On June 10, the Republic of Palau, an island nation in the Western Pacific with a population of 18,000, formally applied for a World Health Organization review of nicotine, under Article 2 of the 1971 UN Convention on Psychotropic Substances. This would have the potential to place nicotine under similar international drug restrictions to GHB, say, or methamphetamine—making the sale of non-medical nicotine products illegal.

The government of Palau, which banned vapes in 2023, argues that current efforts to protect people from combustible tobacco need to be sweepingly updated to include newer, safer products such as nicotine pouches and vapes.

“We may be a small nation, but the scale of a problem has never determined who acts on it,” said President Surangel S. Whipps, Jr. He urged governments around the world to follow suit in asking the United Nations “to finally treat nicotine like the toxic and addictive drug that it is.”

“Think of the consequences of prohibiting nicotine in international conventions just like cannabis, cocaine, heroin and so many other drugs.”

Ethan Nadelmann, founder and former director of the Drug Policy Alliance in the United States, said the initiative “may well be one of the most foolish in modern or even ancient history.”

“Think of the consequences of prohibiting nicotine in international conventions just like cannabis, cocaine, heroin and so many other drugs,” he told Filter. “All those drugs became far more popular after their criminalization than before, and far more dangerous.”

Prohibition generates vast illicit markets, corruption, violence and human-rights violations, he continued, “filling prisons with non-violent human beings whose only offense was to grow, possess, buy or sell a psychoactive substance that had long been legal.”

With nicotine, there’s additionally the critical harm reduction role of safer alternatives to smoking.

Smoking rates may be declining worldwide, but 1.3 billion people still use tobacco in risky forms, causing over 7 million deaths each year. Key to reducing this toll is the speed at which people who are unable or unwilling to quit nicotine transition to the safer products that over 100 million already use.

Nadelmann pointed to Sweden and New Zealand as countries that have “dramatically reduced cigarette smoking in recent decades without resorting to criminalization.”

“They claim it is an ‘initiative of the Republic of Palau,’ but it looks more like Palau is the willing puppet for a new billionaire-funded crusade.”

As part of its initiative, Palau’s government presented a scientific dossier and a website making the case against public access to nicotine. One of tobacco harm reduction’s most prominent voices labels this a “false operation.”

“They claim it is an ‘initiative of the Republic of Palau,’ but it looks more like Palau is the willing puppet for a new billionaire-funded crusade,” advocate Clive Bates, of Counterfactual Consulting, told Filter.

“The website is too slick, the lengthy science briefing was prepared in Europe, and an American activist group is involved,” he continued. “There is no disclosure about who is funding and organizing the campaign, but we can be pretty sure it isn’t the taxpayers of Palau with a population of 18k.”

It’s been reported that Palau’s application was put together by individuals who have been heavily involved in lobbying against safer nicotine products in Europe.

“What’s upsetting is that the anti-nicotine agenda being pushed on/by Palau … will do nothing to assist the people who are using deadly oral products.”

Just under 43 percent of Palau’s adult population legally and regularly consume gutka, a chewing tobacco mixed with betel (areca) nut, as David Zaruk described in Firebreak. The highly carcinogenic product is banned in many countries. Curiously, the dossier fails to mention the use of gutka, which is far more prevalent in Palau than smoking.

“What’s upsetting is that the anti-nicotine agenda being pushed on/by Palau … will do nothing to assist the people who are using deadly oral products,” Nancy Loucas, executive coordinator of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), told Filter. 

Loucas added that denying people access to much less harmful products is contrary to basic human rights and the World Health Organization’s own harm reduction mandate. When Palau banned vaping, an option that has helped millions migrate from deadly forms of tobacco, it did so through according to the WHO’s MPOWER strategy. US billionaire Michael Bloomberg, a dedicated opponent of access to safer nicotine products, is a major funder of the WHO.

“Whether for money, for fame or other favors, there are countries willing to pawn their sovereignty and offer their place at the intergovernmental table to aggressive philanthro-colonialists, frustrated that billionaire money alone does not give them the standing and access of a nation state,” Bates commented.

Whether nicotine gets put on the UN’s scheduled list would depend upon a medical and scientific assessment by the WHO Expert Committee on Drug Dependence. That process would conclude in March 2028, subject to the votes of 53 member states.

“If the government of Palau’s proposal ultimately leads to a global prohibition of nicotine, and drug wars resembling those that have caused such devastation around much of the world in recent decades,” Nadelmann said, “then it will go down as a perpetrator of one of the most deadly war crimes in history.”

Photograph (cropped) of Koror, Palau, by Mandrusian via Wikimedia Commons/Creative Commons 4.0  

Update, June 25: This article has been edited to credit David Zaruk’s article for information concerning gutka use and policy in Palau.

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

The post Tiny Pacific Nation Applies for Global Nicotine Ban. Who’s Behind It? appeared first on Filter.

The 152-page report, titled, “Exposing marketing tactics and strategies driving the global growth of nicotine pouches,” was released on May 15. It warns countries of “the global expansion” of the products, which it says are being “aggressively marketed” towards young people. It goes on to state that the lack of regulation in many countries risks the health of minors.

