For years, opponents of tobacco harm reduction have insisted, with absolute certainty, that vaping is just as harmful as smoking. This myth has endured despite a perpetual lack of evidence. Still, people who despise vapes have maintained that one day science would vindicate them. So, when a group of Australian researchers published a paper that they proclaimed “the most definitive determination” to date that vapes cause cancer, the media  did not question that the moment had finally arrived.

Headlines around the world from nanny statists blared that vapes were linked to oral and lung cancer. Comment sections brimmed over with triumphant I told you so remarks. An accompanying video the researchers posted to YouTube claimed outright that “vaping causes cancer,” implying that this was based on “new findings.” It seemed as though the debate had been settled.

Except it hadn’t.

Strip away the media sensationalism, and the paper was simply a flimsy metareview of research conducted between 2017 and 2025. It contributed no new information at all. The authors claimed that vaping is carcinogenic and can “no longer be caricatured as safer than smoking,” but did not support this with anything resembling solid evidence.

The researchers merely recycled existing material, selectively interpreting findings and drawing conclusions that go far beyond what the underlying evidence actually supports. Nor did they evaluate the quality of that evidence. This included a handful of case reports of people who vaped and also developed cancer, an observation that means nothing.

“This is an un-systematic review,” states a comment on PubPeer, an anonymous post-publication review platform that’s highly regarded in the scientific community. “There appears to be no inclusion or exclusion criteria, or a preregistered protocol, or any justification for stopping the retrospective review at 2017. Consequently, no risk of bias assessment was conducted, there is no published protocol etc. Likewise, evidence is never sufficiently discussed in comparative terms to smoking cigarettes, the habit vaping is often designed to replace.”

The true cost of media credulity is not embarrassment, but harm.

The resulting message that vaping causes cancer, and is a public health threat as dangerous as smoking, became a masterclass in how weak evidence—amplified by eager media outlets—can hoodwink a credulous public.

There is a clear appetite in some quarters for bad news about vaping, an eagerness so strong that it overrides basic critical thinking. 

Ben Youdan of Action on Smoking and Health New Zealand warned that this kind of research contributes to the deeply inaccurate public perception that vapes are as harmful as cigarettes. If people who smoke believe there is no reason to switch to vaping, they will continue smoking. Combustible cigarettes cause the vast majority of the world’s lung cancer deaths, and are responsible for more than 480,000 deaths in the United States each year. The link between cigarettes and cancer risk is a textbook example of epidemiological evidence, which is precisely the kind of evidence that the Carcinogenesis paper did not have.

At some point, persistence in the face of overwhelming contrary evidence stops looking like a mistake. There is now more than two decades of research indicating that vaping is substantially less harmful than smoking, with a landmark 2015 review estimating a risk reduction of 95 percent. No one’s claiming it’s risk-free, but it should make the comparison clear.

The true cost of media credulity is not embarrassment—though there should be plenty of that—but real harm.

Image via City of Bridgeport, Connecticut

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The latest example is from the annual National Youth Tobacco Survey (NYTS) in the United States. The 2025 results, released on March 4, show that youth use of tobacco and nicotine products continues to decline.

Overall tobacco use among middle and high school students fell again in 2025, dropping from 8.1 percent in 2024 to 7.5 percent. Youth vaping declined for the third consecutive year, plummeting to 5.2 percent, the lowest level in a decade. Other nicotine products show similar trends; nicotine pouch use edged down slightly from 1.8 percent to 1.7 percent. Cigarette smoking remained extremely low and unchanged, at just 1.4 percent.

If we look beyond experimentation and focus on regular use, the numbers become even more striking. Daily or near-daily use is rare across all products. Among high school students, only 2.09 percent report regular nicotine vaping, 0.39 percent report regular nicotine pouch use, and just 0.23 percent report smoking cigarettes regularly. Across middle and high school students combined, daily smoking sits at 0.22 percent.

In other words, cigarette smoking among young people in the United States has all but disappeared.

Despite the encouraging data, there was no major press release. Compare that lack of fanfare to the years when youth vaping was on the rise.

Despite the encouraging data, there was no major press release highlighting the findings from the Food and Drug Administration or the Centers for Disease Control and Prevention (CDC), the agencies that produce the NYTS.

Compare that lack of fanfare to the years when US youth vaping, which peaked in 2019, was on the rise. The outcry then was relentless—even though youth smoking, the real health threat, not only continued to decline during this period but was found by some researchers to be declining faster than before.

Despite what’s happening in the real world, influential public health bodies continue to repeat claims about a “gateway” from vaping into smoking.

The World Health Organization still warns of “children and adolescents going on to use smoked products following experimentation with [vapes].” The CDC’s website continues to tell the public that “youth who vape may also be more likely to smoke cigarettes in the future,” as do other public health organizations.

These statements are presented as though they reflect established causal evidence. But they do not.

Most research cited in support of the gateway theory relies on observational studies showing that young people who try vaping are statistically more likely to report later smoking. This is a classic example of correlation being mistaken for causation.

If vaping were a “gateway” into smoking, we would expect youth smoking to rise as vaping becomes more common. The opposite has happened.

Young people who experiment with one risky behavior are often more likely to experiment with others. The concept is known as “common liability,” whether it’s a purely a social phenomenon or has a genetic component. A teenager predisposed toward risk-taking might well try alcohol, cannabis, vaping and cigarettes at different times. Observational studies can document this, but cannot easily disentangle the reasons.

What matters most is the population-level trend. If vaping were truly acting as a gateway into smoking, we would expect youth smoking rates to rise as vaping becomes more common. Instead, the opposite has happened almost everywhere.

