“My Administration is committed to expanding access to lifesaving resources and uplifting evidence-based harm reduction strategies to support sustained recovery for those affected by addiction,” Sherill told the New Jersey Monitor in March. “Real recovery means breaking dangerous cycles, removing people from harmful environments and triggers, and ensuring people have stable access to critical resources.”

“We cannot afford to lose momentum in New Jersey’s efforts to end overdose deaths,” she added. 

The battle over New Jersey harm reduction during Gov. Murphy’s tenure was exemplified by years-long efforts to shut down (and save) the South Jersey Aids Alliance syringe service program (SSP) in Atlantic City.

Partly in response to that situation, Murphy signed legislation in January 2022 that removed the requirement for municipalities to approve SSP, though they retained powers over their location. That bill also expanded harm reduction by paving the way for more SSP statewide, establishing overdose fatality review teams, and decriminalizing syringe possession while allowing for expungement of past convictions.

“The Sherrill administration has not yet signaled an appetite for this kind of [spending].”

Will Gov. Sherill accelerate that kind of progress? Her proposed fiscal year 2027 budget, released on March 10, doesn’t offer much cause for optimism, according to Marleina Ubel, senior policy analyst at New Jersey Policy Perspective. Ubel commented that the proposal gives few specific details about the governor’s harm reduction goals, but looks to maintain the funding from the previous fiscal year of $4.5 million.

For Ubel, maintaining the same funding is effectively a cut, when what’s needed is an increase. “Murphy made legalization, harm reduction, decriminalization and criminal justice a priority,” she told Filter. “He did not shy away from these issues. He was a proponent of supervised injection sites, which is seen by many legislators as a radical policy.”

“We don’t know yet how Sherrill will look on these issues because she hasn’t spoken often about them,” she continued. “But I would be surprised if she was as forward and interested about getting some of those same policies done.”

In total, Murphy’s government invested $145 million into harm reduction programs during his tenure, not including increased funding for treatment and recovery programs, and family and peer support networks. That money included funding allocated by the legislature but most significantly, $119 million the state set aside from national opioid settlements. In 2025, an Advisory Council, set up by the state to oversee and make recommendations on how to spend the settlement money, released a strategic plan, focused on investment in the four areas of housing, harm reduction, treatment and coordinated wraparound services.

But Ubel is unsure whether tax money will now be allocated by state legislators and the governor at or above the levels seen under Murphy.

“The Sherrill administration has not yet signaled an appetite for this kind of [spending],” she said. “We’re in a really tight budget year, and that’s going to play a role. It’s going to be very difficult to get increased funding for many different initiatives. We do know the opioid remediation and recovery work is continuing, and more of that settlement money is being used. We do want to make sure it is used for its intended purpose. We want to see data-driven solutions being uplifted by her administration.”

“The governor is very supportive of these issues. It’s just the fiscal background of how we pay for all this.”

Use of the settlement money already sparked a political firestorm in the state capital, when legislators in 2025 voted to divert $45 million to four of the state’s major hospitals. The decision was lambasted by former Attorney General Matt Plotkin and inspired a “die-in” protest in Trenton, urging lawmakers to restore “raided” funds to harm reduction programs.

Axel Torres Marrero, senior director of public policy at the Hyacinth Foundation, takes a positive view of Sherrill’s intentions, but is fearful of how the Trump administration’s cuts to health care and social services will relate to New Jersey’s financial situation. His organization provides harm reduction and HIV services in seven cities statewide, and lobbies state lawmakers to create more favorable policy.

“We have an existing relationship with the governor that began when she was in Congress,” he told Filter. “We worked with our entire NJ delegation on issues like housing, Ryan White [HIV/AIDS program] and harm reduction. That office was always receptive and supportive. There’s no need for ‘level setting’ and the governor is very supportive of these issues. It’s just the fiscal background of how we pay for all this.”

His primary concern is the effect of Trump’s “Big Beautiful Bill,” which makes nearly $1 trillion in cuts to Medicaid spending over 10 years. It’s a devastating blow to harm reduction efforts, as Medicaid is the single largest payer for substance use and mental health treatment, and funds medicine and other essential services for people who use drugs. The $186 billion in cuts to SNAP, the food assistance program for people on low incomes is another major problem.

“We’re critically concerned about Medicaid and making sure NJ commits to mitigating the $400 million-plus funding gap from the ‘Big Ugly Bill.’”

“Our clientele relies heavily on health care safety net programs,” Torres Marrero said. “We’re critically concerned about Medicaid and making sure NJ commits to mitigating the $400 million-plus funding gap from the ‘Big Ugly Bill’ … Given that fact, and that we have to offset $150 million or more to make sure SNAP benefits can remain, we support level [harm reduction] funding for this year.”

“The best estimates say if NJ does not offset these cuts, we’ll have about 3,000 people living with HIV cut from the program—plus another 2,000 people who are at risk for HIV, including people actively engaged in substance use,” he added.

State data show that drug-related fatalities in New Jersey rose from 1,096 annual deaths in 2012, to 3,174 by 2022, the highest total recorded. Since then, deaths have slowly decreased, with 2,025 in 2024, the most recent year with full data—still far higher than historical figures. The impacts of vulnerable people losing food security and services aren’t hard to imagine.

New Jersey harm reduction has significantly scaled up since the years of Governor Chris Christie (R), who embraced recovery support and supply-side attacks on opioid prescriptions but was more hostile to harm reduction efforts. From Murphy’s second term, access to harm reduction services skyrocketed—increasing 122 percent from 2022-2024. That year, 4,500 people participated in programs statewide, which now number 47 in total—a massive jump from previously, when just seven programs operated. Programs reported distributing over 16,000 doses of the overdose-reversing medicine naloxone and 500 prescriptions for the opioid use disorder medication buprenorphine.

With newer harm reduction programs still just beginning to scale up, Torres Marrero urged that now is the time for the state to maintain their funding, so progress doesn’t stall or reverse.