“The use of nicotine pouches is spreading rapidly, while regulations struggle to keep pace,” stated Dr. Vinayak Prasad, unit head of the Tobacco Free Initiative for the WHO, in a press release.

The report, released shortly before World No Tobacco Day, omits the role of pouches in harm reduction. 

“The report is less about evidence and more about pushing the prohibitionist narrative.”

Nicotine pouches can replace combustible tobacco, and are doing so on a large scale in various places. They are exponentially safer than cigarettes—at the very lowest end of the nicotine-products continuum of risk, and about 100 times safer than smoking, according to some research. 

When 1.3 billion people continue to use tobacco, with over 7 million associated deaths per year, a colossal number of people could benefit from switching to pouches. But not in the WHO’s eyes.

“The report itself is less about evidence and more about pushing the prohibitionist narrative,” Nancy Loucas, executive coordinator of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), told Filter.

Her organization believes that the WHO is right to raise concerns about “irresponsible youth marketing,” but “it should not come at the expense of adults who are trying to move away from cigarettes and other high-risk tobacco products.”

Though often categorized as “tobacco products,” nicotine pouches contain no tobacco. They typically contain plant fiber with nicotine and flavorings. Placed between the gum and lip, they release nicotine through the lining of the mouth—avoiding combustion and the inhalation of carcinogenic toxins produced by cigarettes. 

By “focusing mainly on nocitine delivery rather than disease risks,” it “slates over massive harm reduction potential for anyone using nicotine now or in the future.”

Yet the WHO report ignores these critical differences, instead “focusing mainly on nicotine delivery rather than disease risks,” British tobacco harm reduction expert Clive Bates, of Counterfactual Consulting, told Filter. 

“In doing so it slates over massive harm reduction potential for anyone using nicotine now or in the future,” he added.

What makes this even more egregious, Loucas noted, is how it appears to override the WHO’s own international treaty, the Framework Convention on Tobacco Control. The pouch report features “the continued bleating that harm reduction is an industry construct when Article 1(d) of FCTC is clear on the harm reduction mandate,” she said.

That article declares that “tobacco control” equates to “a range of supply, demand and harm reduction strategies [italics added]” aiming to improve public health.

The WHO need only look to Sweden to see the kind of spectacular public health wins oral safer nicotine products can achieve. Easy access to snus and pouches has enabled the country to achieve the world’s lowest smoking rate, at 3.7 percent. 

Pouches also have transformative harm reduction potential in parts of the world, like South Asia, where use of harmful traditional oral tobacco products is widespread.

Yet the WHO’s report simply urges governments to clamp down on pouches with bans or strong restrictions on flavors, plus high taxation to reduce affordability and deter youth use.

“I have had some patients find success in quitting smoking with them. Pouches are one of the least harmful forms of nicotine they can use.”

Todderick Prochnau, a pharmacist in Canada who has run smoking cessation clinics, knows what pouches can do on the ground. 

“Since nicotine pouches have emerged I have had some patients find success in quitting smoking with them,” Prochnau told Filter. 

“Smoking cigarettes is by far the most harmful way a person can consume nicotine,” he continued. “Nicotine pouches are a significantly less harmful form of nicotine than cigarettes, and therefore should be as accessible as possible to adults.”

Prochnau emphasized that while nicotine use can be dependence-forming, it does not in itself cause diseases associated with smoking, such as cancer, cardiovascular diseases or respiratory disease. “If a patient is going to use nicotine, pouches are one of the least harmful forms of nicotine they can use,” he said.

Prochnau has also seen the impacts of harsh restrictions like those urged by the WHO. Canada introduced strict pouch regulations in 2024, ostensibly to reduce youth use. The range of flavors has been reduced, sales have been limited to pharmacies and advertising has been curbed. As a result, some adults who might have given pouches a try are likely to have stuck with cigarettes instead.

Nor has the clampdown fulfilled its stated purpose of eliminating youth use. “In Canada, where nicotine pouches are restricted, we have a large illicit nicotine pouch market,” Prochnau said. These markets are not age-gated, he added, and the products sold often have higher nicotine content than the regulated pouches.

“None of it is justified and no evidence is presented to support the effectiveness of the report’s policy package.”

Another restriction the WHO report urges countries to adopt is capping pouches’ nicotine content. Yet research has indicated that pouches with higher nicotine levels are key to helping some people stay off cigarettes, with the ability to satisfy cravings for people who were smoking heavily. 

All in all, WHO’s latest report is yet another onslaught from the world’s preeminent public health agency on options that help people quit deadly cigarettes. Scientists have subsequently lined up to defend the role of pouches in smoking cessation. 

Bates called the report “fundamentally misleading.” The WHO, he said, searched for “weird outliers like candy branding or super strengths” in order to imply that these are driving global nicotine use. In reality, he continued, these are “marginal products” included in the report simply to cause “outrage.”

The WHO, Bates concluded, “just pulls out its tobacco policy playbook and lists various prohibition measures, like flavor bans, for use where full prohibition is not possible. None of it is justified and no evidence is presented to support the effectiveness of its policy package. The most likely result would be a vast, unregulated illicit market.”

Image (cropped) via Global State of Tobacco Harm Reduction via Flickr/Creative Commons 2.0

The post World Health Organization Misses the Whole Point About Nicotine Pouches appeared first on Filter.

