” indoor places with a complete smoking ban. Malaysia has had smoke-free places since 2004.
The WHO Report on the global tobacco epidemic 2023 launched yesterday – which covered data until 2022 – categorised Malaysia as having a “complete absence of a smoking ban, or up to two public places completely smoke-free,” according to media reports.
Other smoking ban categories in the WHO report were three to five public places completely smoke-free, six to seven public places completely smoke-free, and all public places completely smoke-free (or at least 90 per cent of the population covered by complete subnational smoke-free legislation).
Malaysia’s level of compliance with smoking bans was categorized as “data not required or not applicable”.
Going into further detail on public places with complete smoking bans, Malaysia was marked as having “zero” indoor places with a complete smoking ban, as well as having seven outdoor places where smoking is banned either fully or partially.
The 2023 tobacco epidemic report by the United Nations health agency claimed that Malaysia does not have smoking bans in government facilities, indoor offices and workplaces, and pubs and bars.
On health care facilities, educational facilities except for universities, universities, restaurants, and public transport, the WHO report categorized Malaysia with “no” ban, but with an additional tag: “Smoking is banned and the law does not allow designated smoking rooms, except if the health authority allows them by administrative act. Until now, no such administrative act has been taken”.
Malaysia did not receive a single “yes” in the WHO report across all eight categories of public places on whether there is a complete smoking ban. Compliance levels with smoking bans in Malaysia for all these categories were marked as “data not required or not applicable”.
Other countries in the Western Pacific region, in which Malaysia was categorized, received “yes” in various different categories of public places on whether there are smoking bans.
The WHO report also stated that for Malaysia, smoking is not comprehensively banned in one or more jurisdictions.
In another table comparing countries on additional public places with complete smoking bans, again, the WHO report marked “no” for Malaysia in all categories except one — outdoor children playgrounds or parks — that got a “yes”.
The “no” for Malaysia with a tag — “Smoking is banned and the law does not allow designated smoking rooms, except if the health authority allows them by administrative act. Until now, no such administrative act has been taken” — was marked for these categories: land transport (train, taxi, bus, metro, tram); air transport (plane); water transport (boat, vessel, ferry); indoor waiting areas of public transport (train station, metro station etc.); airports; hotels; prisons; shops (supermarket, shop, shopping mall); and cultural facilities (museum, cinema, theatre, arena). Other countries, on the other hand, obtained a “yes” for various different categories.
On additional characteristics of smoking bans, the WHO report marked “yes” for Malaysia on the requirement to display non-smoking signs in smoke-free places; fines on the establishment for not asking a patron to stop smoking and for not posting no-smoking signs; fines on the patron for smoking; and a citizen complaints and investigations system.
Malaysia was marked “no” for required signs identify a telephone number or other mechanisms for the public to report violations; fines on the establishment for not removing ashtrays; and dedicated funds for enforcement. “No explicit ban on use” was marked for Malaysia for the categories of ban on the use of heated tobacco products (HTPs) and electronic nicotine delivery systems (ENDS) or electronic non-nicotine delivery systems (ENNDS) in public places.
This table on additional characteristics of smoking bans appears to be mostly accurate for Malaysia, except for the ashtray component. Eateries in Malaysia are prohibited from providing ashtrays.
On “no explicit ban on use” of e-cigarettes in public places, although Malaysian health authorities do sometimes take action against people for vaping in no-smoking areas, this is not explicitly prohibited in the law, as the Control of Tobacco Product Regulations only covers cigarettes and conventional tobacco products.
Malaysia has had smoke-free places for nearly two decades since the enactment of the Control of Tobacco Product Regulations 2004 under the Food Act 1983. Section 11 of the 2004 regulation itself prohibits smoking in government premises, air-conditioned eateries, shopping complexes, hospitals or clinics, educational institutions or higher educational institutions, airports, and public vehicles or public transport terminals, among others. Designated smoke-free zones have been increased in Malaysia over the years in amendments to the 2004 regulation.
