THE World Health Organization’s (WHO) opposition to tobacco-harm reduction, a policy embodied in the Framework Convention on Tobacco Control (FCTC), “is dishonest and threatens public health,” the US-based think tank Reason Foundation said.
A treaty created by the WHO in 2004, the FCTC seeks “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke.”
Since the FCTC came into force in 2005, however, the Reason Foundation said the number of smokers in the world has increased, mainly in China and other poor countries that were the FCTC’s primary target.
WHO ignoring evidence
“A KEY problem with the FCTC is that it is beholden to the idea that the only way to reduce smoking is for smokers to ‘quit or die’. It is, thus, highly skeptical of the potential for new technologies, such as vape devices or electronic cigarettes, to reduce smoking-related harms,” Julian Morris, vice president of research at Reason Foundation, writes in a policy brief published on September 15.
Morris cites an FCTC report released in early September that was commissioned in secret from unknown authors, which refers to unpublished evidence from meetings held in secret that advocates vape products should be heavily regulated.
Yet, as Morris pointed out, a recent report from the Royal College of Physicians concluded that vaping is “at least 95-percent safer” than smoking, that vape devices should be widely available and that physicians should encourage smokers to use them instead of smoking.
Moreover, millions of people have already stopped smoking by using vape products. Where vape products are legally available, rates of smoking initiation have fallen faster than in locations where they are not available.
According to Morris, if governments follow the FCTC’s advice, vape products would become less readily available, and more people will smoke regular cigarettes, with far worse health consequences.
Lack of transparency
MORRIS suggests that many of the problems with the FCTC stem from the fact that it violates all the precepts of good governance, especially transparency. He notes that at the two most recent Conferences of the Parties of the FCTC, in Seoul in 2012 and in Moscow in 2014, all journalists were thrown out of the public gallery and the meetings were held in secret.
The FCTC also excludes many groups whose input would be highly relevant, according to Morris. The FCTC web site currently lists only 20 non-governmental organizations (NGOs) as observers, compared to the Framework Convention on Climate Change, which lists over 2,000 NGOs as observers.
Moreover, there is essentially no participation by representatives of many affected groups, including users of tobacco and vape products, vendors and farmers. Participation by international government organizations has also been restricted, most notably Interpol, which has been denied observer status, despite its expertise in combating illicit trade in tobacco, a key topic covered by the FCTC.
The primary justification the FCTC Secretariat gives for restricting participation and operating in secret is the avoidance of conflicts of interest. But the real reason, Morris argues, is that the FCTC does not want to allow any participant who disagrees with its assumption that the only option for smokers is to “quit or die.”
Why the WHO hostility?
MORRIS suspects that the most important reason driving the WHO’s hostility to tobacco-harm reduction is the belief of many people in the public-health community that tobacco-harm reduction is not possible, a belief that seems to have its roots in earlier failed attempts to produce “safer cigarettes.”
“If this were 1986 or even 1996, such a perspective might be intellectually defensible. However, there is now a very solid evidence that vape products are both far, far safer than cigarettes and are resulting in a significant reduction in smoking,” Morris explains.
A second reason, according to Morris, is that the WHO might be responding to pressure from vested interests, specifically companies that apparently benefit from the status quo.
“Tobacco companies that have not developed harm-reduction products would be at a competitive disadvantage if smokers switched to less harmful alternatives. Pharmaceutical companies selling drugs that help smokers to quit would likely experience lower sales if smokers choose to continue consuming nicotine. And pharmaceutical companies selling nicotine-replacement therapy might experience lower sales as a result of smokers having a wider range of substitutes available.”
Third, Morris cites the 2008 Report on the Global Tobacco Epidemic in which the WHO conceives of tobacco itself as a disease and views “the tobacco industry as [the] disease vector,” claiming that “tobacco companies have long targeted youth as ‘replacement smokers’ to take the place of those who quit or die.” Thus, the WHO has chosen to focus its efforts on eliminating tobacco use, rather than on reducing the harm done by tobacco.
As a result, even though substitution with less harmful products is also a proven and important complementary means of quitting or reducing smoking and the diseases associated with smoking, the WHO, according to Morris, has chosen not to include harm reduction in its toolkit and is reluctant even to acknowledge it.
“By seeking to curtail or ban these less harmful alternatives to smoking,” Morris explains, “the FCTC positions itself squarely against smokers and former smokers trying to improve their health while retaining the pleasurable rituals of their habit, as well as companies seeking to produce the less harmful products that would help them to do so.”