The three ex-directors penned an analysis, titled “Smoke-free nicotine products can accelerate the end of the smoking era,” which was published in Nature Health in late April.

“Despite two decades of progress under the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC), smoking remains responsible for more than seven million deaths each year,” it begins, “and declines in prevalence are slowing in many high-burden countries.”

Tobacco harm reduction must be integrated into the FCTC, it argues, to make the international 2040 goal “a realistic, measurable and equitable target.”

Robert Beaglehole, professor emeritus of public health at the University of Auckland, New Zealand, and a former director of the WHO’s Department of Chronic Diseases and Health Promotion, is one of the authors. The original objective of the global FCTC treaty, he explained, was to reduce tobacco-related harms using three strategies: addressing supply, demand and harm reduction. But of these, he said, harm reduction has been “neglected.”

“In some policy debates, tobacco control objectives are framed increasingly in terms of nicotine elimination.” Their conflation goes against “decades of evidence.”

“According to the WHO and the FCTC, the marketing of ‘harm reduced’ products by the tobacco industry undermines their theoretical potential to reduce harm,” Beaglehole told Filter. The policy focus on the products has therefore often been on companies “recruiting new markets, especially youth.”

“In some policy debates, tobacco control objectives are framed increasingly in terms of nicotine elimination rather than eliminating exposure to smoke, and potentially conflate nicotine use with the harms of smoking,” the analysis notes—a conflation that goes against “decades of evidence.”

Meanwhile, Beaglehole said, “Despite widespread endorsement of the FCTC, implementation of the key measures has been limited and smoking rates are declining only slowly.”

This, combined with an aging and growing world population, means the 2040 goal will not be reached unless there’s a radical overhaul of the current FCTC, the analysis suggests. The current model of increased taxation and demand-reduction measures only goes so far. But safer nicotine products offer a “historic opportunity” to finally end the epidemic of smoking-related deaths.

Countries that have adopted tobacco harm reduction policies demonstrate this. The analysis points to Japan, which has halved smoking by embracing heated tobacco products, and Sweden, which has a smoking rate below 5 percent because of snus and nicotine pouches.

Many public health institutions “believe WHO and follow its guidance.” Others have been captured by the same philanthropic actors.

New Zealand is a particular case in point, the authors note. Its adoption of FCTC measures saw smoking rates decline gradually. Only after 2018, when the country allowed broader access to vapes, was the country able to achieve one of the lowest smoking rates in the world at 6.8 percent.

Yet in 2025, New Zealand’s lifesaving progress was smeared with a “Dirty Ashtray” award from the WHO’s NGO allies during the 11th Conference of the Parties (COP11) to the FCTC. The award is meant to shame countries deemed to have implemented policies that are adverse to public health.

Beaglehole said it’s hard to pin down why public health institutions remain reluctant to integrate harm reduction into tobacco control strategies, but “many believe WHO and follow its guidance.” Others have been captured by the same philanthropic actors—like billionaire Michael Bloomberg—that heavily influence the WHO, he added.

Along with former WHO directors Ruth Bonita and Tikki Pang, Beaglehold calls in the Nature Health commentary for a “risk-proportionate regulatory framework.”

While combustible tobacco should be subject to restrictions and taxes reflecting its “harmful nature,” they write, “Smoke-free alternatives should be regulated to ensure product safety, restrict marketing to youth, minimize environmental harm and prevent uptake among non-smokers”—but, critically, “without undermining their capacity to displace smoking.”

Concerns about youth vaping should be seen in the context, Beaglehole said, of smoking rates being at an all-time low in countries such as the United States, Canada and New Zealand. This has happened, he said, “without any robust evidence of a ‘gateway’ effect; youth vaping rates are declining in many countries.”

Derek Yach told Filter that “sadly,” the 2040 goal was too ambitious and represents “magical thinking.”

Derek Yach was a fellow director at the WHO with the authors of the paper, and later the founding director of the Foundation for a Smoke-Free World. He called the publication of the Nature Health commentary “very significant,” though he does not share all of the authors’ optimism.

Yach told Filter that “sadly,” the 2040 goal was too ambitious and represents “magical thinking.”  

China, India, Indonesia, Russia and the US, account for 50 percent of all people who smoke or use tobacco, Yach explained. Of those countries, only the US, “with some reluctance,” facilitates THR. The others either ban vapes and pouches or are in a “regulatory void,” with no sense of urgency or NGO advocacy to change this. Tobacco use is actually increasing in Indonesia and India, he added.

The authors look at countries like Sweden and New Zealand, Yach said, but, “There’s zero chance the countries above—or other large countries where male smoking rates are extremely high, like Jordan, Ukraine and Turkey—are going to take a serious look at Sweden or New Zealand.”

“They might look at Japan and [South] Korea, where smoking rates have been cut as heated tobacco took off,” he suggested, “or Pakistan, where what could be the start of a serious movement suggests increased pouch use is underway among previous toxic oral tobacco products users—or the United Kingdom, where vape use now exceeds smoking.”

“I am hopeful that in the end the evidence will prevail and the politics will come into line.”