According to an update as of 2020 by Tobacco Control Laws – a website by U.S.-based International Legal Consortium, a team of lawyers who specialize in tobacco control – Malaysia is 100 percent smoke free in multiple indoor places, including public transport, government facilities, health care facilities, schools and universities, and restaurants, among others.
In 2019, then-Health Minister Dzulkefly Ahmad expanded the smoking ban from indoor restaurants to open-air eateries.
August 1, 2023
WHO: Uganda Holding Firm on Vaping Product Ban

Credit: ATDR
Uganda is standing firm on its eight-year-long ban on the sale of electronic cigarettes according to the World Health Organization (WHO) Country Representative Yonas Tegegn Woldemariam.
The Tobacco Control Act 2015 sought to effectively remove vaping products from the Uganda market.
“Despite Uganda’s high and increasing burden of non-communicable diseases morbidity and mortality rates, one in ten people still smoke cigarettes daily, making the practice an ongoing and dire public health threat. This justifies the Tobacco Control Act and all the other government initiatives to regulate products, including e-cigarettes,” said Yonas.
Uganda is one of the 35 countries globally where e-cigarettes are banned. The law bans the importation, manufacture, distribution, processing, sale, or offer for sale of e-cigarettes, including nicotine- and non-nicotine-containing e-liquids.
The WHO agent also cited a retracted 2016 study reported in the Lancet journal that found that people who use or have used e-cigarettes are less likely to stop smoking.
Even though legal consequences aren’t optimally enforced, it is encouraging to see that there are now comparatively fewer people smoking in public, according to the statement.
Uganda is a signatory to the WHO Framework Convention on Tobacco Control, which provides countries with evidence-based strategies to address the tobacco epidemic in their national contexts.
WHO continues to support the Ministry of Health Tobacco control initiatives, including sensitizing communities about the negative impacts of tobacco consumption on health and the environment, and encouraging local farmers to plant food rather than tobacco.
June 8, 2023
Advocates Clarify Science Controversies Ahead of COP10

Photo: Alliance
Tobacco harm reduction advocates are keen to clarify controversies surround the science on nicotine and vaping ahead of the Conference of the Parties (COP10) to the World Health Organization’s Framework Convention on Tobacco Control (FCTC), which will take place in November 2023.
The Coalition of Asia Pacific Tobacco Harm Advocates (CAPHRA) has written FCTC delegation heads to help inform their respective countries’ positions.
In its letter, CAPHRA notes that two high-profile studies, which have been quoted by tobacco controllers regarding the dangers of nicotine and vaping, have since been retracted and removed from significant medical journals.
“The first retraction is an article published in February 2022 in The World Journal of Oncology, claiming that nicotine vapers face about the same cancer risk as cigarette smokers,” CAPHRA wrote.
Another article, in the Journal of the American Heart Association, which reported an association between vaping and heart attacks was also retracted. Astoundingly, advocates noted, this article is still used as a reference in the FCTC guidelines around e-cigarettes.

Consumers’ rights to choose to use less harmful products to switch from smoking remain under tremendous threat from FCTC’s continuing failure to address scientific evidence, democratic processes and human rights.
Nancy Loucas, executive coordinator, CAPHRA
In addition, the THR regional advocacy group sent delegates a bibliography of key and current studies that disprove some of the more outrageous claims around harm.
On the supposed “youth vaping epidemic,” CAPHRA noted “a new survey from the Centers for Disease Control and Prevention and Food & Drug Administration suggests that youth vaping rates appear to be dropping, compared to pre-pandemic levels… In fact, youth vaping in the U.S. has plummeted by 60 percent over the past two years.’
“Consumers’ rights to choose to use less harmful products to switch from smoking remain under tremendous threat from FCTC’s continuing failure to address scientific evidence, democratic processes and human rights,” says CAPHRA executive coordinator Nancy Loucas.
The CAPHRA representatives reminded the health leaders that the FCTC has a mandate to pursue Harm Reduction as a core tobacco control policy—a position it has failed to acknowledge or implement since its inception, according to CAPHRA.
“WHO and its FCTC continue to press for signatory states to adopt ever more restrictive policies, including outright bans, based on dubious science. Delegates to COP10 should be representing the rights and aspirations of the citizens,” wrote the CAPHRA member organizations.