In the United States, youth smoking has fallen to historically unprecedented levels during the same period that vaping emerged. The latest NYTS data simply extend a pattern that has been visible for more than a decade: Experimentation with new nicotine products may occur, but smoking continues to collapse.

That pattern is difficult to reconcile with the gateway narrative. Indeed, if anything, the data are more consistent with a theory that alternative nicotine products may be diverting young experimenters away from cigarettes.

Yet instead of acknowledging this, many public health authorities continue to frame vaping as a threat to youth smoking prevention, thereby misleading the public.

Recognizing this success requires a willingness to look at the data as they are, rather than as some might wish them to be.

Good public health policy depends on honest communication about evidence. When institutions continue to repeat claims that are not supported by real-world population data, they risk undermining their own credibility.

The latest NYTS results should be cause for cautious optimism, even celebration. Youth smoking is now extraordinarily rare. Regular nicotine use among adolescents is limited. And across most categories, usage is declining.

This represents one of the most significant public health successes of recent decades. But recognizing that success requires a willingness to look at the data as they are, rather than as some might wish them to be.

If public health authorities want to maintain public trust, it is long past time that they updated their messaging. The facts are increasingly clear. Youth smoking is collapsing and the long-predicted vaping “gateway” into smoking remains nowhere to be seen.

Photograph by Matthew MacQuarrie via Unsplash

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The agency’s behavior at the recent Conference of the Parties (COP11) to its Framework Convention on Tobacco Control (FCTC), held in Geneva, revealed a bureaucracy that has drifted away from science—now swayed less by the truth than by the priorities of wealthy private donors. Instead of striving to reduce the burden of disease from smoking, the WHO’s leadership appears wedded to a prohibitionist agenda that would deny millions of people access to safer alternatives, thus perpetuating the harms the treaty was created to end.

Throughout COP11, the FCTC Secretariat and its network of allied NGOs attempted to paint proven reduced-risk nicotine products as an urgent threat to global health. Delegations were pressured to treat nicotine pouches, vapes and heated tobacco products as if they were as deadly as combustible cigarettes, despite overwhelming evidence that their risk profiles differ by orders of magnitude.

Delegates were urged to regulate SNP more harshly than cigarettes—protecting products that kill while strangling the potential of substitutes that do not.

The world suffers 8 million annual deaths from cigarette smoking and other harmful tobacco use. Not one death has ever been reliably attributed solely to regulated safer nicotine products.

Yet delegates were urged to regulate these more harshly than cigarettes—a logically backward position, protecting products that kill half their long-term users while strangling the potential of substitutes that do not.

Fortunately, the effort largely failed. Delegates pushed back forcefully, refusing to accept proposals that had no scientific foundation. Attempts to smuggle in sweeping “forward-looking measures” that would have turned voluntary restrictions into de facto obligations were instead watered down to preserve national sovereignty.

Most tellingly, the attempt to force reduced-risk products into the same regulatory category as cigarettes met with widespread resistance. Parties made clear that no consensus existed, kicking the discussion to the 12th COP meeting in 2027.

The Secretariat and its allies presented evidence that was weak—naturally enough, when their case is anti-science. Less natural was the almost cult-like way in which this already-exclusionary discussion was managed.

Any delegate who raised the fact that non-combustibles are significantly less harmful was accused of making “industry-aligned” arguments—a way of silencing dissent.

Any delegate who raised the simple, indisputable fact that non-combustible nicotine products are significantly less harmful than smoking was accused of making “industry-aligned” arguments. That term is designed as a convenient rhetorical tool to dismiss anyone who prioritizes real-world health outcomes over ideological purity—a way of silencing dissent, no matter the extent of its evidential support.

The ubiquitous delusion reached its peak when COP11 President Dr. Reina Roa closed the meeting by declaring that novel nicotine products cause “disability and death.”

It defies belief that the president of a global health congress would make a statement so demonstrably false, and so profoundly damaging.

But the whole event was drenched in hypocrisy. The FCTC groupthink was illustrated through the “Orchid” and “Dirty Ashtray” awards, in bulletins compiled by the closely affiliated Global Alliance for Tobacco Control (GATC). Mexico, a country with soaring smoking rates, a vape ban and a growing illicit market, was lavished with praise in receiving the Orchid Award. New Zealand, which has more than halved smoking prevalence by embracing harm reduction, was condemned with the Dirty Ashtray Award.

The clear message was that the FCTC values ideological loyalty over real reductions in smoking-related harms.

When the funding ecosystem is so lopsided, it is unsurprising that the treaty process has degenerated into a dismal echo chamber.

Following the money helps to explain the inexcusable. As investigative reporting has shown, 15 of the 29 NGOs accredited by the Secretariat for COP11 receive funding from Michael Bloomberg, whose personal crusade against nicotine has distorted global policy. Organizations promoted for supposedly neutral expertise are financially tied to a single billionaire, whose quit-or-die stance on smoking is treated as sacred doctrine. Almost 200 accredited delegates at COP11 were from Bloomberg-funded organizations—not including the WHO itself, which also receives Bloomberg money.

Contributors of articles in the GATC COP11 bulletins included the Global Center for Good Governance in Tobacco Control, University of Bath, Action on Smoking and Health USA, the Smokefree Partnership, the Campaign for Tobacco Free Kids, Vital Strategies, European Network for Smoking and Tobacco Prevention, the NCD Alliance and the South-East Asia Tobacco Control Alliance. All are heavily funded by Bloomberg’s array of anti-nicotine organizations, as indeed is the GATC.

When the funding ecosystem is so lopsided, it is unsurprising that the treaty process has degenerated into a dismal echo chamber.

Outside the WHO bubble, a very different conversation was taking place. Just down the road, the Taxpayers Protection Alliance hosted its “Good COP” conference, which brought together researchers, doctors and consumers from around the world. Unlike the WHO’s closed-door proceedings, Good COP was transparent and openly accessible to people on all sides of the debate. It demonstrated what scientifically grounded, ethical and genuinely public-health-oriented dialogue looks like.