The paper stresses that achieving the 2040 smoke-free goal relies on “combining established FCTC measures with wider access to regulated smoke-free nicotine alternatives.” However, FCTC leadership have so far shown no signs in flexibility.

What the WHO got right is some of the basics of its MPOWER measures: tobacco tax above inflation, banning cigarette advertising, supporting quit programs, and youth smoking prevention, Yach said. “All this makes sense and has had an impact, albeit a slow one, that has stalled.” However, the WHO’s refusal to embrace tobacco harm reduction despite the evidence, and to adopt regulations proportionate to the risks of different nicotine alternatives, has been a disaster for global public health.

Beaglehole remains sanguine. “As a public health physician, I am optimistic, despite the proceedings of COP11 last November,” he said. “I am hopeful that in the end the evidence will prevail and the politics will come into line. The new WHO director-general in 2027 may be more sympathetic to harm reduction; who knows?”

Photograph by United States Mission Geneva via Wikimedia Commons/Creative Commons 2.0

The post Three Former WHO Directors Urge It to Back Tobacco Harm Reduction appeared first on Filter.

Most of those people in my life smoked—a significant risk factor for many cancers besides the most obvious ones. Only a couple of them survived cancer, which means I’ve become familiar with premature death and the long-term emotional and financial strains families are left with.

So when World Cancer Day takes place on February 4 each year, it isn’t a meaningless awareness campaign to me. It’s personal. 

As I watch entities like the World Health Organization (WHO) mark World Cancer Day, despite willfully spreading misinformation about things that can reduce cancer risk, I find myself lost in dark anger. I know that more people will die because they don’t know the truth.

Public health organizations’ messaging should make it easier, not harder, for people to reduce their risk of early death.

People need to know that it is the smoke from combustible tobacco, not the nicotine, that greatly increases cancer risk. People need to know that quitting smoking at any age, by any means, has health benefits. 

Public health organizations’ messaging and policy recommendations should make it easier, not harder, for people to reduce their risk of early death. The WHO’s constant blurring of a crucial distinction—between deadly combustible tobacco and the safer nicotine products that have helped millions quit smoking—does the opposite. 

A recent example comes from the WHO’s International Agency for Research on Cancer (IARC) and the fifth edition of its European Code Against Cancer. Released to the medical community in late 2025, it’s due to be presented to the public this World Cancer Day. It contains drastic changes in its messaging about smoking and nicotine. 

In the European Code’s 2014 fourth edition, the tobacco guidance included the basic recommendation of “Do not smoke. Do not use any form of tobacco.” But what made it extra helpful was that it anticipated questions people might have and answered them in plain language. It accurately explained that it’s not nicotine that causes cancer, but exposure to carcinogens in combustible tobacco.

The fourth edition also addressed nicotine vaping with a degree of nuance. While stating that “Long term safety is unknown at present” and raising concerns about potential youth use, it said that vaping “is expected to have a lower risk of disease and death than tobacco smoking,” due to the absence of combustion. If people switch to vapes, it added, that has “the potential to reduce the enormous burden of disease and death caused by tobacco smoking.”

This is not some minor editorial adjustment. It fundamentally changes what the public will understand.

Compare that with what the European Code’s fifth edition emphasizes. Its headline guidance on smoking is short and misleading: “Do not smoke. Do not use any form of tobacco or vaping products. If you smoke, you should quit.” 

Smoke and vapor are now treated as if they belong under the same warning label, without the explanatory details previously provided. 

This is not some minor editorial adjustment. It fundamentally changes what the public will understand. When you remove the nuance and the “why,” and keep only the “don’t,” people will be led to believe that vaping and smoking are equally harmful, which is unequivocally false.

It doesn’t stop at individual advice. The fifth edition policy brief calls for measures such as heavy taxation—”All tobacco products should be taxed in a comparable way as appropriate, in particular where the risk of substitution exists.”—and steps to “restrict the availability and accessibility of tobacco products.” And it explicitly says that policymakers should “Extend such regulations to apply to all tobacco products, electronic cigarettes and all novel tobacco and nicotine-containing products.” 

The document states that products like vapes and pouches are “relatively new,” and that “further research is needed to understand their potential links to cancer.” Yet it doesn’t mention that no cancer link has been proven to date, despite the best efforts of some researchers. It completely ignores these products’ role in smoking cessation. It just goes ahead and includes them in its blanket policy recommendations.   

When institutions conflate nicotine and smoking, they harden confusion into common knowledge; myths become facts. One of the most damaging misperceptions I’ve seen, widespread among the public and among clinicians, is the belief that nicotine causes cancer. The consequence is that some people will continue to smoke instead of trying a much safer alternative.

If the WHO were to include people who use nicotine in the conversation, it would find it harder to ignore our experiences and our needs.

The WHO’s framing of harm reduction communication adds another layer of confusion by arguing that nicotine companies “cloak” their marketing in “the public health language of harm reduction.”

Regardless of what companies do, harm reduction is not a tobacco-industry invention. It’s a longstanding public health framework that the WHO supports in other areas of drug use. This framework acknowledges that drug use will happen, but that public health efforts can still reduce death and disease by making it safer. The public deserves balance: skepticism about marketing claims, paired with truthful risk communication that keeps the focus on whatever helps save the lives of people who smoke.