“Consumers have the right to make choices that help them avoid adverse health outcomes and smokers have the right to access less harmful nicotine products as alternatives to smoking. Please take account of these rights when making and presenting your submissions to COP10,” the letter concluded.
January 20, 2023
New Report Questions WHO’s Anti-Vaping Stance
A new report, published today, raises major questions about the anti-vaping arguments and approach of the World Health Organization and billionaire philanthropist Michael Bloomberg.
The WHO and Bloomberg have both made clear their opposition to safer nicotine alternatives despite growing evidence of lower harm and efficacy for smoking cessation.
The WHO’s tobacco control program is funded in part by Bloomberg Philanthropies. In July of this year, the two parties restated their joint position at the launch of the WHO Report on the Global Tobacco Epidemic, 2021: Addressing New and Emerging Products. In this report, the WHO emphasized that electronic nicotine delivery systems are “a threat to tobacco control,” are harmful, and should be banned or highly regulated. Bloomberg, in his capacity as the WHO Global Ambassador for Noncommunicable Diseases and Injuries, and founder of Bloomberg Philanthropies, stated that tobacco companies are marketing new products such as e-cigarettes to “hook another generation on nicotine.”
The International Network of Nicotine Consumer Organizations (INNCO) has now compiled a new dossier, titled, Bloomberg, WHO and the Vaping Misinfodemic, containing statements and evidence from healthcare experts, leading academics, politicians, respected journalists and research organizations that question the stance of the WHO and Bloomberg on safer nicotine alternatives to smoking and the relationship between the two parties.
This dossier comes just a week after the U.K. Department of Health and Social Care announced that e-cigarettes could be prescribed on the National Health Service, a world first. That move by the U.K. government provoked significant public debate around the polar opposite views towards safer nicotine alternatives, such as vaping, held by the British government and the WHO.
The dossier also comes as the Parties to the WHO Framework Convention on Tobacco Control convene to discuss tobacco and nicotine policy.
The outcomes from COP9 discussions will determine how international tobacco control policies are implemented at a country level across the globe to address the fact that 1.1 billion people still smoke worldwide and 8 million die every year from tobacco-related diseases.
The dossier highlights nine reasons why serious questions need to be raised about WHO and Bloomberg’s outright opposition to safer nicotine alternatives to deadly smoking. High on the list is their failure to distinguish between smoking addiction and nicotine dependence.

They are shifting the harm focus from smoking to tobacco to nicotine—where it obviously doesn’t belong.
Charles A Gardner, executive director, INNCO
“Effectively, through this failure they are shifting the harm focus from smoking to tobacco to nicotine—where it obviously doesn’t belong—nicotine does not cause cancer, heart or lung disease. Smoking does,” says Charles A Gardner, executive director at INNCO.
This is backed up in the dossier by expert views on the profound difference between cigarette smoke and the drug, nicotine, including those expressed by Jamie Hartmann-Boyce, senior research fellow in health behaviors at the University of Oxford; Professor John Britton, emeritus professor of epidemiology University of Nottingham and special advisor to the Royal College of Physicians on Tobacco; Adam Afriye MP; and a joint statement by 15 past-Presidents of the world’s top professional society in the field of tobacco control, the Society for Research on Nicotine and Tobacco.
The report also scrutinizes the WHO’s role in COP events, with evidence suggesting that it is very controlling in terms of the agenda and attendance. Unlike COP26, these tobacco control COP meetings are described as “all but excluding the media,” “well-known for the routine ejection of the public from proceedings,” and “notoriously secretive.”
The dossier also reports on claims that only tobacco control nongovernmental organizations (NGOs) allowed to attend are those who subscribe to the WHO’s tobacco harm reduction denialist stance. The U.K. Parliament’s All-Party Parliamentary Group for Vaping recently issued a warning about the participation at COP9 of The Union, a major global NGO funded by Bloomberg Philanthropies.