The FCTC treaty was designed to save lives, not become a platform for moral panic and donor-driven dogma.

The tragedy is that the FCTC treaty was designed to save lives, not become a platform for moral panic and donor-driven dogma. Article 1(d) explicitly identifies harm reduction as a pillar of tobacco control, yet the WHO behaves as though this principle never existed. Its refusal to acknowledge overwhelming evidence in favor of safer nicotine products goes against the purpose of the treaty described in Article 3: to protect against harms from “tobacco consumption and exposure to tobacco smoke.”

This dereliction of duty is already costing lives, and will cost more—above all in low- and middle-income countries where smoking remains endemic and alternatives are desperately needed.

If the WHO does not correct course, it risks becoming entrenched not as a guardian of public health but an obstacle to it. Science, ethics and the taxpayers who fund the WHO demand better.

Photograph (adapted) via Pickpik

The Influence Foundation, which operates Filter, received a one-off donation from the Taxpayers Protection Alliance in 2024 to support travel to a harm reduction event. Filter‘s Editorial Independence Policy applies.

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And then, those same governments turn around and do something extraordinary. They hand a near-monopoly on the future of nicotine to the tobacco industry.

They do this by systematically eliminating meaningful competition to the traditional cigarette—the disruptive technologies that have helped millions of people switch to safer alternatives. Where those safer products aren’t outright banned, governments skew the new-nicotine market against smaller manufacturers, reducing the range and effectiveness of legally available smoking-cessation options. 

Arkansas, for instance, has a new law that doesn’t just ban sales of many vaping products, but also bans personal possession of them. In doing so, Arkansas joins a cozy club including Qatar, Singapore, Venezuela and North Korea. 

Under the guise of “protecting youth” and “ensuring compliance,” Arkansas has adopted a Premarket Tobacco Product Application (PMTA) registry law that only allows the sale (or possession) of vaping products authorized by the United States Food and Drug Administration (FDA). 

All currently authorized products are owned by tobacco companies; the FDA’s arduous and opaque PMTA process favors companies with the deepest pockets. A few menthol options aside, all are in tobacco flavor only—courtesy of the FDA’s de facto flavor ban—which helps explain why most people in the US who switch from cigarettes to vapes are using the unauthorized products that politicians want to stamp out.

This is like saying you hate fossil fuels while banning electric cars.

All over the world, from the US to the United Kingdom, from India to Australia, governments are taking a sledgehammer to nicotine innovation, destroying the very products that are actually reducing cigarette smoking. 

This is like saying you hate fossil fuels while banning electric cars.

Various factors help explain it. In some places, such as India and Vietnam—both of which have banned vapes—governments own large stakes in their nations’ dominant tobacco companies. Tobacco industry lobbying, as seen with US PMTA registry bills, is powerful. And everywhere, the demonization of safer nicotine products, spearheaded by the World Health Organization, is instrumental.

The UK has for years been a leader in tobacco harm reduction. Now, with a new disposable vapes ban and the government’s Tobacco and Vapes Bill barrelling through Parliament, the country risks reversing years of progress. This bill promises a total ban on advertising for reduced-risk products, a prohibition on heated tobacco products and Swedish snus, plain packaging rules for vapes, the removal of flavors that adults actually like, and even a bizarre crackdown on vending machines in mental health facilities.

And just to show it really means business, the UK government plans to impose the highest vape liquid taxes in Europe, starting in 2026. Because nothing says “we care about smokers” like making safer alternatives more expensive than the deadly ones. 

The Tobacco and Vapes Bill also includes the incremental prohibition of cigarette sales to anyone born after 2008. But this targets a young population with a very low smoking rate. Like all drug prohibitions, it is sure to foster an illicit market—and especially so when access to the safer substitutes that youth prefer is so hampered.  

In so many jurisdictions, policies banning or restricting safer products amount to a gift-wrapped market handoff to the cigarette industry and its few government-sanctioned safer-nicotine subsidiaries. By choking off independent and disruptive players, governments are guaranteeing that the only nicotine products readily available will be those manufactured by the companies they claim to despise.

Millions of people who might have switched are being locked into, or pushed back to, a behavior that governments claim to oppose.

To be clear, in any real-world projection of a positive outcome, tobacco companies have an important role. These companies are not going to disappear, and a realistic best-case scenario involves them transitioning to sales of safer products instead of cigarettes, as some have pledged to do. Their reach and huge customer bases would make such transitions very significant.

But to expect optimally fast and effective transitions in this environment—where innovation and disruptive competition are being stifled, where options that people prefer are being removed, and where cigarettes as a result will remain extremely lucrative—is to live in a fantasy land.

The irony is staggering. The same officials who denounce the influence of Big Tobacco are now regulating smaller, innovation-driven companies out of existence, effectively turning the nicotine landscape into a cartel with little else to choose from except the most harmful products.

Millions of people who might have switched are being locked into, or pushed back to, a behavior that governments claim to oppose. It’s a perverse outcome dressed in the language of public health.

The only thing more dangerous than cigarettes is a public health policy that ensures they remain the only game in town.

What’s missing from all of this is any sense of proportion, or of basic pragmatism. Harm reduction is no longer a radical concept. It’s been used successfully in everything from syringe provision to sexual health. And yet when it comes to nicotine, we’re stuck in a 1990s playbook where governments want just two acceptable options: quit completely or die trying.

People who can’t or won’t quit nicotine deserve the right to make healthier choices. And governments that claim to be against Big Tobacco should try proving it by supporting competition, not crushing it.