Harm reduction is also a movement—led by and centered on the agency of directly impacted people. If the WHO were to include people who use nicotine in the conversation, it would find it harder to ignore our experiences and our needs. 

The WHO is already aware, but chooses to obscure, that modern vapor products were invented in 2003 by Hon Lik—a pharmacist who was seeking to quit smoking after his father, who also smoked, was diagnosed with lung cancer. Legacy tobacco companies did not enter the vapor market until years later, long after people who smoke had been taking matters into their own hands, building and improving vaping devices, and spreading the word in an inspired grassroots effort. To equate tobacco harm reduction with Big Tobacco is no more valid than equating opioid harm reduction with the Pharma companies that make opioids and medications for opioid use disorder.

The goal should not be a moralistic crusade to make people do what the WHO wants. The goal should be fewer funerals of the kind I’ve attended far too often.

Unfortunately, the perversion of harm reduction messaging and the truth is a pattern the WHO has repeated, growing more brazen over the years. 

World Cancer Day is not the time to hide the truth behind a mask of moral outrage. It’s time to communicate risk precisely. That means naming the core cancer hazard clearly: smoking. It means being clear that nicotine is associated with dependency, but not with cancer. And it means recognizing and learning from the lived experience of people whose health and lives have been transformed by switching to safer nicotine.

The goal should not be a moralistic crusade to make people do what the WHO wants. The goal should be fewer funerals of the kind I’ve attended far too often.

Photograph (adapted) by Klaus Nielsen via Pexels

The post Shameful Changes in the WHO’s European Code Against Cancer appeared first on Filter.

The move makes the country’s total ban on these harm reduction alternatives to smoking—implemented at the beginning of 2025, and including personal possession and use—even more absolute.

The World Health Organization—which broadly opposes and demonizes tobacco harm reduction—had previously urged Vietnam to add the safer nicotine products to its list of prohibited businesses, as a means to “ensure this ban can be effectively enforced.” There must be no exceptions even for exporters, the WHO insisted, as that could “undermine public health objectives, as well as create significant enforcement challenges.”

The WHO duly applauded the Vietnamese National Assembly’s compliance.

The WHO has also been praising Vietnam’s original prohibition of the world’s most successful smoking cessation aids, with a November 29 post marking the first anniversary of the legislature’s decision. The country’s smoking rate is just over 20 percent; among Vietnamese men, it’s over 40 percent.

The WHO elaborated on what it portrayed as the benefits of the ban: “Fewer young people using these products; Fewer cases of hospital admissions; A major drop in online promotion, in partcular [sic] that targets vulnerable young people.”

“Southeast Asia is one of the world’s highest-density regions, with highly uneven economic development. This makes harm reduction vulnerable to policy volatility.”

Experts are skeptical. Clive Bates, of Counterfactual Consulting, was among those to point out on social media that no data had been made available to validate the WHO claims. He added that one year was little time to get a clear picture of all the ramifications of the prohibition, given factors like stocks running out, potential behavioral changes and how the illicit market would respond.

“I am pretty sure the cigarette business and organized crime will be high-fiving the ban,” Bates wrote in a followup post, demanding evidence from the WHO’s Vietnam office.

Experts with a focus on Asia are similarly troubled. Alan Zhao is the CEO of a vape-oriented publication called 2Firsts, and has reported on Vietnam.

“Southeast Asia is one of the world’s highest-density regions, with some of the highest smoking rates and highly uneven economic development,” he told Filter. “This makes tobacco control and harm reduction particularly vulnerable to policy volatility.”

“When we look beyond the surface,” Zhao continued, “whether a country allows, bans or wavers, my personal observation is that the biggest risk is this: Policymaking seems driven more by interest-group dynamics than by evidence-based, scientific reasoning.”

The majority of people who smoke live in Asia. Yet though the continent includes tobacco harm reduction success stories like Japan, bans and restrictions on safer substitutes for cigarettes are widespread.

Vietnam’s state-owned tobacco company has about 60 percent of the cigarette market share.

Conflicts of interest can be observed in some of these policies—as in India, where the government holds a significant stake in the country’s dominant tobacco company, while banning the vapes that might outcompete it.

“Vietnam is really not so different than Thailand, India and China with regard to government tobacco interests,” Nancy Loucas, executive coordinator of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), told Filter regarding Vinataba—Vietnam’s state-owned tobacco company, with about 60 percent of the cigarette market share.

“All those countries mentioned get accolades for banning safer products whilst manufacturing and selling deadly products,” Loucas said of reactions from the WHO and the network of anti-vape nonprofits funded by billionaire Michael Bloomberg.

Combustible tobacco use is a huge driver of death and disease in Vietnam. In 2021, over 14 percent of all the country’s deaths were linked to smoking.

The government seems determined to make sure that the most dangerous nicotine products are the only ones available. However, an illicit vape market is sure to give at least some consumers another option, as Loucas noted, albeit with more risks than if the products were regulated.

“Illicit products flow across borders easily between Vietnam, Laos and Thailand,” she said.

Loucas described developments in Vietnam as part of a pattern in Asia, with predatory external NGOs pushing bans that hamper smoking cessation while fueling illicit markets. “The issue of sovereignty doesn’t even rate,” she said, “because the countries with tobacco interests are still profiting from selling death.”