“The Union [International Union Against Tuberculosis and Lung Disease] recently issued a major report titled Where Bans are Best: Why Low- and Middle-Income Countries Must Prohibit E-cigarette and HTP Sales to Truly Tackle Tobacco. The Union is one of Bloomberg Philanthropies’ two top tobacco control grantees—the other is the U.S.-based Campaign for Tobacco-Free Kids,” says Gardner.
“We are a good case in point. INNCO, which represents and supports the rights of 98 million adults worldwide, who use safer nicotine to avoid toxic forms of tobacco, has once again been denied Observer Status at COP9 (as it was denied at COP8, and at COP7).”
The Bloomberg, WHO and the Vaping Misinfodemic report calls for:
Governments around the world to collectively challenge the WHO and Bloomberg’s current prohibitionist position on safer nicotine alternatives, and to demand to know why, in the face of 8 million tobacco-related deaths every year, the tobacco control field is the only field of public health that rejects harm reduction.
The formation of a global independent Tobacco Harm Reduction Working Group comprised of independent scientists, global health experts, specialist academics, and people who use safer nicotine (ex-smokers)
Withdrawal of funding from and/or boycott of future Conference Of Parties (COP) tobacco control meetings until the WHO considers the overwhelming evidence that safer nicotine alternatives such as vapes, snus, nicotine pouches and heat-not-burn help smokers quit, and save lives
Complete transparency in all tobacco control funding, grants and collaborations involving the WHO and Bloomberg
A full independent and international review into current and past tobacco control dialogue between Bloomberg Philanthropies, Bloomberg-funded NGOs and national governments in LMICs following allegations in the Philippines that the country’s Food & Drug Administration received funds from Bloomberg groups to support the implementation of the national tobacco control program
A complete review of the WHO’s public web-based Q&A on e-cigarettes, which has been described as “astonishingly bad”
The dossier also spotlights the EVALI (e-cigarette, or vaping, product-associated lung injuries) crisis of 2019. The U.S.-only outbreak of lung injuries caused by bootleg THC (cannabinoid) vape oils “cut” with one or more adulterants was wrongly reported to be caused by legal nicotine vaping.
According to the report, the EVALI outbreak triggered Bloomberg Philanthropies to invest $160 million over a three year period to prohibit all e-cigarette flavors other than tobacco flavor. EVALI is also still incorrectly referenced by the WHO in its Q&A on vaping products in response to the question as to whether e-cigarettes cause lung injuries.
However, by early 2020, U.S. authorities identified vitamin E acetate, a cutting agent used in some bootleg THC vaping oils—mainly in US states where cannabis remains illegal—as the primary cause of the outbreak.
As reported in the dossier and which escaped the attention of the world’s media, last month, 75 global experts with no tobacco industry ties, including seven individuals who have served as president of the Society for Research on Nicotine and Tobacco, wrote to the CDC’s Director asking her to change the name “EVALI” because it fails to alert THC vapers to their potential risks, and it misleads smokers and nicotine vapers to believe e-cigarettes were the cause.
“I’ve spent 30 years in global health, including three years as a senior advisor on research to the WHO. For most of my career, I worked on HIV, TB, malaria, dengue, rabies, nutrition and child health issues. So, I’ve never seen anything as crazy as what’s happening now in tobacco control. What troubles me is how few people outside of my ‘little’ echo chamber, the community of millions of ex-smokers who use safer nicotine, knows what’s going on,” says Gardner.
“There are 1.1 billion smokers now in the world, a situation that has barely changed in the last 20 years. The anti-harm reduction conservatism of the WHO and Bloomberg is not working.
“That’s why we are calling for a global response in the form of a tobacco harm reduction working group and international governments collectively questioning and challenging the WHO and Bloomberg’s prohibitionist and evidence-denialist approach to safer nicotine. Because we are ex-smokers who use safer nicotine. We see what’s happening, and we have great empathy for smokers and ex-smokers who vape.
“The goal is simple. Save lives. Only the starting assumptions and strategies to get there differ. These can be debated. But this debate is unethical if it does not include people who have, themselves, made the transition from smoking to not-smoking, using tobacco harm reduction products (nicotine patches, nicotine gum & lozenges, nicotine vapes, nicotine pouches, snus and HPTs).”
