As the WHO Gathers, Our Global Tobacco Control Framework Needs Radical Overhaul

October 3, 2018

Twenty-five years ago, when I started working on tobacco control at a government policy level, the politicians used to reject our recommendations that they ban tobacco advertising and up the tax on cigarettes. They said it was a slippery slope, the thin edge of the wedge—after demanding that they ban smoking, would we turn on chocolate, beer, eating out?

Of course not! I said. Smoking is totally different to obesity! Most people who drink alcohol aren’t addicted! I thought they were being misled by industry lobbyists.

How naive was I?

This year’s World Health Organization (WHO) Conference of the Parties (COP8) is currently taking place in Geneva. Dr. da Costa e Silva is head of the secretariat of the WHO Framework Convention on Tobacco Control (FCTC)—which was adopted in 2003, came into force in 2005 to restrict all forms of tobacco use, and is legally binding in 181 countries.

She reportedly said: “We hope [COP8] will be the starting point [for] a wider application of the FCTC as an international Treaty that extends beyond tobacco control to support strategies aimed also at promoting [Social Development Goals] & protecting environmental resources.” (My emphasis.)

The FCTC was the first international treaty addressing a health issue. The WHO, with the support of public health academics, was able to launch such a ground-breaking global initiative because there was robust scientific evidence that smoking tobacco caused disease.

The evidence is simply not there to support using a heavy-handed international juggernaut like the FCTC to demonize sugar like we demonized nicotine—to ban wine (watch out, Italy), or to deny people jobs, accommodation and a day at the beach because they’re now classified as obese.

Imagine how Thailand would enact a FCTC-like treaty aimed at reducing obesity. Perhaps threaten 10 years’ jail for possession of donuts? It sounds ridiculous. But that’s what they do now to people caught with an electronic cigarette!

In Australia, they’d run multi-million dollar fat-shaming campaigns, saying “Every sausage roll is doing you damage.” You think I’m joking. But the campaign exists now, though it’s confined to Western Australia. Thankfully, academics concerned about the ethics of stigmatizing overweight people have stopped the campaign from going national.

No one cared about ethics when we did the same thing to smokers. Our campaigns inciting hatred towards cigarette smoke were so effective that no one cared if we completely banished smokers from society. They’re all weak-willed losers anyway—that’s what tobacco control campaigns taught the public, politicians and doctors.

Two generations on, the FCTC is a runaway train. The newcomers to public health, that we veterans trained, uncritically swallowed our exaggerated health warnings. They were only too ready to pillory smokers and win awards at global conferences for doing it. They didn’t need to read the research; we’d done that for them. Now they seem to have foregone that skill altogether.

Twenty-five years ago, the much smaller tobacco control community that I joined was already working towards the foundation of the FCTC. Large international consultation meetings were held with different interest groups. In the late 1990s I attended the women’s meeting in Osaka, Japan. The focus then was on reducing morbidity and mortality—on reducing the incidence of lung cancer, cardiovascular disease, stroke and oral cancers. The initial purpose, and the mandate for the FCTC to be established, was that it would reduce harm.

It’s a very different world today. Technology has advanced everything we do. Cessation products have come and gone. But today, we have a wide range of tobacco and nicotine-delivering products that don’t result in the suffering and premature death that we railed against in the past. A new industry, built by ex-smokers turned to vaping, presented the first real threat to the traditional tobacco industry, whose profits had previously been largely unaffected by our glacially slow progress of reducing smoking by an average of 0.5-1 percent per annum.

There was a knee-jerk reaction to ban their new products, and if necessary, punish smokers for using them. We didn’t want to get sucked in again like we did when the tobacco industry sold everyone on their “light” and “low tar” products, which didn’t end up reducing harm at all.

The full weight of the WHO and billionaire philanthropist Michael Bloomberg have been called upon to stamp out what has been incorrectly portrayed as just another tobacco industry tactic. Reportedly, the countries signed up to the FCTC have agreed that “all harm reduction is industry interference”!

Any group known to support “new products” are marked as “industry,” even consumers. All non-medicinally approved tobacco or nicotine products, regardless of their risk profile, are deemed to be the same as the combustible commercial cigarette. Now this is ridiculous.

Ironically, it was this kind of public-health sabotage of the fledgling vaping industry that gave the cigarette companies enough time to catch up and release their own range of risk-reduced alternatives to smoking.

The new world of relatively harmless (certainly compared to smoking) recreational nicotine use has arrived. The big players driving smoking prevalence down at rapid drops like we’ve never seen before are—shock horror!—companies that make vaping products. They don’t describe vaping as “cessation,” of course, because we don’t allow them to make any health claims. God forbid that they should actually help anyone quit smoking.

The “conversion rate,” as they call it, of smokers to risk-reduced nicotine users makes my eyes water. Using a retail model, salespeople and peer-to-peer coaching to ensure successful complete transition, tens of millions of people now snus, vape, or heat-not-burn their tobacco rather than smoking. This exodus, in countries and cultures as diverse as Iceland, Japan, France, the USA and the UK, is so massive, so quick, that smoking prevalence statistics are out of date before they go to print.

The FCTC, penned last century, is seemingly stuck there. It’s time it was thoroughly overhauled—not copied to be inappropriately applied to dissimilar concerns. And this should be done not by people stuck in a past that doesn’t exist anymore, but by scientists, innovators and leaders who can see that a smoke-free future is within our grasp.

I’m proud that New Zealand has that vision. Our delegation reported to COP8 that New Zealand will be introducing risk-proportionate regulation. Adoption of a harm reduction approach is also well underway. Will this cause delegates from other countries to question the FCTC Secretariat’s prohibitionist guidance? In the short-term, probably not. The dictates to come out of COP8 will likely rattle with extremism typical of a despot who knows their time has come. Why else would they start laying the ground for a future direction “beyond tobacco control”?

[The main image shows signatories (green) and parties (orange) to the FCTC.]

Marewa Glover

Dr. Marewa Glover is a Maori behavioural scientist, and the founder and director of the Centre of Research Excellence: Indigenous Sovereignty & Smoking (COREISS) in New Zealand (funding disclosure), which has an international focus on reducing tobacco related harms among Indigenous peoples. She received a 2018 Professional Advocate award from the International Network of Nicotine Consumer Organizations. She was a finalist in the 2019 New Zealander of the Year awards. Neither Dr. Glover nor COREISS have any commercial interests in nicotine products.

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