If they really want to hit the cigarette trade where it hurts, they should unleash the full potential of safer alternatives, regulate them sensibly, stop lying to the public about relative risks and let innovation flourish. Because the only thing more dangerous than cigarettes is a public health policy that ensures they remain the only game in town.

Photograph via Stockvault

The author’s employer, the Taxpayers Protection Alliance, previously provided a one-off donation to The Influence Foundation, which operates Filter, to support travel to a harm reduction event. Filter‘s Editorial Independence Policy applies.

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The fingerprints of Michael Bloomberg—the billionaire former NYC mayor, who bankrolls a global vendetta against people who vape—are all over it. 

“We thank the Partnership for Healthy Cities Initiative, Bloomberg Philanthropies, Vital Strategies, and the World Health Organization for funding this collaborative effort,” said NYC Health Department Acting Commissioner Dr. Michelle Morse. 

Every one of those groups is Bloomberg-funded. Morse’s department received $100,000 from the Health Cities Initiative in 2024, “to combat the harms of commercial tobacco and nicotine products, like e-cigarettes (vapes).” 

At the heart of the press release is a glaring falsehood: the conflation of vapes with “one of the leading preventable causes of death in our city.”

Cloaked in public health language, the department’s announcement of its future tobacco control plans signals that the city is doubling down on ideological opposition to tobacco harm reduction.

At the heart of the press release is a glaring falsehood: the conflation of vapes, and other safer nicotine alternatives like pouches and heated tobacco products, with “one of the leading preventable causes of death in our city.” 

This is not only wrong, but dangerous due to the influence it will have on people who smoke. The NYC campaign has been issuing grants to various organizations to “share tobacco-related educational messaging.” 

What people won’t have been told is that there has not been a single reliably documented death anywhere in the world that’s directly attributable to the use of regulated safer nicotine products. Smoking, on the other hand, is responsible for 480,000 deaths every year in the United States alone, including 28,000 in New York State. Equating these radically different products is not public health, it is propaganda.

The press release applies some sleight of hand to this fundamental, inconvenient difference. It warns that promoting harm reduction options “may lead to a new generation being hooked on these highly addictive commercial nicotine products”—as if addiction (the existence of which is dubious in the absence of serious harms) should be considered a problem comparable to mass death.

But how much does it have to say about the real killer?

Tellingly, the term “smoking” is used just three times in the release, while “nicotine”—the stimulant that does not cause smoking-related diseases—earns twice as much ink. 

The term “e-cigarettes” appears nine times; the term “cigarettes” is not used even once.

It’s worth asking why smoking has declined so much in NYC. A significant part of the answer is vaping.

This misdirection ignores decades of scientific consensus. It is the combustion of tobacco—the inhalation of smoke filled with thousands of toxins and carcinogens—that causes cancer, heart disease and death. To center the conversation on nicotine rather than combustion is to wilfully ignore the cause of the problem.

The press release boasts that New York City’s adult smoking rate has fallen from 22 percent in 2002 to 8 percent in 2023. That is commendable progress. But it’s worth asking why smoking has declined so much in that timeframe. A significant part of the answer is vaping. Millions of people in the US have turned to vapes and other low-risk options to quit smoking. Yet instead of celebrating these tools, the city demonizes them.

The city is engaged in an ongoing crackdown. Since May 2024, “Operation Padlock to Protect” has seized more than $94 million in “illegal” vaping and cannabis products. Rather than advocating for the FDA to do its job of regulating vapes, NYC is content to raid stores. 

When people want substances, and restrictions on legal access make unregulated markets lucrative, such crackdowns are futile. In this scenario, adults who smoke are left with fewer options to switch, youth can buy from unregulated vendors, and vapers of all ages are left without consumer safeguards.

The city’s recent lawsuit against distributors of flavored disposable vapes, accused of selling products in “such youth-attracting flavors as pink lemonade, watermelon, banana ice, lychee ice, and cool mint,” further highlights its moral panic. Adults also like flavors. In fact, flavors are a key reason why vaping helps people quit smoking. 

Yet the city would rather frame flavors as a youth-only issue and pretend that banning them, as New York State did in 2020, is the answer.  

New York City’s stance on safer nicotine products does nothing to diminish smoking. On the contrary, it protects the combustible cigarette trade by kneecapping its safer competitors. 

Ironically, the press release tacitly acknowledges the role of nicotine alternatives when it points to the New York State Smokers’ Quitline, through which people can “apply for a free starter kit of nicotine medications”—a level of access and attraction that will never remotely match being able to pick up enjoyable vaping products at your local store.

NYC supports harm reduction in other areas. But when it comes to nicotine, the city discards that logic entirely.

Harm reduction is a well-established public health principle. If people cannot or will not quit a risky behavior, the state should facilitate less harmful alternatives. New York City supports seat belts, methadone, syringe service programs and two overdose prevention centers—where people can use banned drugs like fentanyl in safe conditions.

But when it comes to nicotine, the city discards that logic entirely.

The Bloomberg organizations involved in this campaign have poured hundreds of millions of dollars into anti-vaping efforts worldwide, distorting or dismissing the evidence as they go. Their influence is pushing cities like New York into regressive policies, and denying the public honest and accurate health information about relative risks.

The people of New York City—including thousands whose lives could be saved by switching from cigarettes to safer alternatives—deserve better.

Public health isn’t served by fear, ideology or misguided moral crusades. It is served by facts, compassion and a commitment to saving lives—even when that challenges entrenched beliefs and powerful institutions.

Photograph by Arturo Pardavila III via Wikimedia Commons/Creative Commons 2.0

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As the first-ever global health treaty, the FCTC, to which 183 countries are parties, promised a revolution in tackling the harms of smoking. Yet, two decades on, the WHO, which guides implementation of the FCTC, bears substantial responsibility for vast numbers of people continuing to smoke. Despite grand ambitions, the treaty has failed to achieve its stated goals and, in many respects, has done more harm than good.