“Our future policy recommendations will focus on the need to change research priorities, just as HIV/AIDS activists sought to do in the 1990s. Global tobacco control research priorities today are skewed towards finding harms of alternative nicotine products while ignoring—or not even exploring—benefits, in particular the potential therapeutic benefits of nicotine. The health benefits of medical marijuana are now recognized because of research. The potential therapeutic benefits of psilocybin are now being explored (e.g., for PTST, and even for smoking cessation). However, research to explore those potential benefits was locked in amber for 30 years because of prohibitionist drug laws.”
November 9, 2021
Bates: COP9 is ‘Closed Bubbles of Cultivated Groupthink’

Credit: Artur
In a new blog post, tobacco control advocate Clive Bates says that the World Health Organization’s tobacco control treaty meetings are “closed bubbles of cultivated groupthink.” Bates compares the United Nation’s climate change treaty with its tobacco control treaty , claiming the two groups use science and logic in completely different ways.
“At the start of COP9, the head of the [Framework Convention on Tobacco Control] FCTC convention secretariat proudly drew a comparison with the other COP, the one going on in Glasgow dealing with the UN Framework Convention on Climate Change (UNFCC),” Bates writes. “Perhaps she hoping some of the interest in UNFCCC COP-26 would rub off on the altogether more tawdry FCTC COP-9. But the tobacco COP takes an aggressive exclusionary and insular approach to stakeholders that would never be tolerated in the climate COP.”
Clive Bates
There is a sharp contrast between the climate COP meetings and tobacco COP meetings, according to Bates. The FCTC tobacco COP has “highly restrictive and opaque practices” that ensure that it operates as an “echo chamber populated by compliant observers.” He says that the COP9 chooses so-called “civil society” organizations according to their willingness to support the FCTC and contribute to its implementation.
“It excludes many legitimate perspectives: notably consumers, pro-harm reduction public health experts, policy think tanks and critical economists, libertarians, and commercial entities affected by decisions made by COP,” he says. “For this COP, the FCTC process will be used to exclude several organizations and bolster the groupthink bubble … This insularity is not a feature of the UNFCCC climate COP meetings. A comparison with the UN Framework Convention on Climate Change is revealing.”
In the FCTC, any non-governmental organization (NGO) can be refused observer status at the request of a single party. NGOs are required to be international and committed to tobacco control, ruling out most consumer organizations who see themselves as victims of tobacco control. NGO observers are required to file reports on their activity with the Secretariat for approval.
“The Secretariat then makes recommendations about who should be granted observer status, retained as observers, or expelled,” he says. “The ‘civil society’ organizations chosen are mainly grant-funded tobacco control organizations, often with bizarre views about public health that bear little relationship to the norms in the countries they come from or anything like good practice in policy and science.”
November 8, 2021
A Tale of Two COPs

Image: Tobacco Reporter archive
This year, the first two weeks of November will witness two COPs (Conference of Parties), large policy gatherings aimed at moving the needle on ratified global U.N.-related conventions. Both have to do with health—individual, population and the planet’s health. Yet, one COP is attracting the leaders of the developed world as well as developing worlds in Glasgow, United Kingdom, along with another 20,000-odd stakeholders. The other COP will be held virtually and quietly from its secretariat in Geneva, Switzerland.
The United Nations Framework Convention on Climate Change (UNFCCC) secretariat is tasked with supporting the global response to the threat from climate change. With 197 members, the UNFCCC has a near universal coverage. The 26th Conference of the Parties (COP26) Glasgow was kicked off on Oct. 31 with great fanfare, high expectations and drama befitting a Hollywood premiere—e.g., Greta Thunberg arrived on a “climate train,” a test in patience and endurance for Greta, her 150 fellow passengers, the media and the climate activists’ mob at Glasgow Central.
Throughout the course of these two weeks of negotiations, haggling and posturing, the best possible outcome from COP26 could be that all countries commit to keeping global warming limited to 1.5 degrees Celsius. That calls for some serious re-engineering of human behavior and entire societies. Millions of conventional jobs and livelihoods will be lost, millions more potentially created in the new green economy. Some would argue (and justify): Desperate times call for desperate action. Green economy advocates and solution providers, including transforming oil companies and automobile manufacturers, are in full attendance at the summit and are missing no photo-op to burnish their green credentials.

