The World Health Organization marked an anniversary in late February: “Celebrating 20 years” of its Framework Convention on Tobacco Control (FCTC) treaty.
As the first-ever global health treaty, the FCTC, to which 183 countries are parties, promised a revolution in tackling the harms of smoking. Yet, two decades on, the WHO, which guides implementation of the FCTC, bears substantial responsibility for vast numbers of people continuing to smoke. Despite grand ambitions, the treaty has failed to achieve its stated goals and, in many respects, has done more harm than good.
Since its implementation in 2005, the FCTC’s track record has been abysmal. Smoking prevalence, as a percentage of the world’s population, has declined—but not nearly as fast as it should have done. The absolute numbers are flat, at best, with the WHO reporting 1.3 billion tobacco users worldwide.
Small wonder that a press release from one of the WHO’s regional offices, its title crediting the FCTC with “saving millions of lives,” instead touts the number of people now living under tobacco control policies as its main metric of success.
Central to the FCTC’s failure is its departure from its original mission.
This is no triumph of public health. Studies published in esteemed journals such as the British Medical Journal and the Lancet have criticized the treaty for its lack of impact, particularly in lower-income countries, where smoking rates remain stubbornly high.
Central to the FCTC’s failure is its departure from its original mission. The treaty was meant to reduce the “consequences of tobacco consumption and exposure to tobacco smoke.” Its text even acknowledges, in theory, that harm reduction has a role to play.
However, instead of focusing on reducing smoking-related harms, the WHO and its associated bodies have prioritized targeting nicotine, which is not the direct cause of major smoking-related harms. This has detracted from efforts to address the real issue, and reflects WHO policies now more rooted in dogma than in evidence-based public health.
This blinkered approach is exemplified by the way it has wielded Article 5.3 of the treaty. The provision was initially intended as a conflict-of-interest safeguard to prevent undue tobacco-industry influence. However, it has since been used as a justification for stifling debate, barring critical stakeholders—including harm reduction advocates, independent researchers, and consumers—from discussions on tobacco control.
The WHO’s FCTC Secretariat has exploited Article 5.3 to shut out voices that challenge its preferred narrative.
Experts with even the most tenuous, second-hand relationships with nicotine industry funding—or with no such relationships at all—are shunned, regardless of the validity of their evidence or experiences.
The WHO’s FCTC Secretariat, along with various member states and allied NGOs like the Global Alliance for Tobacco Control, have exploited Article 5.3 to shut out any voices that challenge their preferred narrative. As a result, the treaty’s decision-making processes have become increasingly secretive. Conferences of the Parties (COP) meetings, where global tobacco control policies are discussed, are held behind closed doors. The public and media are routinely denied access, ensuring that discussions happen without scrutiny.
This lack of transparency contradicts fundamental principles of good governance and raises serious concerns about the legitimacy of the policies being pursued.
By far the most damaging failure of the FCTC has been its outright rejection of innovative harm reduction strategies. Despite mounting evidence that safer nicotine products help people quit smoking, the WHO remains entrenched in its opposition.
Millions of people who smoke have been denied or dissuaded from options that could save their lives.
A 2016 report from the WHO actually acknowledged the potential of non-combustible nicotine products in reducing smoking rates. Yet, instead of embracing this opportunity, the agency has doubled down on its hostility.
Instead of endorsing safer nicotine alternatives—such as vapes, nicotine pouches, and heat-not-burn technology—the WHO has continued to wage an ideological war against them. As a result, hundreds of millions of people who smoke, and who are unable or unwilling to quit nicotine, have been denied or dissuaded from options that could save their lives.
The WHO’s anti-health stance reached a nadir in June 2024 when it posted that vapes are “designed to kill.” This statement is not just false; it is dangerously irresponsible. Decades of research have shown that vaping is exponentially less harmful than smoking, and many millions of people worldwide credit vapes with helping them quit combustible tobacco for good. The WHO’s rhetoric actively discourages people from making the switch, leaving them at greater risk of disease and death.
A global tobacco control strategy that is outdated, ineffective and counterproductive.
As the FCTC marks its 20th anniversary, the messaging continues to reveal a deep-rooted unwillingness to adapt. In its celebratory statements, the WHO speaks of “addressing the challenges brought by new and emerging tobacco and nicotine products” rather than seizing the clear opportunity they represent.
The result is a global tobacco control strategy that is outdated, ineffective and counterproductive.
The world needs a new approach—one that is fit for the next 20 years and beyond. The FCTC (as it stands) has proven inadequate. Instead of continuing on this failing path, global health authorities must recognize the potential of harm reduction and modernize their strategies accordingly. Countries that have done so have seen some extraordinary results. The WHO should take note and follow suit.
As people who use nicotine—and the global taxpayers who ultimately fund the WHO—reflect on 20 years of the FCTC, they should know that its legacy is one of missed opportunities and distorted priorities. To dramatically reduce the global burden of smoking-related disease, the WHO must abandon its ideological opposition to harm reduction and embrace policies that reflect the realities of modern science. Until then, there is little worth celebrating.
Photograph by Robert Ruggiero via Unsplash
The author’s employer, the Taxpayers Protection Alliance, previously provided a one-off donation to The Influence Foundation, which operates Filter, to support travel to a harm reduction event. Filter‘s Editorial Independence Policy applies.
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