Since its implementation in 2005, the FCTC’s track record has been abysmal. Smoking prevalence, as a percentage of the world’s population, has declined—but not nearly as fast as it should have done. The absolute numbers are flat, at best, with the WHO reporting 1.3 billion tobacco users worldwide.

Small wonder that a press release from one of the WHO’s regional offices, its title crediting the FCTC with “saving millions of lives,” instead touts the number of people now living under tobacco control policies as its main metric of success.

Central to the FCTC’s failure is its departure from its original mission.

This is no triumph of public health. Studies published in esteemed journals such as the British Medical Journal and the Lancet have criticized the treaty for its lack of impact, particularly in lower-income countries, where smoking rates remain stubbornly high.

Central to the FCTC’s failure is its departure from its original mission. The treaty was meant to reduce the “consequences of tobacco consumption and exposure to tobacco smoke.” Its text even acknowledges, in theory, that harm reduction has a role to play.  

However, instead of focusing on reducing smoking-related harms, the WHO and its associated bodies have prioritized targeting nicotine, which is not the direct cause of major smoking-related harms. This has detracted from efforts to address the real issue, and reflects WHO policies now more rooted in dogma than in evidence-based public health.

This blinkered approach is exemplified by the way it has wielded Article 5.3 of the treaty. The provision was initially intended as a conflict-of-interest safeguard to prevent undue tobacco-industry influence. However, it has since been used as a justification for stifling debate, barring critical stakeholders—including harm reduction advocates, independent researchers, and consumers—from discussions on tobacco control. 

The WHO’s FCTC Secretariat has exploited Article 5.3 to shut out voices that challenge its preferred narrative.

Experts with even the most tenuous, second-hand relationships with nicotine industry funding—or with no such relationships at all—are shunned, regardless of the validity of their evidence or experiences. 

The WHO’s FCTC Secretariat, along with various member states and allied NGOs like the Global Alliance for Tobacco Control, have exploited Article 5.3 to shut out any voices that challenge their preferred narrative. As a result, the treaty’s decision-making processes have become increasingly secretive. Conferences of the Parties (COP) meetings, where global tobacco control policies are discussed, are held behind closed doors. The public and media are routinely denied access, ensuring that discussions happen without scrutiny. 

This lack of transparency contradicts fundamental principles of good governance and raises serious concerns about the legitimacy of the policies being pursued.

By far the most damaging failure of the FCTC has been its outright rejection of innovative harm reduction strategies. Despite mounting evidence that safer nicotine products help people quit smoking, the WHO remains entrenched in its opposition. 

Millions of people who smoke have been denied or dissuaded from options that could save their lives.  

A 2016 report from the WHO actually acknowledged the potential of non-combustible nicotine products in reducing smoking rates. Yet, instead of embracing this opportunity, the agency has doubled down on its hostility.

Instead of endorsing safer nicotine alternatives—such as vapes, nicotine pouches, and heat-not-burn technology—the WHO has continued to wage an ideological war against them. As a result, hundreds of millions of people who smoke, and who are unable or unwilling to quit nicotine, have been denied or dissuaded from options that could save their lives.   

The WHO’s anti-health stance reached a nadir in June 2024 when it posted that vapes are “designed to kill.” This statement is not just false; it is dangerously irresponsible. Decades of research have shown that vaping is exponentially less harmful than smoking, and many millions of people worldwide credit vapes with helping them quit combustible tobacco for good. The WHO’s rhetoric actively discourages people from making the switch, leaving them at greater risk of disease and death.

A global tobacco control strategy that is outdated, ineffective and counterproductive.

As the FCTC marks its 20th anniversary, the messaging continues to reveal a deep-rooted unwillingness to adapt. In its celebratory statements, the WHO speaks of “addressing the challenges brought by new and emerging tobacco and nicotine products” rather than seizing the clear opportunity they represent.

The result is a global tobacco control strategy that is outdated, ineffective and counterproductive.

The world needs a new approach—one that is fit for the next 20 years and beyond. The FCTC (as it stands) has proven inadequate. Instead of continuing on this failing path, global health authorities must recognize the potential of harm reduction and modernize their strategies accordingly. Countries that have done so have seen some extraordinary results. The WHO should take note and follow suit.

As people who use nicotine—and the global taxpayers who ultimately fund the WHO—reflect on 20 years of the FCTC, they should know that its legacy is one of missed opportunities and distorted priorities. To dramatically reduce the global burden of smoking-related disease, the WHO must abandon its ideological opposition to harm reduction and embrace policies that reflect the realities of modern science. Until then, there is little worth celebrating.

Photograph by Robert Ruggiero via Unsplash

The author’s employer, the Taxpayers Protection Alliance, previously provided a one-off donation to The Influence Foundation, which operates Filter, to support travel to a harm reduction event. Filter‘s Editorial Independence Policy applies.

The post After 20 Years of Its Tobacco Treaty, the WHO Has Little to Celebrate appeared first on Filter.

The decision is a win for science and harm reduction, safeguarding cigarette alternatives that the FDA now acknowledges “offer greater benefits to population health than risks.” However, this progress also highlights absurd contradictions in the FDA’s overall approach to nicotine and tobacco.

Pouches like these contain nicotine without the toxic chemicals and carcinogens involved in combustible cigarettes. The FDA’s scientific evaluation found that the products offer significant harm reduction benefits, and that adults who use nicotine pouches are more likely to quit smoking—hugely reducing their exposure to known harms—than those who try to go cold-turkey.

The FDA’s evaluation underscores a key point: The potential benefit to adults who smoke outweighs any risks of youth use.