“Some organizations are further along than others, those that have a  historical footprint in [this field],” he said. “They have some structural advantages. Those that are newer in this space require and deserve more time. It’s difficult to hire and maintain professionals in this field. It takes about 18 months from receiving funding to then start seeing significant results. Level funding will ensure these programs can remain open. And phase two would be the expansion of these into other communities and counties where the prevalence and incidence rates [show a need].”

That geographic expansion, he continued, should include adding more programs in different neighborhoods of large cities like Newark or Paterson, as well as additional programs in suburban and rural communities in New Jersey’s south and shoreline regions.

Photograph (cropped) by Collin via Wikimedia Commons/Creative Commons 2.0

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Close to $1 trillion will be cut from Medicaid over 10 years, under the One Big Beautiful Bill Act that President Trump signed in July 2025. Medicaid is the biggest payer for substance use disorder treatment in the United States, and around 40 percent of people with opioid use disorder rely on the program for health coverage.

Specific cuts and further threats apply to naloxone provision, medications for opioid use disorder, harm reduction research and much more. 

Then in January, the administration abruptly slashed $2 billion from Substance Abuse and Mental Health Services Administration (SAMHSA) grants to public health and social programs, including harm reduction—before reversing the decision the very next day. The impacts on scrambling providers were still real.

“As far as scaling up to meet the community’s need, that’s not the conversations providers are having. It’s really about survival mode.”

The Legal Action Center (LAC) works for health justice, advocating for the rights of people impacted by criminalization, substance use disorders and HIV. To help get a sense of the current damage and future prospects, Filter spoke with Gabrielle de la Guéronnière, LAC’s vice president of health and justice policy. Our interview has been edited for length and clarity.

Tana Ganeva: What’s your overview of the situation with the cuts, and how they threaten access to care and harm reduction for people who use drugs? 

Gabrielle de la Guéronnière: We’ve been very concerned. It’s been a very challenging time for people who are running programs on the ground. People are trying to help people stay healthy and stay alive, and there has been a lot of confusion from the administration in a number of different ways, and a lot of really concerning, harmful rhetoric that’s very stigmatizing toward the people who are being served by those programs and toward people working in those programs.

Suggesting that these are dangerous services, that they are not evidence-based, that they are ineffective, and that they shouldn’t receive support—when we know that they are evidence-based. They are extremely effective in preventing infectious disease, and also in connecting people who would like substance use disorder treatment and recovery services to those services. 

So it’s been a very difficult, challenging time. 

TG: What was it like for programs that were told, if only for one day, that their grants were going to be cut under the January SAMHSA defunding decision?

GdlG: Programs received notification that grant funds would be terminated immediately—and we know that people lost their jobs because of that, because programs were told that this was happening, that funding would not be coming. And so in very real terms, we know that there were programs that were impacted. 

When you think about how difficult this work is, when we know how many people are at risk for overdose and are at risk for all kinds of other health problems, the focus should be what [harm reduction programs] need and doing what they do best, which is providing those critical health services, because they are health services.

Instead, providers are worrying about how they’re going to keep the doors open. As far as potential expansion or scaling up to meet the community’s need, that’s not the conversations people are having. 

It’s really about survival mode. It’s hard to forecast. And nonprofits need to forecast. It’s very difficult. 

“We are very worried with what we’ve seen with the work requirements for Medicaid … They are forecasting that millions of people will lose health coverage.”

TG: Without being in the administration’s heads—a scary place—can you guess why, having yanked the SAMHSA funding, they then reinstated it?

GdlG: I think one positive thing has been that there are a lot of people in both parties who understand the value and the need for funding for these services around the country. 

We immediately saw that policy change, literally overnight, because there were all kinds of stakeholders who weighed in with their members of Congress, and talked about how critical these dollars were, both substance use funding, and mental health dollars that help people in their community to get healthy, to maintain their health, to prevent all of the different harms that could occur if someone’s disconnected from care and services and supports and medications. 

TG: Then there are the massive cuts to Medicaid over 10 years. What do you make of that, and what is LAC doing to try to mitigate the impacts?

GdlG: We’re extremely concerned about the Medicaid cuts. We do a lot of work with people who have substance use disorders, have mental health conditions, have histories of incarceration, and face a lot of stigma and discrimination in the job market. 

We are very worried, too, with what we’ve seen with the work requirements—as different states have tried work requirements, and attaching that to Medicaid—that people who are working often lose coverage, because the administrative burden is really difficult. 

So they are forecasting that millions of people will lose health coverage. We’re extremely concerned about that, and doing a lot of work to try to engage with decision-makers, and states and localities and stakeholders, to try to help people to maintain coverage. It’s so critical to helping people stay safe and alive. 

TG: In the wake of all this, do you envision a spike in overdose deaths? 

GdlG: I worry about that. There are many people who worry about that, that people are vulnerable, and if you make it harder for them to be able to access health care, it’s going to make it more difficult for them to stay healthy. Our whole health care system is very unaffordable and it’s a very challenging time with the economy and getting jobs. So we’re worried about it. We’re very worried about it. 

“There are a number of things that states can do to try to minimize the burden on individuals … There are ways that you can create systems to protect people.” 

 

TG: Looking ahead, in terms of these and potential further cuts, what are your worst fears? And do you see any more encouraging signs?  

GdlG: We were pleased that the conferenced fiscal-year 2026 Labor, Health and Human Services, and Education bill, which President Trump signed into law, increases SAMHSA funding by $65 million over last year’s levels. We appreciate the continued strong bipartisan support in Congress for treatment, prevention and recovery services.

We continue to be extremely concerned about the administration’s repeated attempts to claw back Congressionally appropriated funds which have created huge uncertainty and upset for community-based programs providing life-saving services in our communities.

We are also extremely concerned about the administration’s continued negative, inaccurate rhetoric and damaging actions related to harm reduction services. Harm reduction strategies and interventions are evidence-based health services that are effective in meeting the health-care needs of people who use drugs, and connecting people who need and want it to substance use disorder services, medications and support in treatment and recovery. 

Precluding the use of federal dollars for critical harm reduction services will make it more difficult for community programs to keep their doors open, will make communities less healthy, and will put more people at risk for overdose.

