The World Health Organization’s reputation took another big hit at a conference in London earlier this month that discussed global vaping policy. The E-cigarette Summit featured a keynote address by Professor Robert Beaglehole. As well as being emeritus professor of public health at the University of Auckland, he was formerly director of the Department of Chronic Diseases and Health Promotion at the WHO.
Deeply critical of the WHO’s opposition to tobacco harm reduction, his speech was all the more pointed considering his WHO past.
He argued that saving millions of smokers’ lives through a “smoke-free world” depends on the availability of safer alternatives to smoking, such as vapes—not on aiming for a nicotine-free world, as the WHO would like.
In his keynote, Beaglehole took aim at the WHO’s Framework Convention on Tobacco Control (FCTC) treaty, highlighting that its failure to achieve success is because of its unrealistic drive for nicotine abstinence and a stubborn resistance to embracing less harmful products. He also criticized the FCTC’s obsession with youth vaping, which has been to the detriment of making alternatives available for adults who smoke.
Beaglehole recommended an independent inquiry into the WHO’s leadership.
Accusing the WHO of having “lost its way,” Beaglehole condemned the secrecy of its biennial FCTC Conference of the Parties (COP) meetings. He also castigated the WHO for its reliance on funding from Bloomberg Philanthropies, which he sees as driving the WHO in the wrong direction due to Michael Bloomberg’s personal prohibitionist ideology towards vaping and nicotine use. Bloomberg’s donations—thought to total around $1 billion to-date—have accompanied the WHO’s adherence to an initiative called MPOWER, which entirely excludes tobacco harm reduction as an option.
Beaglehole noted that wherever MPOWER has been implemented, smoking rates have either risen or declined very slowly, whilst in countries which have embraced harm reduction, smoking prevalence has declined, often quite dramatically. He also criticized the WHO’s policy of giving awards to countries (such as India) which ban safer nicotine products, despite such prohibition leading to smoking rates increasing.
The WHO, Beaglehole summarized, presides over 8 million smoking-related deaths per year, while failing to explore all options for reducing the toll.
He went on to make some stark recommendations for the WHO to find its way again. The agency must lead, not obstruct, harm reduction strategies, he said. (It’s notable that the WHO promotes harm reduction in realms such as illicit drug use and HIV/AIDS.) Countries should be encouraged to adopt targets according to science-based recommendations, rather than ideology, Beaglehole said. He added that success would arrive faster if tobacco companies were not obstructed in transitioning from the most harmful products to less harmful ones.
To do this, Beaglehole recommended both an independent inquiry into the WHO’s leadership, and action from countries that support tobacco harm reduction in different ways to reform the WHO and FCTC. Active promotion, not suppression, of reduced-risk products is required. Beagleholde suggested that such parties should take advantage of the WHO’s scheduled director-general election in May 2022 to question the incumbent, Dr Tedros Adhanom Ghebreyesus, about his organization’s approach.
“What if you are wrong? If you are wrong, the cost will be huge and will be measured in millions of preventable deaths.”
Finally, Professor Beaglehole posed a question for those in the WHO and elsewhere who deny the benefits of tobacco harm reduction.
“What if you are wrong?” he asked. “If you are wrong, the cost will be huge and will be measured in millions of preventable deaths. This seems to me a totally unnecessary and unacceptable risk to take, and I would ask you to consider the possibility that you are wrong.”
Such criticism from a former director should be deeply embarrassing to the WHO. The agency’s head-in-the-sand attitude to tobacco harm reduction is all the more baffling considering it is one of the three pillars that its FCTC treaty was built upon, together with restricting supply and demand. It’s just that the FCTC has ignored and actively opposed the harm reduction part in practice. This is damaging public health in more than 180 countries that are signatories to the FCTC, and whose taxpayers fund the activities of its Secretariat, as Beaglehole pointed out.
The WHO surely cannot continue to tread a nicotine-prohibitionist path forever while people die unnecessarily and the scientific evidence in favor of tobacco harm reduction continues to grow. Professor Beaglehole’s speech is a significant dent in the WHO’s authority and his recommendation for fundamental reform should be taken seriously.
Photograph by Leif Jørgensen via Wikimedia Commons/Creative Commons 4.0