The UN climate change conference will consider the input of the manufacturers it seeks to regulate, many of which are eager to show how they can be part of the solution. (Photo: adrian_ilie825)
The other COP, of the Framework Convention on Tobacco Control (FCTC), created by the U.N.’s World Health Organization and run by the FCTC secretariat, follows a completely different tack. It is notionally intended for addressing the harms to society and the world due to risky forms of smoked (cigarettes, bidis, cigars) and smokeless (khaini, gutkha, zarda, etc.) tobacco products that over a billion people consume today. The FCTC is ratified by most of the countries in the world (the USA and Indonesia being notable exceptions), and the ninth Conference of Parties from Nov. 8–13 will see yet another biannual get together making decisions that affect 1.3 billion tobacco users, their families and millions from the tobacco supply chain globally. However, it is held behind closed doors, driven by health activists that simply see the tobacco industry as the problem and tobacco users as AstroTurf for the tobacco industry. Neither are allowed anywhere near the meeting nor are the lay media.
The FCTC, in its simplest form, is a demand and supply reduction treaty, underpinned by tobacco harm reduction principles. Broadly, what this could mean in policy as well as practice is that those not currently using risky forms of tobacco products, especially children and young adults, should be disincentivized from initiation, and those currently using risky forms of tobacco should get the necessary help to quit. This may take the form of providing nicotine-replacement therapy, prescription medications and behavioral support. It could also mean that those involved in the supply chain, such as farmers and bidi worker women, should be given support to switch to alternative livelihoods.
Sixteen years on from the ratification of the FCTC, great progress has been made in adopting parts of the treaty that relate to demand reduction by prevention of initiation into national regulations. Advertising campaigns, tax hikes, health warnings and packaging and sale restrictions have led to significant reductions in initiation, especially among youth. On the other hand, support to current users of risky forms of tobacco remains wanting, lacking innovation and largely under-funded.
The nicotine in these products makes consumers dependent. The cancers, however, are caused by the toxic chemical mix in the smokeless products and from the smoke itself—but not the nicotine. Pharmaceutically licensed nicotine-replacement therapy products, in the form of gums and patches, are on the WHO’s model essential medicines list for tobacco dependence treatment. It is scientifically proven: Quitting risky forms of tobacco (cessation) is not easy; relapse is very common. The high retail price of the cessation products, poor availability and inadequate training of doctors in prescribing these cessation treatments means that current tobacco users miss out on any meaningful access and support.
It is easy to point to the tobacco industry’s morally and ethically unacceptable behavior for most of the 20th century that led to the smoking epidemic globally, and even today, to the manufacturers of gutkha and pan masala in India who are fueling an oral cancer epidemic. Based on this historical context, the COP organizers exclude this industry from their deliberations. Sadly, that exclusion extends to consumers, effectively the current and future patients suffering from tobacco dependence.
This raises a sticky question: Are the global public health community, led by the WHO’s FCTC signatories who meet every two years formally at the COP, simply giving up on the 1.3 billion current users of cigarettes, bidis, khaini and gutkha-like products, letting them die preventable premature deaths, for the want of adequate cessation products and support? Would public health not benefit from a wider range of innovative nicotine-replacement products, manufactured to high standards, regulated appropriately and specifically available as cessation aids for current adult users of risky tobacco products?

In stark contrast to the climate change COP26, at this tobacco-related COP9, manufacturers of cleaner nicotine products (the “solution providers” to the problem) and consumers (the victims of the problem) will be glaringly absent. (Photo: lezinav)
This COP season, it may be time to draw parallels between two very similar gatherings with diametrically opposite profiles and approaches. Climate change and tobacco-related harms—both are urgent issues facing humankind. Both are being addressed by global treaties and conventions. For both problems, a wide range of solutions are coming from old and new industries.