TG: What’s the best realistic outcome in the next couple of years? What can be done to adapt?

GdlG: There are a number of things that states can do to try to minimize the burden on individuals. There are different systems they can set up, so if they have data about a person’s health history or work history, they can use that data to demonstrate that that person qualifies for an exemption to the work requirements [for certain Medicaid enrollees]. 

There are a number of provisions that create exemptions—for people who are in certain kinds of substance use to start treatment, or people who have recently reentered from incarceration, or a person who has a chronic, serious health condition. There are certain protections there, so there are ways that you can create systems to protect people. 

There are also wonderful people in our field, who will be working to really protect people and ensure that people are able to demonstrate what they need to, to maintain coverage. It’s really going to take all of us working together to make sure people can continue to access coverage and care.

Photograph by Nikolaos Dimou via Pexels

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SAMHSA employees, including leadership, were reportedly unaware of the cuts until a few hours before the letters went out. The decision to terminate the grants is being widely attributed to Department of Health and Human Services Secretary Robert F. Kennedy Jr., who in 2025 gutted SAMHSA and intends to consolidate the remains into his proposed Administration for a Healthy America, once it exists.

“After national outrage, Secretary Kennedy has bowed to public pressure and reinstated $2 billion in SAMHSA grants that save lives. These are cuts he should not have issued in the first place,” Representative Rosa DeLauro (D-CT) stated January 14. “Our policy must be thoughtful—not haphazard and chaotic. This episode has only created uncertainty and confusion for families and healthcare providers.”

The services targeted include naloxone distribution, access to medication for opioid use disorder and treatment for pregnant and postpartum SUD patients, among others. But SAMHSA grants keep the lights on for a huge number of projects that extend beyond harm reduction, like suicide prevention and first responder training. Even the American Psychiatric Association Foundation’s program offering free mental health training in K-12 schools would have been shuttered.

“[N]o corrective action is possible here since no corrective action could align the award with current agency priorities,” SAMHSA told the grant recipients.

“Although in its discretion SAMHSA may suspend (rather than immediately terminate) an award to allow the recipient an opportunity to take appropriate corrective action before SAMHSA makes a termination decision,” stated the letter issued en masse the night of January 13, “after review and consideration, no corrective action is possible here since no corrective action could align the award with current agency priorities.”

Government Executive reported that a source with access to the data put the number of affected grants at between 2,500 and 2,900. Because the grants had already been awarded, terminating them would have not just pulled the plug on future projects, but cut off substance use disorder (SUD) patients from treatment and cost providers their jobs.

“A majority of the funding for these grants was already appropriated by Congress, so their termination is technically illegal,” Maggie Hart of Drug Policy Alliance (DPA) said in a statement. “And over the last few months of ongoing federal appropriations negotiations, this funding was on track to being preserved by Congress. These terminations come on top of $1 trillion cuts to Medicaid—the single largest source of funding for addiction treatment.”

However, on the same day it issued the grant termination letters, SAMHSA posted a $231 million grant to run the 988 Suicide & Crisis Lifeline. The National Council for Mental Wellbeing stated January 14 that in addition to the 988 lifeline, funding has continued for the State Opioid Response Grant and the Certified Community Behavioral Health Clinic program.

The turmoil comes just two weeks before the deadline for Congress to reach a new funding agreement or face another government shutdown. It also hasn’t been the only chaotic reversal within HHS during this time.

The same day grant recipients were notified of the cuts, HHS reinstated some 400 National Institute for Occupational Safety and Health employees. They’d been on paid leave since April 2025, in limbo with no indication from HHS as to the future of their jobs, until they were unexpectedly informed that the previous “reduction in force” notice they’d received was being revoked, effective immediately.

Image via State of Oregon

The Influence Foundation, which operates Filter, previously received a restricted grant from DPA. Filter‘s Editorial Independence Policy applies.

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The “Advancing Cross-Cutting Engagement and Service Strategies for People who Use Drugs” program, known as ACCESS, made history in 2020 as the first in the state to provide funding directly to harm reduction organizations.

Years later, as President Donald Trump’s administration ramps up its drug war and slashes funding that’s crucial to prevent overdose deaths, the latest request for applications (RFA) from the Maryland health department’s Office of Harm Reduction—which gives little time for organizations to adjust their own language when they apply—has dropped the name of the movement from which the office takes its title.

This follows open hostility to harm reduction from the Trump administration, as demonstrated by a July “Dear Colleague” letter, which stated that Substance Abuse and Mental Health Services Administration (SAMHSA) funds “will no longer be used to support poorly defined so-called ‘harm reduction’ activities.”

“I think these are unspoken messages about what their leadership’s opinion is on harm reduction.”

“In my opinion, Maryland is taking [federal guidance] to an extreme,” Erin Russell, a harm reduction consultant who started the ACCESS program while chief of the former Center for Harm Reduction Services, told Filter.

“I think these are unspoken messages about what their leadership’s opinion is on harm reduction,” she said of the Maryland administration. “They’re not being transparent about the funding amount, and they’re not supporting the team by producing a transparent and normal RFA process. The scrubbing of harm reduction is not coming from the harm reduction team themselves, so we can only assume that someone higher up is parsing this change.”

Funding for ACCESS grants has been made up of both state and federal dollars. A state health department spokesperson told Filter that the program allocated a total of $26 million in the most recent fiscal year, but declined to comment when asked about the next budget allocation and whether there would be cuts.

The program has been responsible for allocating millions to local harm reduction organizations annually, and there are fears that there will be a significant decline in grant funding for the upcoming fiscal year.

The ACCESS RFA opened on December 22, and will close on January 22. The state health department says the timeframe exceeds the three-week minimum for notices required under state law. But Russell called the timeframe “absurd.”

The request was issued over the holiday season, she noted, giving organizations even less time to apply for funds when they will likely have to modify their application language to do so.

“I don’t think the work will continue at the same volume … It hurts people, and more people will die with the system as it’s been redefined.”