Moreover, the FDA’s evaluation underscores a key point: While youth use of nicotine pouches remains low—only 1.8 percent of US middle and high school students reported using these products in 2024—the potential benefit to adults who smoke outweighs any risks of youth use.

This is the essence of tobacco harm reduction: a public health strategy that prioritizes transitioning people away from products that kill, rather than worrying excessively about products that don’t.

The FDA’s recent decision reflects a growing recognition of nicotine’s role in harm reduction. Despite its addictive properties, nicotine is not the direct cause of smoking-related illnesses; the culprits are the tar and thousands of chemicals produced when tobacco is burned. By separating nicotine from combustion, products like Zyn provide a pathway to reduce harm, without the obstacle of having to quit nicotine, which many people either can’t or won’t do.

While the FDA’s Zyn authorization is commendable, it stands in stark contrast to many of its other moves. These include its shameful record of fearmongering and stoking misinformation about nicotine.

Then there are its rejections of countless vaping products: After years of PMTA applications, only a short list of vapes, often outmoded and unpopular, have been authorized. Despite the established importance of flavors in attracting adults to safer products—now belatedly reflected in the Zyn decision—just a handful of menthol-flavored vapes have been authorized. The rest are in tobacco flavor only.

A more recent example is the FDA’s renewed proposal to mandate the reduction of nicotine in combustible cigarettes to negligible levels. This plan, though well-intentioned, risks undermining harm reduction. People who switch to smoking very low-nicotine cigarettes are likely to take more puffs. Many more might instead turn to an illicit market for higher-nicotine cigarettes, a scenario that would exacerbate, rather than mitigate, public health risks.

The FDA’s approval of Zyn pouches should serve as a wake-up call for policymakers. Harm reduction is not about coercing people to quit smoking; it’s about offering them viable and safer alternatives. Rather than pursuing heavy-handed restrictions, the FDA should double down on encouraging the development and availability of reduced-risk options like pouches, vapes and heated tobacco.

The FDA’s broader tobacco strategy must change. Harm reduction must take precedence over punitive measures and scare tactics.

Globally, countries that embrace harm reduction have seen remarkable public health benefits. Sweden, for example, has the lowest smoking rates in Europe—and the lowest rates of lung cancer, and smoking-related deaths—thanks largely to the widespread use of snus, a smokeless tobacco product similar in principle to nicotine pouches.

The FDA’s decision to authorize ZYN nicotine pouches brings the US one step closer to adopting this successful model, with a more pragmatic, science-based approach to tobacco control.

However, the FDA’s broader tobacco strategy must change. Policies that prioritize harm reduction must take precedence over punitive measures and scare tactics. Public health is best served not by trying to force people to quit smoking at all costs, but by providing them with tools and information to make their own informed decisions.

The FDA must build on its welcome Zyn authorization by embracing a consistent harm reduction framework that prioritizes people who smoke, reduces risks and avoids unintended consequences. Only then can we hope to see a meaningful, accelerated reduction in smoking-related deaths and diseases.

Photograph by Aphis Marta via Wikimedia Commons/Creative Commons 4.0

Swedish Match, Zyn’s manufacturer, is a subsidiary of Philip Morris International. The Influence Foundation, which operates Filter, has received unrestricted grants from PMI. Filter also received a one-off donation from the Taxpayers Protection Alliance, the author’s employer, to support travel to a harm reduction event. Filter‘s Editorial Independence Policy applies.

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Goldman Sachs’ “Nicotine Nuggets” report, published on April 22, offers a fascinating glimpse into the tobacco industry through the eyes of retailers. Intended to inform investors, the report should provide public health authorities with valuable insights too.

It paints a clear picture of cigarette sales declining. Dollar sales of regulated cigarettes fell 5.1 percent in the year ending April 6. Many consumers are turning to cheaper alternatives.

The authors “remain cautious” on the short-term outlook for the industry, they write, “given continued economic pressures on the tobacco consumer, with many growing increasingly selective in their purchases, turning to more affordable alternatives, such as 4th tier/deep discount cigs, modern oral tobacco and illicit/gray market disposable vapor products.”

But while aspects of this trend are positive, it could and should be bigger and better, turning into the kind of sustained collapse in sales that doesn’t depend on economic hardship. Millions of people, often on low incomes, continue to smoke because US public health authorities give them no confidence in harm reduction alternatives.

And among those people who do switch, large numbers are compelled to use products that aren’t subject to safety standards and consumer protections. If they want flavored vapes, for example, as most adults who switch do, this is their only option.

The situation means FDA enforcement efforts against unregulated vapes are directly targeting major competitors to cigarettes.

While the report says the true size of the unregulated market “is hard to gauge due to limited visibility,” 82 percent of surveyed retailers expect it to grow further—up from 57 percent three months prior.

This could put people at risk. Adulteration of unregulated products is always a possibility, as the 2019 “EVALI” outbreak demonstrated (first falsely attributed to nicotine vapes, but in fact caused by vitamin E acetate turning up in unregulated THC vaping products).

The rise of unregulated vaping products is a direct consequence of the FDA’s overly restrictive regulations, with an applications process that has failed to authorize a single non-tobacco flavored vape. The agency has effectively ceded control of most of the US vapes market.

It’s a situation that means FDA enforcement efforts against unregulated vapes, and related legislation, are directly targeting major competitors to cigarettes identified in the Goldman report.

The report also reflects the surge in popularity of modern oral nicotine products such as ZYN and on!. Retailers and wholesalers report robust growth in this category—an 18 percent increase year-on-year. Like vapes, these pouches offer a much less harmful alternative to cigarettes, and their popularity illustrates that people who smoke are willing to switch if given appealing options.