Photograph (cropped) of Ho Chi Minh City by calflier001 via Wikimedia Commons/Creative Commons 2.0

The post Cheered On by the WHO, Vietnam Tightens Total Vape Ban appeared first on Filter.

COP10, which was held in Panama in February 2024, provided a template. The worst potential outcomes from a THR perspective—like parties agreeing to more bans and restrictions on THR products such as vapes and pouches, or a formal redefinition of “smoke” under the FCTC to include vapor—were averted, though such threats will arise again at COP11.

COP10 also failed to move the dial on reducing the world’s 8 million annual smoking-related deaths. And part of the reason, advocates say, is that the voices of directly impacted people were silenced. Nicotine consumer groups, THR advocates and media were excluded from the talks, forestalling balanced discussion and coverage.

To people with lived experience of nicotine use and smoking, it felt like “everything about us without us.” Meanwhile, representatives of anti-THR groups like the Campaign for Tobacco-Free Kids flooded COP10.

“As always, the question arises as to what they have to hide.”

THR advocates anticipate more of the same at COP11. On September 23, the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA) issued a press release condemning the impending conference, accusing it of “erecting deliberate barriers to prevent public participation.”

The critique refers to a convoluted registration system for members of the public who wished to attend—designed, CAPHRA said, to “exclude rather than include.” Applicants had to provide passport details, photos, a letter of intent and a comprehensive CV, among other requirements. And the complicated system only opened for a brief window in September—it closed on September 18—”despite being available since February,” CAPHRA stated.

“As always, the question arises as to what they have to hide,” Martin Cullip, a British THR advocate, told Filter. “If they truly believe their approach is the right one, surely they would be eager to show off their event?”

Organizational affiliation is unlikely to get you in, either. CAPHRA pointed to the fact that equivalent global climate change conferences “have granted observer status to over 3,000 non-governmental organizations.” In contrast, the FCTC “has approved just 26 NGOs for observer status,” and, “No consumer advocacy groups representing people who smoke or use safer nicotine products have ever been granted access.”

The WHO’s “worst-case scenario is to have people who have benefited from THR telling their stories and providing input on how safer nicotine products have helped them.”

Nancy Loucas, CAPHRA’s executive coordinator, believes this all stems from the WHO’s fear of not being able to push through its desired outcomes—such as stronger enforcement of vape bans in countries that have imposed them, and flavor bans, other restrictions and medical-only access in countries that currently permit consumer sales.

“If the goal is complete abstinence,” Loucas told Filter, the WHO’s “worst-case scenario is to have people who have benefited from THR telling their stories and providing input on how safer nicotine products have helped them.”

Loucas framed the main threat of COP11 as the conflation of smoking and nicotine use. “This is what they are trying to do,” she said. “They completely disregard the real killer of combustion—it’s a denialism of harm reduction.” A related threat she pointed to is the distortion of what harm reduction means: “If they define that as nicotine-free, then there’s a major problem.”

Cullip (who has written for Filter) said the COP11 agenda clearly shows an intent to undermine harm reduction. For instance, agenda item 4.5 is described as, “Implementation of measures to prevent and reduce tobacco consumption, nicotine addiction and exposure to tobacco smoke.”

The agenda attacks THR with a reference to “the tobacco industry’s narrative on ‘harm reduction’” as an area of concern.

“It is arguable that the use of nicotine products can reduce [smoking and tobacco] consumption and exposure,” Cullip said. “So this agenda item elevates nicotine addiction above the harms of tobacco.”

That agenda item also attacks THR with a reference to “the tobacco industry’s narrative on ‘harm reduction’” as an area of concern.

During COP10, Cullip and his employer, the Taxpayers Protection Alliance, hosted a counter-event in Panama called Good COP. In Geneva, they’ll be doing the same on a larger scale. With 38 expert speakers from 22 countries, the event aims to illustrate the wealth of evidence that making safer nicotine products available reduces harm.

“Unlike COP11, all are welcome to attend and watch,” Cullip said. The event will be live-streamed, and audience members are encouraged to ask questions.

Such efforts are designed to show COP11’s organizers that their closed-doors policy won’t prevent public scrutiny. But is there hope for what goes on inside the COP11 room?

There were certainly glimmers at COP10, when countries including New Zealand, the Philippines and Saint Kitts and Nevis made statements pushing back against the WHO’s narrative, and saying that THR should be part of the global tobacco control strategy. COP10 ultimately failed to reach the required consensus on multiple anti-THR proposals. In November, observers will be watching closely for a repeat.

“The approach in advance of COP11 is unsustainable, and parties to the convention should recognize that they are being gaslighted and raise their objections.”

“As far as New Zealand’s position at COP11, I am not entirely sure,” Loucas said of her home country, which has seen impressive public health outcomes after embracing vaping. “They tend to keep to themselves and do what they need to for NZ without raising their head above the parapet,” she said of the government’s approach. “It’s a very Kiwi way: Don’t make too much noise, and do what needs to be done without attracting too much attention.”