The terminology change in the RFA, which replaces “harm reduction” with phrases such as “services designed to reduce morbidity and mortality among people who use drugs,” isn’t in and of itself the problem, Russel said. Regardless of what compassionate care for people who use drugs is called, the movement will go on, and life-saving services will continue.

However, the move, combined with actions at the federal level, has negative implications for local harm reduction initiatives. Not only could they receive less aid because the grant program itself is underfunded, but they could be pushed further underground.

“I don’t think the work will continue at the same volume that it is now, or has been,” Russell said. “There are plenty of programs that were maybe renting space and offering drop-in services that are not going to move back to the trunk of someone’s car. Or places that were going to buy mobile vans are now not going to do that level of expansion.”

“It hurts people,” Russell said, “and more people will die with the system as it’s been redefined.”

In July, Trump signed an executive order in July to criminalize homelessness, ramp up forced institutionalization of people with mental illnesses and substance use disorders, and defund life-saving harm reduction programs. The SAMHSA letter, stating that certain harm reduction programs  “only facilitate illegal drug use and its attendant harm,” followed days later.

“It’s very frustrating … but in the end, I think this is a compromise that they may need to make to be able to provide services that really do save people’s lives.”

Dr. Joshua Sharfstein, professor at the Johns Hopkins Bloomberg School of Public Health, told Filter that a shift in how the Maryland government speaks about harm reduction may be a necessary hardship under the Trump administration.

“For people who understand and practice [harm reduction], hearing the words vilified is unpleasant—that’s the minimum,” Sharfstein said. “It’s very frustrating. It’s unfortunate, but in the end, I think this is a compromise that they may need to make to be able to provide services that really do save people’s lives.”

It’s unclear what policy impact these changes will have, he added, as the federal government seems to have thus far equated harm reduction with programs such as overdose prevention centers, of which there are only three sanctioned examples in the country.

In Baltimore, where OPC have been debated for years as the city’s fatal overdose rate climbed to the highest in the nation, the federal guidance has already been felt on that front.

In October, Baltimore Health Commissioner Dr. Michelle Taylor told Filter that the city wouldn’t pursue these life-saving spaces because of fears of losing federal funding.

More recently, Mayor Brandon Scott (D) removed OPC from his list of legislative priorities. And members of the state’s Harm Reduction Standing Advisory Committee announced in December that OPC legislation wouldn’t be introduced in the upcoming state General Assembly session, as they will instead channel their energy into decriminalizing drug “paraphernalia.”

“[The department] remains focused on protecting the health and safety of our communities, which includes addressing the health, well being and mortality of Marylanders who use drugs.”

Still, state officials have insisted that existing programming will not suffer. Health Department spokesperson David McCallister told Filter that the agency is simply adjusting its language to abide by guidance from the Trump administration.

“This funding, along with state funds and other federal grants, is critical to our mission of continuing life-saving, evidence-based interventions for Marylanders who use drugs,” he said. “The Maryland Department of Health remains focused on protecting the health and safety of our communities, which includes addressing the health, well being and mortality of Marylanders who use drugs.”

The state likely cannot afford to have its harm reduction efforts take a hit. Its overdose prevention initiatives have contributed to a notable decline in deaths statewide. In Baltimore, which has by far the highest fatal overdose rate in the state, there were 777 overdose deaths in 2024, a historic 25.5-percent decrease from the year prior, according to preliminary data.

In the 12-month period ending in October, the most recent data available, Baltimore saw 560 deaths, indicating that the trend continued into much of 2025.

Update, January 13: This article was updated to reflect information about the last ACCESS budget allocation, received from the Maryland Department of Health after publication time.

Image by Filter

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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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In 2018, the SUPPORT Act established Medicaid coverage for all three medications for opioid use disorder (MOUD)—methadone, buprenorphine and naltrexone. But the 251-page document doesn’t acknowledge harm reduction outside of a single paragraph covering syringe service programs, and the 2025 reauthorization doesn’t add anything on the subject.

The original Act commissioned a study focused on access barriers to buprenorphine, naltrexone and “buprenorphine-naloxone combinations” AKA Suboxone. It left out methadone, the MOUD with the most obvious access barriers, but seven years later one of the more notable additions in the new version is a section that advances the potential rescheduling of Suboxone, or any buprenorphine/naloxone combination product. 

Naloxone is not a controlled substance. But buprenorphine is, under Schedule III alongside drugs like ketamine and testosterone. The Act directs the Department of Health and Human Services (HHS) to “review the relevant data pertaining to the scheduling of products containing a combination of buprenorphine and naloxone that have been approved under section 505 of the Federal Food, Drug, and Cosmetic Act [and] if appropriate, request that the Attorney General initiate rulemaking proceedings to revise the schedules accordingly with respect to such products.”

This requirement appeared in the reauthorization bill approved by the House Committee on Energy and Commerce in 2023, but neither that bill nor the Senate version was advanced in time to replace the original Act before it expired that September.

The reauthorization quietly advances the campaign to install nalmefene as a viable alternative to naloxone.

Among the other additions that weren’t in the 2018 version is an amendment approved by legislators in June—proposed by Rep. Robert P. Bresnahan (R-PA), whose cousin died of overdose. It prohibits HHS grant guidance from singling out naloxone as the default opioid-overdose reversal medication:

“The Secretary of Health and Human Services shall ensure that, as appropriate, whenever the Department of Health and Human Services issues a regulation or guidance for any grant program addressing opioid misuse and use disorders, any reference to an opioid overdose reversal drug (such as a reference to naloxone) is inclusive of any opioid overdose reversal drug that has been approved … for emergency treatment of a known or suspected opioid overdose.”

Bresnahan, who since taking public office for the first time in January has become best known for ethically dubious stock trades, described this slightly differently in his testimony to colleagues. He stated that current “HHS regulations refer to certain name-brand drugs, such as Narcan, which can limit usage of other versions that may be more readily available.”

This is a really good point, though completely different from the one Bresnahan is intending to make. Using the brand name “Narcan” rather than the generic “naloxone” does contribute to generic injectable naloxone being overlooked by public officials, even though it’s more affordable and in many cases more humane. This is not the problem Bresnahan is looking to solve.