All of this should demonstrate to public health that working with market forces here—responding to what people who use nicotine actually want, rather than imposing regulations that suppress their preferences—is a path to significant progress.

The Barclays “State of Global Tobacco” report, published four days earlier on April 18, further strengthens this argument. It shows how, in the current regulatory climate, cigarettes remain extraordinarily profitable. Manufacturers’ operating margins stand at between 38 and 56 percent—far in excess of other regulated staple goods.

The threat that disruptive technologies pose to these profits is being artificially deflated, when manufacturers of safer nicotine products face onerous and often insurmountable regulatory hurdles. Under the current system, it is easier for new cigarettes to gain FDA authorization than new vapes. Cigarettes remain a highly lucrative venture for tobacco companies, thanks in part to the agency.

Something is very wrong with this picture.

It’s time to embrace a smarter approach, one that harnesses nicotine consumers’ choices—which involves simply telling them the truth about relative risks—to hasten a smoke-free future.

The FDA urgently needs to change course. It should be guided by both science and consumer preferences in creating a landscape where people who smoke have good access to a wider range of much less harmful options.

That approach would incentivize the industry to innovate and develop better reduced-risk products, more rapidly undermining the dominance of cigarettes. Some tobacco companies have already moved in this direction: Philip Morris International (PMI) recently stated that 39 percent of its revenues now come from smokeless products. A landscape where these products weren’t placed at a regulatory and messaging disadvantage compared to cigarettes would force companies to move further and faster.

US public health authorities’ strategy of demonization and prohibition-by-stealth toward products that can save lives has protected the cigarette trade and failed people who smoke. It’s time to embrace a smarter approach, one that harnesses nicotine consumers’ choices—which involves simply telling them the truth about relative risks—in order to hasten a smoke-free future. Instead of swimming against the current, the FDA must adapt its regulatory systems to propel us towards a healthier society.

Photograph (cropped) by Mike Mozart via Flickr/Creative Commons 2.0

The Influence Foundation, which operates Filter, has received unrestricted grants from PMI, as well as a one-off donation from the author’s employer, the Taxpayers Protection Alliance, to support travel to a harm reduction event. Filter‘s Editorial Independence Policy applies.

The post Recent Reports Reflect How the FDA Props Up the Cigarette Trade appeared first on Filter.

A commitment to combating the real problem of health rumors and falsehoods is commendable. But Califf’s recent statements regarding tobacco harm reduction reveal a concerning level of misinformation of his own—and the distinct whiff of hypocrisy.

In January, the FDA announced an initiative designed to address public health misinformation. Explaining the rationale, Califf stated, “I actually believe that misinformation is the leading cause of death right now in the US.”

He added that “people are making bad choices driven by the information that they get.”

In May, Dr. Califf doubled down on this, declaring: “The distortions and half-truths of misinformation and disinformation pose enormous dangers to the effectiveness of science and to public health itself, through the negative impact it has on individual behavior.”

“That’s why I’ve made combating misinformation one of my priorities,” he promised.

A statement doesn’t have to be an outright lie to be a costly distortion.

Yet on November 2, he tweeted, “Use of tobacco products in any form—including e-cigarettes—is unsafe, especially among youth.”

A statement doesn’t have to be an outright lie to be a costly distortion. Calling vapes “unsafe” is only true if you apply a standard of safety far higher than we apply to other life activities or consumption choices.

Oversimplifying a complex issue, Califf ignored a large body of evidence that alternative nicotine products are exponentially safer than combustible tobacco—a distinction that is surely the key public health point, when the cigarettes that these products can replace kill nearly half a million Americans each year.

Numerous studies have demonstrated that switching from cigarettes to vapes or other reduced-risk products substantially reduces a person’s health risks. By sidelining these findings in favor of a simple recommendation not to use nicotine products in any circumstances, Califf contradicts the principles of harm reduction and contributes to the perpetuation of misinformation.

Califf obscured realities once more, this time expressing alarm about “millions of teenagers getting addicted to nicotine through vaping.”

Youth vaping, which Califf and his FDA colleagues continually emphasize, is a subject of debate regarding the extent, or presence, of net harms at a population level. What is not debatable is that any vaping harms do not come remotely close to those of smoking.

Califf obscured this reality once more on November 8, this time expressing alarm about “millions of teenagers getting addicted to nicotine through vaping.”

The same tweet also warned of smoking-related deaths. But rather than point out how millions of people have quit smoking thanks to vapes, Califf chose to make youth use his sole vaping point.  Again, it’s a distortion of public health priorities.

Califf’s depiction is also directly misleading. According to the Centers for Disease Control and Prevention (CDC), “current use” of vapes among US middle and high school students stood at 2.13 million in 2023, a big decline on the previous year. Yet most of this “current use” was occasional; well under a third of that 2.13 million total (29.9 percent of high school students who vape) reported the daily use that could even potentially qualify as addiction—not “millions.”

What’s more, modern definitions of addiction or substance use disorder rely significantly on the presence of serious life harms—harms largely absent with most teen vaping.

A more helpful approach would be nuanced enough to recognize that harm reduction strategies can be tailored to different age groups. It would balance legitimate concerns around youth access with the top priority of providing accurate information to people who smoke—including on harm reduction tools shown to be effective for smoking cessation.

In the fight against misinformation that Commissioner Califf ostensibly champions, it is crucial for public officials to lead by example.

By communicating an unequivocal stance against both combustible tobacco and harm reduction alternatives, Califf risks contributing, however inadvertently, to the burden of smoking-related illnesses.

Frustratingly, Califf has the platform to promote harm reduction as a valid strategy for adults who smoke, in a way that could meaningfully swell the numbers of those who benefit. His FDA role does not preclude this, when agency colleagues at least grudgingly admit that tobacco harm reduction has a role to play.