In the case of climate change, the Teslas of the world lead the rally. Conventional fossil fuel giants such as BP (of the Gulf of Mexico spill fame) and Shell are not far behind either, showcasing their renewables’ commitment in every ESG communication. The Volkswagen emissions scandal (from less than five years ago) is distant memory, and the automobile industry is at the table, providing cleaner cars by “electrifying” their offerings.
In tobacco cessation, underpinned by tobacco harm reduction principles, innovation came from a wide range of inventors and manufacturers globally: e-cigarettes from China, heated-tobacco products from Switzerland and the U.K., nicotine pouches from Sweden and cessation apps from the USA. Pharmaceutical manufacturers of conventional nicotine-replacement products and prescription medications are either withdrawing from the markets or not innovating any more. They have not made any visible effort to make their products available at affordable prices in the developing world—and there was never a huge hue and cry about that from public health.
None of the new innovative products are a silver bullet but promise to provide cleaner, safer nicotine to the billion-plus current consumers of risky forms of tobacco. In countries such as the U.K. and USA, where regulators are informed by scientific evidence and risk assessment, these products are regulated and allowed. Slowly but surely, this will transform the nicotine use profile in these countries, no doubt saving millions of lives and billions of dollars in future health costs from tobacco-related diseases. In Japan, previously known for its high smoking incidence among men, nearly 30 percent of the cigarette market has been replaced by heated-tobacco devices. These devices are increasingly acknowledged for their reduced toxicant exposure vis-a-vis cigarettes. The U.S. Food and Drug Administration has authorized the sale of a specific brand of heated device, an e-cigarette and a Swedish snus-style smokeless tobacco product for their reduced toxicant exposure and potential to reduce tobacco-related harms. In the U.K., e-cigarettes are one of the many options of quitting tools supported by national health bodies.
In stark contrast to the climate change COP26, at this tobacco-related COP9, manufacturers of cleaner nicotine products (the “solution providers” to the problem) and consumers (the victims of the problem) will be glaringly absent. In countries where regulators do not need the WHO’s blessings to make their own policies (the U.S., U.K. and increasingly the EU), innovation and better regulation will lead to a reversal of harms from risky 20th century tobacco products. In the developing world, including South Asia, the harms from tobacco will remain unabated in the absence of strong regulatory leadership and industry transformation.
Whether or not we can manage to curb the global temperature rises to a maximum of 1.5 degrees Celsius by 2050, today’s direction of tobacco control as symbolized by COP9 will hinder access to safer nicotine alternatives to over 1.3 billion current users, 80 percent of whom live in developing countries, accounting for millions of preventable deaths in the next three decades.
Sudhanshu Patwardhan is a British-Indian, U.K.-licensed medical doctor who is passionate about helping people quit risky forms of tobacco. For the past two decades, he has lived and worked in three continents, doing senior roles in research, strategy and policy in the pharmaceutical and tobacco industries.

In his early years in tobacco harm reduction, his team of clinical researchers and lab scientists set the foundations for the assessment of reduced-risk products, now accepted by regulators and the industry as the definitive approach for duty of care and regulatory compliance. At Nicoventures, a wholly owned subsidiary of British American Tobacco, he was instrumental in enabling the first e-cigarette company acquisition by a global tobacco business. In his policy role there, Patwardhan shaped the creation of a global key opinion leader network in consumer advocacy and public health champions. .

With the British Standards Institution, Patwardhan led the creation of the world’s first vaping products’ standards for safety and quality in 2015 and the BSI Online Age Checking specifications in collaboration with the Westminster-based Digital Policy Alliance in 2018. .

In 2018, he co-founded the Centre for Health Research and Education that now has a team of over 40 medical and public health experts globally working in cancer prevention. Patwardhan splits time between the U.K. and South Asia on tobacco harm reduction projects that address the needs of the most disadvantaged tobacco users. He is also a board director of Art Asia, a charity with a mission to communicate the rich and exciting experience of South Asian Arts to the widest possible audiences.

November 3, 2021
100 THR Experts Pen Letter Against WHO Vapor Stance
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.
Credit: Igor Golovnev.
“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.”
October 18, 2021