Many overdose-response regulations refer to naloxone as the default opioid-overdose antidote because up until 2023 there weren’t any others. But since Food and Drug Administration approved the first such antidote formulated with nalmefene, a different chemical compound, pharmaceutical companies and other stakeholders have been pushing legislators to cut references to naloxone in favor of “any opioid overdose reversal drug” approved by the FDA. The campaign to install nalmefene as a viable alternative to naloxone has continue despite emphatic warnings from public health experts about nalmefene’s higher risk of overdose and unnecessary suffering for people who regularly use opioids.

Image (cropped) via Drug Enforcement Administration

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Mayor Brandon Scott (D) appointed Taylor—the former director of the Shelby County Health Department in her home state—as Baltimore’s top health official in August, and she was confirmed by the City Council on September 15.

She’s taken the reins as President Donald Trump targets harm reduction initiatives nationwide and slashes public health funding. Locally, a string of mass overdose events in Baltimore’s Penn North neighborhood has struck fear into the community, and police have cracked down harder on people who use drugs.

At a time when public health faces an uncertain future and fear is being weaponized to fan the flames of the drug war, Taylor says she is forced to be realistic.

“We always have to be cognizant of who’s in office right now.”

That includes taking a step back regarding overdose prevention centers (OPC) in Baltimore. Taylor is a vocal advocate for the facilities, and harm reductionists have ramped up demands for city-sanctioned sites in response to a spate of overdoses and repeated failures to legalize them at the state level. 

“While local public health would love to do everything that could potentially fit under our umbrella, we always have to be cognizant of who’s in office right now, not only federally [but] at the state level and city level,” Taylor told Filter during a sit-down interview.

“I want to be compassionate,” she continued. “But does being compassionate mean that we are not going to be able to maintain our levels of federal funding, where we need to do all of the other services that we need to do?”

Taylor’s concerns over potential retaliation if the city were to press forward unilaterally with OPC stem from the fact that nearly half of Baltimore City Health Department’s $201 million budget comes from federal funding.

Nonetheless, she asserted that the city has “all the pieces it needs” to turn the tide of the overdose crisis, though the federal government’s position impedes the efforts of some City Council members to push for more tools to save lives.

Even without the issue of a hostile White House, Taylor’s department must also operate on $7.3 million less in funding than in 2024.

Baltimore’s most recent budget entails a 3.5 percent cut to the health department funding due to a decrease in state and federal aid. Yet its police budget has been boosted by $22 million. That increase comes as officers have targeted people who use and sell drugs under the guise of violence prevention.

The tension between policing and harm reduction has been an ongoing problem in Baltimore.

As of September, there was a 21 percent increase in misdemeanor drug arrests compared to the January-September period of 2024, and some police districts have seen drug-related arrests double. Baltimore Police Commissioner Richard Worley told a September public hearing “there’s no way around” targeting drug users for arrest.

Asked about the impact of drug-war policing on public health efforts—studies have shown that crackdowns can increase fatal overdoses and violence—Taylor would not directly answer the question.

Although she said there are cases when the police and public health officials “shouldn’t meet in the middle,” she asserted that public safety and public health are still “inextricably linked.”

“There are times when public health should be the focus. But at the same time, we know when police should be the focus,” Taylor said. “The question is, how do we get to a place in our community where the police get to do the work they’re supposed to do, and public health can continue to save lives in every way we can?”

The tension between policing and harm reduction has been an ongoing problem in Baltimore.

It was on display after July saw the first of a series of mass overdose events in the city, which was attributed to a mix of fentanyl and a rare, potent benzodiazepine. Nearly 30 people were hospitalized, though a cadre of harm reduction workers were on the scene to prevent deaths and conduct outreach.

Shortly afterward, police raided the neighborhood and arrested five people.

Since then, two additional mass overdose events have occurred, the most recent on October 8. Each time, city officials attempted to emphasize a public health-focused response—while police officials assured residents they would crack down on those involved.

“The city is being very intentional about investments. In Memphis-Shelby County, I had to beg for half a million dollars for naloxone and test strips.”

To Taylor, who said her department is now drafting a mass-overdose response protocol, there’s evidence that the city prioritizes public health over interdiction. Despite cuts to the health department, $9.8 million was allocated to mental health and substance use programs in the most recent budget—more than quadrupling expenditure in those areas from a decade ago.

“While it’s not perfect, the proof is in the investments being made,” Taylor said. “And the investments are truly being made in public health. You can’t argue with that. And now it’s up to us to really use those investments in such a way that not only are we going to be able to save more lives, and we think we’re already starting to do that, but we can work on all these other issues that come with it.”

The total health department budget is still dwarfed by the police department’s budget of over $600 million, however.

Despite the precarity of public health funding, Baltimore is in a unique position to ramp up investments in harm reduction and treatment initiatives.

After years of litigation, the city is slated to receive roughly $580 million from lawsuits against opioid distributors and manufacturers over the city’s overdose crisis.

A significant portion—more than $100 million—must be used to cover legal fees. And one of two distributors that a judge ordered to pay Baltimore $150 million in an August decision has appealed, making that award uncertain.

Still, the city has already received nearly $240 million after accounting for fees. The money is slated to be allocated over 15 years, and none of it can be used for “punitive” programs, officials have said.

Taylor acknowledged the money isn’t as much as it seems when spread out over that period, but she is confident the city will use it wisely and be proactive about planning for funding sources further down the line.

“The city is being very intentional about investments,” Taylor said. “They’ve made a $20 million investment over five years in the health department. That’s huge for a health department. In Memphis-Shelby County, I had to beg for half a million dollars for naloxone and test strips.”

“It’s really about showing people you do care—that you’re showing up, that you at some level know what they’re dealing with.”

In the current budget, Baltimore earmarked nearly $37 million for harm reduction and treatment initiatives. Of that, the city’s new Restitution Advisory Board only has discretion over $2 million, and that money is now being advertised to community-based organizations through a competitive application process.