Califf’s failure to take this opportunity, along with the FDA’s refusal to properly regulate a wide array of vaping products to be made available to people who smoke, undermines public health goals. Talking down, or even ignoring, the benefits of harm reduction hampers the prospects of millions of people who smoke taking steps to improve their health.

In the fight against misinformation that Commissioner Califf ostensibly champions, it is crucial for public officials to lead by example. They have a duty to provide accurate, evidence-based and proportionate information to the public. Califf’s ill-conceived comments on tobacco harm reduction fail that test. 

Photograph of Dr. Califf in 2020 by Christopher Michel via Wikimedia Commons/Creative Commons 2.0

The post The Hypocrisy of FDA Commissioner Califf’s Stance on Vaping appeared first on Filter.

In July I wrote for Filter about COP10 threats to products that have helped millions quit smoking. These threats could, in Panama City this November, become formal WHO policies with worldwide impacts. COP10’s provisional agenda and other preparatory reports had previously been published, though were short on detail.

But a recent flurry of documents has revealed more of the WHO’s hostile strategy.

With no substantive justification, the WHO pronounces that “there is a need to regulate novel and emerging tobacco products by applying traditional tobacco control measures.”

Particularly egregious is a WHO report on regulation and disclosure of contents of alternative nicotine products. This document dismisses vaping for smoking cessation, stating that evidence in favor is “low” or “insufficient”—ignoring the November Cochrane Review finding of “high certainty evidence that nicotine e-cigarettes are more effective than traditional nicotine-replacement therapy (NRT) in helping people quit smoking.”

The WHO’s 9th “report on the tobacco epidemic” has also just been published. It’s funded by Bloomberg Philanthropies, which bankrolls global tobacco control efforts to restrict or ban alternative nicotine products. 

It claims that “aerosols commonly emitted by [heated tobacco products] do fall under the definition of tobacco smoke.”  The citation for this claim is not a scientific document, but an opinion given by one of the WHO’s handpicked reviewers in a previous report, who mused, “… aerosols generated by chemical reactions involving heat are termed ‘smoke’ … Can the aerosols of novel and emerging tobacco products qualify as ‘tobacco smoke’ ? Yes. … strictly speaking, visible aerosols deriving in whole or in part from thermally driven chemical reactions qualify as ‘smoke,’ even when combustion is not involved.”

The WHO’s tobacco epidemic report further insists that “[s]moke-free legislation should encompass new and emerging nicotine and tobacco products and specific products, like [vapes], should never be excluded from its provisions”—despite scant research on the effects of second hand vapor for bystanders, let alone any solid evidence of harm. Claiming that vaping is “undoubtedly harmful” and that vapes are “specifically targeted at children,” it calls for taxation at the same level as cigarettes, imposition of health warnings, and a ban on all non-tobacco flavors.

The WHO has also just published a report on heated tobacco products (HTP), which have led to a dramatic collapse of cigarette sales in countries such as Japan, South Korea, Italy and Lithuania. HTP are significantly less harmful than smoking, and one brand has been authorized by the United States Food and Drug Administration to be marketed as “modified risk.”

The WHO has also moved aggressively to cut the chances of COP10 parties being swayed by evidence-based opposition to a crackdown on harm reduction.

The WHO concedes that levels of Harmful and Potentially Harmful Constituents (HPHC) in heated tobacco aerosol are “typically lower than those found in the smoke from [combustible cigarettes].” But it still recommends that policymakers tax HTP as heavily as cigarettes, ban public use and mandate “large graphic health warnings and plain packaging … as for any other smoked tobacco product.” Here, the significance of the WHO’s “smoke” definition kicks in.

But perhaps the bluntest signal of the WHO’s intent came from a report made public on July 17, four months after the relevant meeting of the WHO Eastern Mediterranean region. With no substantive justification, the WHO pronounces that “there is a need to regulate novel and emerging tobacco products by applying traditional tobacco control measures.” The report recommends that governments “strengthen tobacco product legislation by regularly updating laws to include novel and emerging products.”

The WHO has also moved aggressively to cut the chances of COP10 parties being swayed by evidence-based opposition to a crackdown on harm reduction. It has now belatedly made public a report on how evidence on alternative nicotine products will be gathered to inform COP debates.

A working group, open to all signatories to the FCTC, used to compile up-to-date science on testing and reporting of product content and emissions. It was suspended in 2018. Administrators surveyed WHO members in 2020 and found that “60% of the Parties that responded indicated that they would like the Working Group to continue its work.” A second survey in 2021 also found that a majority of respondents favored reactivation of the working group—rather than replacing it with “an advisory group of experts and relevant partners … invited by the [FCTC] Secretariat” (read: carefully handpicked by the WHO).

Yet the WHO considers that these majorities “suggest little support at present for the reactivation of the mandate of the Working Group.” Siding with the minority, its report recommends that “an expert group be established to consider and make recommendations to the COP.”

It is vital that COP10 parties recognize these tactics for what they are, and make decisions based on robust evidence, rather than a steady stream of propaganda.

There appears to be no room for objective evaluation of the science in advance of COP10. Instead, the WHO is dishonestly railroading delegates toward a preordained outcome of heavy restrictions and prohibition when they gather in Panama.

In reviewing these concerted and gratuitous attacks on safer substitutes, you could be forgiven for concluding that the WHO wished to protect the incumbent cigarette trade.

For the good of global public health, it is vital that COP10 parties recognize these tactics for what they are. It is vital that they make their decisions based on robust evidence, rather than a steady stream of propaganda.

Photograph via Pxfuel

The post The WHO’s COP10 Takedown of Tobacco Harm Reduction Takes Shape appeared first on Filter.