Cullip is more sanguine. Recalling how certain countries spoke up for THR in 2024, he said that for COP11, he’s “hopeful that more will be emboldened by those arguments and further emphasize to the WHO that it must change course for the good of public health.”

“This year, the agenda has been forced to include discussion on harm reduction against the wishes of the organizers,” Cullip noted. “They are trying to do so on their own terms, though, and attempting to portray it as an industry invention rather than a valid public health approach which is accepted by countries all over the world in many different policy areas.”

In order for the FCTC treaty to work in a meaningful way, it “needs to get back to basics” of focusing on smoking-related harm, Loucas said, and “stop being influenced by funders with their own agendas and put health first.”

Cullip agrees. “The approach in advance of COP11 is unsustainable,” he said, “and parties to the convention should recognize that they are being gaslighted and raise their objections.”

Photograph (cropped) by Leif Jørgensen via Wikimedia Commons/Creative Commons 4.0

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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Tobacco harm reduction experts criticize the guidance for badly identified targets, and for recommendations with gaping holes.

The guideline endorses behavioral support from health care providers, “digital cessation interventions” and pharmacological treatments as ways of helping people quit tobacco. These recommendations, states a July 2 press release, “are relevant for all adults seeking to quit various tobacco products, including cigarettes, waterpipes, smokeless tobacco products, cigars, roll-your-own tobacco, and heated tobacco products (HTPs).”

“This guideline marks a crucial milestone in our global battle against these dangerous products,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus in the release.

But those “dangerous products” include examples with utterly different risk profiles—some of which have been responsible for large-scale smoking cessation.

It is “ridiculous” for the WHO to place smokeless tobacco products and HTP in the same category as deadly cigarettes and other combustibles, “as if there is no difference in risk,” British tobacco harm reduction expert Clive Bates, of Counterfactual Consulting, told Filter.

Scientific estimates have placed the risks of HTP use at somewhere around 10 percent of the risks of cigarette smoking—and the risks of snus, a form of smokeless tobacco, far lower still.

“The WHO is not really serious about solving the smoking and disease problem. It’s more about what its bureaucrats are comfortable with.”

“Swedish snus is responsible for the best tobacco and health outcomes in the world, yet [the WHO authors] just ignore this,” Bates said.

Widespread replacement of cigarettes with snus has seen Sweden’s rates of smoking and tobacco-related deaths plummet. Sweden is now poised to become the world’s first “smoke-free” country, defined as an adult smoking rate below 5 percent.

Japan, meanwhile, has halved its cigarette sales within a decade—a “globally unprecedented” shift that experts attribute to the rapid adoption of HTP devices by people who smoke.

“The basic problem is that WHO is not really serious about solving the smoking and disease problem,” Bates said. “It’s more about what its bureaucrats are comfortable with, rather than what works.”

The WHO’s recommendations for tobacco cessation include nicotine replacement therapy (NRT), which has been found to be less effective for smoking cessation than nicotine vapes. 

They also include the medications bupropion, cytisine and varenicline. Some evidence has indicated relatively good efficacy for some of these, but prescribed medications will never be nearly as accessible (or often, affordable) as consumer products sold in shops. Further issues include side effects.  

Riccardo Polosa, professor of internal medicine at the University of Catania, Italy, told Filter it’s “appalling that a trusted organization like the WHO continues to recommend varenicline.” The drug, he said, is “known to contain unsafe levels of carcinogenic nitrosamines and [was] withdrawn by Pfizer nearly three years ago.” Varenicline (Chantix) is largely unavailable worldwide.

One elephant in the room is the total absence of vapes from the WHO’s recommendations.

“They deal with the massive opportunity of quitting smoking by switching to a low-risk alternative through the absurd tactic of ignoring it.”

“E-cigarettes are beyond the scope of this guideline because the potential benefits and harms of using these products are complex, and are addressed in a separate body of literature,” it briefly states. “These products may be addressed in the future as evidence accumulates.”

Other health authorities have called vapes “one of the most effective tools for quitting smoking,” and assessed vaping as at least 95 percent less harmful than smoking. Many millions of people—including in countries like the United Kingdom and New Zealand, as well as the United States and others—have used vapes to quit smoking. 

Yet the WHO has mounted a hostile and escalating campaign against vapes—continually spreading misinformation about them, and even describing them in one recent tweet as “designed to kill.”

In the new WHO guideline, “they deal with the massive opportunity of quitting smoking by switching to a low-risk alternative [through] the absurd tactic of ignoring it,” Bates said. 

Dr. Polosa described the WHO’s “complete disregard for Cochrane’s recommendation that e-cigarettes lead to higher quit rates and are substantially more effective than NRT” as “shocking.”

The omission of a range of tools that have prompted real-world mass smoking cessation amounts to anything but “the best possible support.” 

Ruediger Krech, director of health promotion at the WHO, said the guidelines were “designed to help communities and governments provide the best possible support and assistance for those on this challenging journey.”

The omission of a range of tools that have prompted real-world mass smoking cessation amounts to anything but “the best possible support.” 

The world continues to suffer around 8 million smoking-related deaths each year.

The premise of the WHO’s guideline is “naive,” Bates said, when people will continue to use nicotine—the only question is how.