Whatever the amount, those dollars could be crucial in the city’s efforts to combat the overdose crisis. Although fatal overdose rates have dropped significantly in the past year, Baltimore has continued to see the highest overdose deaths per capita of any major city in the United States.

The numbers further demonstrate that Taylor has taken over as health commissioner amid myriad unknowns.

It’s unclear if that downward trend will hold, and she’s helming the health department of a city that’s already in the federal government’s crosshairs. Heavy-handed policing, an increasingly unpredictable drug supply and the threats to federal funds combine to imperil efforts to keep people who use drugs alive.

Yet the new health commissioner was drawn to Baltimore in part because of its rich harm reduction history, with its syringe service program dating back to 1994, and she intends to maintain that image.

Harm reduction advocates have fought for more, including OPC and “paraphernalia” decriminalization. But even if those things don’t come soon, Taylor said the city has the most important tool: compassion.

“It’s really about showing people you do care—that you’re showing up, that you at some level know what they’re dealing with,” she said. “And if you don’t know, at least we are empathetic to what you have to deal with. That alone gives people hope that we can get to the other side. It took time to get to this point, and it’s going to take time to get out of it. But it means we have to show up.”

Photograph of Baltimore City Health Commissioner Dr. Michelle Taylor by Logan Hullinger

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Regardless, President Donald Trump justified the act as a new front in a very literal drug war. “Let this serve as notice to anybody even thinking about bringing drugs into the United States of America,” he said. “Killing cartel members who poison our fellow citizens is the highest and best use of our military,” Vice President JD Vance posted.

Over the course of the week, government officials pledged to take more military action against alleged drug-trafficking groups in Latin America.

“They say they want to protect Americans from drugs, but their policies don’t match these words. They’re cutting services that save lives.”

Yet as members of the Trump administration bluster about military drug-war escapades in multiple countries, they’re simultaneously gutting federal programs that provide crucial care for people who use drugs or suffer from mental illness—actions that may be less dramatic, but have at least as much deadly threat.

“They say they want to protect Americans from drugs, but their policies don’t match these words,” Hanna Sharif-Kazemi, policy manager with the Drug Policy Alliance (DPA) Office of Federal Affairs, told Filter. “They’re cutting services that save lives.”

A new tracker created by DPA and the Legal Action Center outlines the staggering array of cuts to federal programs that fund services that people who use, or have used, drugs rely on to stay healthy and safe.

In 2024, overdose deaths dropped by a substantial 27 percent, the CDC reports, after a spike during the COVID-19 pandemic. The steady decrease is significantly attributed to harm reduction efforts like increased access to naloxone and medications for opioid use disorder. The administration’s cuts, drug policy experts say, will be catastrophic, halting the downward trend in overdoses and leading to more large-scale death and suffering.

The administration is demanding a massive shakeup of the Department of Health and Human Services that will likely dismantle SAMHSA.

The administration has already pulled $345 million from federal programs that fund services around the country and $588 million from drug research. Medicaid is the largest provider of substance use disorder treatment, according to a report by the Brookings Institute, and its budget has been slashed by $1 trillion over the next decade.

Now, the administration is demanding a massive shakeup of the Department of Health and Human Services that will likely dismantle the Substance Abuse and Mental Health Services Administration (SAMHSA). The elimination of SAMHSA would see an estimated $26 billion more pulled from overdose prevention and addiction care.

Virtually no US program designed to help people who use drugs won’t be affected. SAMHSA funds naloxone distribution and training, treatment programs and access to medications. The agency also helps people in underserved rural areas obtain treatment. HHS, its parent department, is expected to lay off 20,000 federal employees.

“The landscape is brutal,” Sharif-Kazemi said. “We are seeing the end of services people are relying on to stay alive.”

The situation on the ground has already gotten grim. Sharif-Kazemi pointed to a Wisconsin treatment center that had to shut down, which provided treatment for women with children. Hundreds of peer recovery staff were laid off, drastically jeopardizing patients’ own path to recovery. After losing a DOJ grant, a North Carolina nonprofit will no longer help people into treatment instead of jail, according to the tracker. Texas shut down a 24/7 addiction and mental health support line due to lost funding.

“I can’t stop thinking about the parent who won’t have naloxone on hand to reverse an overdose and save their child’s life.”

The impact of the cuts will only get worse over time. Unlike the federal government, states have to balance their annual budgets. So programs that are left primarily relying on state, rather than federal, funds will be further impacted.

Lawmakers have decried previous cuts impacting their states. “At a time when New York is facing an ongoing opioid epidemic, multiple confirmed cases of measles and an ongoing mental health crisis, these cuts will be devastating,” New York Gov. Kathy Hochul said in March, after an initial round had been announced. “There is no state in this country that has the financial resources to backfill the massive federal funding cuts.”

“I can’t stop thinking about the parent who won’t have naloxone on hand to reverse an overdose and save their child’s life,” Sharif-Kazemi said. “Or a person who can’t access buprenorphine to check their cravings, relapses.”

She sees no logic, only cruelty, when harm reduction interventions and other public health spending can ultimately save money, as well as lives.

“It’s truly devastating,” she concluded. The Trump administration tries to justify their War on Drugs as a way to keep Americans safe from drugs. Their actions make us far less safe.”

Photograph via PXHere/Public Domain

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The event took place weeks after the host nation—where the government is pursuing reform—had achieved a significant international victory, with positive implications for future global drug policy.

In March—at the 68th session of the Commission on Narcotic Drugs in Vienna, Austria—Colombia proposed a resolution calling for an independent, external review of drug treaties. The resolution passed with 30 affirmative votes, 18 abstentions and three rejections—from Argentina, Russia and the United States.

The resulting review will conclude with a series of policy recommendations made by 19 interdisciplinary experts evaluating the effectiveness of current UN drug policy, which underpins worldwide prohibition.

“This is a sign that the global debate on drugs has gone into a new phase. A phase that values accountability more than silence, and progress more than inertia,” said Laura Gil, ambassador-at-large for Colombia’s Global Drug Policy, in her plenary speech at HR25.

Gil’s work focuses on gender equity, environmental justice and human rights. Her work in Vienna was applauded throughout the conference as a step toward what delegates described as “evidence-based, people-centered drug policy reform”—and an example of strong leadership from the Global South.

“We have seen there is a crop of leaders who are coming from the Global South.”

“It is time for the people who use drugs to take leadership,” Ahmed Said told Filter at the conference. Said, from Kenya, represents the African Network of People who Use Drugs (AfricaNPUD) and identifies as a person who uses drugs himself.

“We have seen there is a crop of leaders who are coming from the Global South, and we also have a crop of leaders from the Global North who come from the community of people who use drugs and really complement the effort,” he said.

Yet at the same time, in many places, “exclusionary ideologies are gaining ground,” as Shaun Shelly, executive director of HR25 organizer Harm Reduction International, noted at the conference.

One element of the threat this poses, felt directly by many of those present, concerns funding for harm reduction work.

Large harm reduction projects in the Global South are often internationally funded. The Trump administration’s decimation of the US Agency for International Development (USAID) has already impacted access to HIV services in countries like South Africa.

“We’ve been hit hard, and currently America and South Africa aren’t seeing eye-to-eye,” Klaas Melusi Mtshweni, of the South African Network for People who Use Drugs, told Filter. He expects the worst is yet to come, with ramifications far into the future when “research has been unfunded by the US in South Africa.”

“USAID was providing about 17 percent of the HIV response in South Africa and mostly covering rural areas, covering doctors and some facilities,” Mtshweni explained. Since the US cuts, “We’ve lost about 23,000 staff members that were seeing clients. Some clinics have closed. But the most hit are the NGOs, the organizations on the ground that are mobilizing communities, that are doing … testing, tracing. We have about 150 organizations that have closed.”

Funding often goes to larger organizations that do not “understand how that community operates, and are not able to meet that community’s needs in an effective way.”

Lack of financial support is a ubiquitous problem for community-led organizations, in particular—something that often reflects the choices made by those awarding scarce funding. 

Sex worker activist Claire Macon, who is the overdose prevention center manager for Project Weber/Renew in Rhode Island, told Filter that small organizations created and led by people with lived experience often struggle to access the same financial support as larger organizations. She spoke of small organizations being overlooked because funding “is going to a ‘rescue’ organization that is not from that community.”  

Claire Macon (right) with Julianna Brown, MD, of Decrim305 and Idea Exchange. The two presented collaboratively on sex worker-led harm reduction.

When funding is allocated to harm reduction, Macon continued, it often goes to larger organizations that are not created by the people most impacted, and which do not “understand how that community operates, and are not able to meet that community’s needs in an effective way.”

“We are not taken into account when public policies are being built.”

The need to support initiatives led by people with lived experience, with the awareness they bring to intersecting needs, was a central message throughout HR25—including centering Indigenous-led initiatives.

“We are not taken into account when public policies are being built,” said Luz Mery Panche Chocué, an Indigenous leader from Colombia’s Amazonian territory of Caquetá, in her plenary speech. Saying that Indigenous communities have begun to work their way into participating in policy spaces, she continued that, “if we are going to talk about experts, then really the experts in the care of the Amazon rainforest are the native peoples [translated from Spanish].”

Luz Mery Panche Chocué giving her speech at HR25

“When we talk about peace and justice in relation to drug policy,” said Dandara Rudsan of the Black Initiative for a New Drug Policy in Brazil (pictured top), in her plenary address, “we must directly face the truth that it will not be possible to achieve a state of peace and justice without guaranteeing the right to land, without agrarian reform, and without the direct participation of traditional communities and peoples in the development of policies [translated from Portuguese].”

“It’s time now [for people who use drugs] to be presented as partners in the field of harm reduction,” Said told Filter. “If you present us as partners, you attract possibility, you attract resources. If you represent us like a patient, you attract punishment and you attract vulnerability, and you attract the stereotyping part of it.”

“People who use drugs are no longer sick people,” he emphasized. “They are just partners. They are just equal leaders that can lead. They can lead the movement. They can work with other stakeholders with different expertise.”

All photographs by Anna Wilcox

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Nevertheless, Vietnam’s National Assembly voted in November 2024 to ban nicotine vapes, which help drive down smoking rates in those countries where they are available. For people who smoke and cannot or will not quit nicotine, vaping is a far safer way to get it.

Smoking kills; vaping, as best as we can tell, does not.

So why did Vietnam ban vapes? A cynic might say that lawmakers were trying to protect Vinataba, the government-owned tobacco company, from a competitive threat. Vinataba controls about two-thirds of the cigarette market.

Disinformation from the Bloomberg network and from the WHO played a role. The WHO is a key cog in the Bloomberg machine.

But some credit—or blame—for the vaping ban surely belongs to Michael Bloomberg, the billionaire American philanthropist whose foundation supports an influential global network of anti-tobacco groups, including the World Health Organization. These groups oppose vaping as well as smoking, not just in Vietnam but in more than 50 low- and middle-income countries, from Argentina to Zambia.

The Bloomberg-funded crusade against vaping has scored big wins in some of these countries over the years. Brazil became one of the world’s first countries to ban vape sales in 2009. A decade later, India did so by executive order. At about the same time as Vietnam acted, Mexico enshrined a complete ban on nicotine vapes in its constitution.

Unsurprisingly, illicit vape markets have flourished in all those countries.

Vapes are advertised on Instagram and WhatsApp in Brazil, sold by brick-and-mortar retailers in India and available on street corners in Mexico, where experts say drug trafficking organizations are trying to capture the market.

Vapes, like drugs in general, will remain available where there is demand. But problems with illicit markets include that consumers don’t know what they are buying. Unregulated manufacturers and retailers have little incentive to adhere to quality controls or to age restrictions, when youth use was cited as a justification for Vietnam’s ban. Misinformation about vapes, which dissuades people from switching, remains widespread, and those messages are only reinforced when governments impose prohibition.

All of this was known—or should have been—as Vietnam debated its vape ban.