“The challenge for society is to make it available in a lawful, proportionately regulated market in a form that has acceptable risks,” he told Filter. “That’s what we do with other substances, and what we need to do with nicotine.” 

Image (cropped) by Marco Verch via CCNull/Creative Commons 2.0

Both The Influence Foundation, which operates Filter, and the Center of Excellence for the Acceleration of Harm Reduction, founded by Dr. Polosa, have received grants from Global Action to End Smoking. Filter’s Editorial Independence Policy applies.

The post Experts Slam “Ridiculous” WHO Tobacco Cessation Guidelines appeared first on Filter.

At the end of November, Panama City will host the 10th Session of the Conference of the Parties (COP10) to the WHO Framework Convention on Tobacco Control (FCTC). 

The FCTC is an international treaty, signed and ratified by 182 countries, which was originally drafted to address the harms of combustible tobacco. In recent years, however, those administering the treaty—the FCTC Secretariat and Bureau—have increasingly turned their guns on vapes and other reduced-risk products, such as heated tobacco and nicotine pouches. And many national governments, especially in Africa, Asia and other parts of the Global South, automatically adhere to the WHO’s positions.

The biennial COP was last held in-person in 2018. COVID-19 saw the 2020 gathering postponed until a virtual iteration in 2021—when all decisions were kicked down the road until this year, due to it being considered suboptimal to hold serious discussions remotely.

That does not mean that the WHO’s well-established hostility to tobacco harm reduction was parked for the last five years. On the contrary, FCTC administrators have been steadily building up a portfolio of cherry-picked evidence and shonky reports from sources carefully selected for their ideological opposition to anything but quit-or-die tobacco control policies. 

One proposal seeks to redefine “smoking cessation” as quitting not only smoking, but all nicotine use. 

Numerous consumer advocacy organizations have recognized the threats which could be posed at the COP10 meeting. Published WHO reports have suggested banning open vaping systems; prohibiting all the non-tobacco e-liquid flavors which most people who use vapes to quit smoking prefer; banning nicotine salts in liquids; and regulating vapes according to nicotine emissions over time, ultimately replacing the wide range of devices currently available with homogenized options that don’t meet people’s diverse needs. 

Further WHO reports have recommended redefining “smoke” to include “visible aerosols deriving in whole or in part from thermally driven chemical reactions”—gases which are certainly not smoke. This verbal subterfuge would drag vaping firmly into the remit of the FCTC treaty. A similar proposal seeks to redefine “smoking cessation” as quitting not only smoking, but all nicotine use. 

Another recent WHO report recommended “that regulations of tobacco products [be] extended and applied to all forms of nicotine and tobacco products and not restricted to conventional cigarettes.” This would subject safer nicotine products to every onerous restriction currently applied to combustible tobacco: taxation at the same rate as cigarettes; public vaping bans, both indoors and outdoors; graphic health warnings; prohibition of advertising, and plain packaging. 

Until now, the runup to COP10 has felt like a phony war. The WHO has been patting itself on the back for its 75th anniversary—and at the end of May, just before WHO No Tobacco Day, celebrated 20 years since the 2003 signing of the FCTC treaty. 

With these events out of the way, harm reduction deniers have rolled up their sleeves, and are now working tirelessly towards the eradication of products which have driven dramatic declines in smoking rates wherever they have been liberally regulated. 

At the beginning of June, the WHO Eastern Mediterranean region held a third meeting on taxation of tobacco and nicotine products. Two weeks later, another secret meeting was held in Geneva on the issue of flavors, which will likely influence preparations for COP10 by the WHO and FCTC Secretariat in persuading delegates to impose bans. 

Immediately after that, the WHO’s misnamed Global Consultation on Novel and Emerging Nicotine and Tobacco Products followed, discussing potential regulations on the whole range of safer nicotine products, which will almost certainly lead to more policy recommendations ahead of COP10. Naturally, only those fully committed to prohibition were invited. 

In the coming weeks, the ninth report of the WHO study group on tobacco product regulation (TobReg9) will be published. This will finally reveal the full extent of the assault on safer nicotine products planned by the WHO for November—no doubt containing many of the draconian proposals already seen in interim documents. 

If the WHO’s inexorable march toward depriving the world of products which have helped tens of millions quit smoking is to be obstructed, the time to try is now.

Then it is just a matter of cramming them all into the COP10 agenda. The provisional agenda, which lists vague details of items to be discussed, has already been posted online; the annotated version will carry much more information and is required to be made public in September. Pre-COP meetings of the WHO regional groups will take place soon after, to further cement a unified approach. 

In other words, despite November being months away, time is rapidly running out.

The only way that the public, the safer nicotine trade and tobacco harm reduction advocates can have an impact on events in Panama is by petitioning elected representatives and government officials in their own countries. 

Decisions at COP10 are made by the national delegations, so it is crucial to engage at a national level with key policymakers and potential delegates. With the clock ticking, this action is becoming more urgent by the day. As we speak, national delegations and country positions are already being decided. The registration process has been open since early May. 

If the WHO’s inexorable march toward depriving the world of products which have helped tens of millions quit smoking is to be obstructed, the time to try is now.

Update, July 13: This article has been updated to reflect the publication of the provisional COP10 agenda.

Photograph by Agê Barros via Unsplash 

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