It’s difficult from afar to understand how and why lawmakers ignored or glossed over the evidence that vaping bans don’t work. But disinformation from the Bloomberg network and from the WHO played a role. The WHO is a key cog in the Bloomberg machine, as I’ve reported.

According to Vietnamnet Global, a popular news site, an official from Vietnam’s ministry of health said at an October 2024 seminar that “no scientific evidence supports the claim that e-cigarettes or heated tobacco products reduce harm or aid in quitting smoking.” This is patently false.

The ministry official is also quoted as saying that “the notion that e-cigarettes are 95 percent less harmful than traditional cigarettes, often quoted by a small group of experts, stems from a study funded by the tobacco industry and lacks scientific credibility.” This, too, is false: The 95 percent figure, which is admittedly a rough estimate, came from the United Kingdom’s leading public health agency.

The Bloomberg team has enjoyed a “deep collaboration with the government … in Vietnam,” Dr. Kelly Henning of Bloomberg Philanthropies wrote in a blog post, since deleted.

Why did the ministry get things so wrong?

Clive Bates, an advocate for tobacco harm reduction, wrote on a nicotine Listserv:

It is inconceivable to me that the Ministry would have a tobacco control seminar and WHO and its Bloomberg funded “partners” would not be present. So it is difficult not to conclude that they have promoted, passively or actively, these blatant falsehoods. 

Vietnam is one of 10 priority countries identified by the Bloomberg Initiative to Reduce Tobacco Use. And the Bloomberg team has enjoyed a “deep collaboration with the government and local organizations in Vietnam,” Dr. Kelly Henning, who leads Bloomberg Philanthropies’ public health work, wrote in a blog post, since deleted, after a visit to Vietnam in 2018.

Bloomberg and its allies cheered Vietnam’s vape ban.

Under the headline “Vietnam Acts Decisively to Protect Youth From Heated Tobacco Products and E-Cigarettes,” Vital Strategies—a nonprofit focused on global health, which supports harm reduction with other drugs—characterized the ban as a victory over the tobacco industry. Sandra Mullin, a senior vice president at Vital Strategies, is quoted as saying: “The government of Vietnam is to be commended for this life-saving measure.”

Vital Strategies received more than $43m for its tobacco work from Bloomberg Philanthropies in 2021 and 2022, according to the foundation’s income tax return. Bloomberg is Vital Strategies’ biggest funder, by far.

Angela Pratt, the WHO’s representative in Vietnam, wrote on social media: “This is a vote for health, especially the health of Vietnam’s young people.” Dr Tedros Adhanom Ghebreyesus, the WHO’s director-general, chimed in to say: “Congratulations, #Vietnam, on making this bold decision to protect your citizens, especially the young ones, from vaping and heated tobacco products.”

When people are given the option to switch to vapes, millions do. The Bloomberg network wants to eliminate that option.

Bloomberg Philanthropies gave the WHO more than $18m for its anti-tobacco work in 2021 and 2022, tax filings show. WHO officials have said that Bloomberg’s money helps them implement their programs but does not affect policy making.

Not to be outdone, the Campaign for Tobacco-Free Kids published a statement “commending the Vietnamese government for prioritizing the health and well-being of youth.” The campaign had nothing to say about the 16 million adults who smoke in Vietnam and could benefit from access to safer nicotine alternatives.

Bloomberg Philanthropies gave more than $40 million to the Campaign for Tobacco Free Kids in 2021 and 2022 for its tobacco work, and tens of millions more for other projects. It is the campaign’s biggest donor.

All of this would be laughable if the life-and-death stakes were not so high.

Jonathan Foulds, a professor of public health at Penn State and smoking cessation expert, wrote on social media that Vietnam’s decision, “to leave cigarettes as the monopoly legal source of nicotine is to negligently cause excess deaths. This is public health ignorance at its worst.”

He’s got good reason to be concerned: Peer-reviewed studies in the United States, funded by the National Institutes of Health, have found that bans or restrictions on vape sales are associated with increases in smoking. When people are given the option to switch to vapes, millions do. The Bloomberg network wants to eliminate that option.

The most powerful evidence that bans on safer nicotine products do more harm than good comes from countries that have taken the opposite approach. They have permitted and, in some cases, promoted safer nicotine products, including vapes, oral tobacco and devices that deliver nicotine by heating tobacco, as opposed to burning it.

In Sweden, where people get their nicotine from smoke-free pouches called snus, smoking has nearly disappeared. In Japan, cigarette sales have fallen by more than half, as people switch to heat-not-burn devices. New Zealand, where vapes are legal—and the government encourages people who smoke to switch—is on track to reduce its smoking rate to below 5 percent.

None of this evidence seems to matter to Bloomberg Philanthropies and its allies. The foundation is accountable to no one and has been unwilling to listen to critics.

Bloomberg Philanthropies, Vital Strategies and the Campaign for Tobacco-Free Kids did not respond to Filter’s interview requests for this story.

Incredibly, Angela Pratt, the WHO’s representative in Vietnam, told Filter that “there is no evidence that these products help people to give up smoking tobacco.”

The WHO office in Vietnam responded via email to several questions.

Angela Pratt, the WHO’s representative in Vietnam, said that “new nicotine and tobacco products are not safe, and they are not healthy.” But this ignores the critical comparison with the deadly combustible tobacco they can replace.

She also said, correctly enough, that “regulating or restricting these products is extremely difficult.” 

Pratt spouted some nonsense, too. Incredibly, she said that “there is no evidence that these products help people to give up smoking tobacco.”

No evidence? The UK’s National Health Service says that “you are roughly twice as likely to quit smoking if you use a nicotine vape compared with other nicotine replacement products, like patches or gum.” Consider, too, this summary of numerous studies from the trusted Cochrane group of health researchers, as well as the testimony of countless people who say vaping helped them to quit smoking.

Facts and evidence, it’s clear, are again being cast aside in the debate about smoking and vaping. People who smoke—an estimated 1.3 billion of them, most living in low- and middle-income countries—pay the price.

Photograph of a man smoking in Hanoi, Vietnam, by Clemence B. via Flickr/Creative Commons 2.0

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