Storm clouds continue to gather over the global future of tobacco harm reduction. New harbingers are constantly emerging as the World Health Organization prepares for the 10th Session of the Conference of the Parties (COP10) to the WHO’s Framework Convention on Tobacco Control (FCTC). This is a treaty signed and ratified by 182 countries, originally drafted to tackle the harms of tobacco smoke.
In July I wrote for Filter about COP10 threats to products that have helped millions quit smoking. These threats could, in Panama City this November, become formal WHO policies with worldwide impacts. COP10’s provisional agenda and other preparatory reports had previously been published, though were short on detail.
But a recent flurry of documents has revealed more of the WHO’s hostile strategy.
With no substantive justification, the WHO pronounces that “there is a need to regulate novel and emerging tobacco products by applying traditional tobacco control measures.”
Particularly egregious is a WHO report on regulation and disclosure of contents of alternative nicotine products. This document dismisses vaping for smoking cessation, stating that evidence in favor is “low” or “insufficient”—ignoring the November Cochrane Review finding of “high certainty evidence that nicotine e-cigarettes are more effective than traditional nicotine-replacement therapy (NRT) in helping people quit smoking.”
The WHO’s 9th “report on the tobacco epidemic” has also just been published. It’s funded by Bloomberg Philanthropies, which bankrolls global tobacco control efforts to restrict or ban alternative nicotine products.
It claims that “aerosols commonly emitted by [heated tobacco products] do fall under the definition of tobacco smoke.” The citation for this claim is not a scientific document, but an opinion given by one of the WHO’s handpicked reviewers in a previous report, who mused, “… aerosols generated by chemical reactions involving heat are termed ‘smoke’ … Can the aerosols of novel and emerging tobacco products qualify as ‘tobacco smoke’ ? Yes. … strictly speaking, visible aerosols deriving in whole or in part from thermally driven chemical reactions qualify as ‘smoke,’ even when combustion is not involved.”
The WHO’s tobacco epidemic report further insists that “[s]moke-free legislation should encompass new and emerging nicotine and tobacco products and specific products, like [vapes], should never be excluded from its provisions”—despite scant research on the effects of second hand vapor for bystanders, let alone any solid evidence of harm. Claiming that vaping is “undoubtedly harmful” and that vapes are “specifically targeted at children,” it calls for taxation at the same level as cigarettes, imposition of health warnings, and a ban on all non-tobacco flavors.
The WHO has also just published a report on heated tobacco products (HTP), which have led to a dramatic collapse of cigarette sales in countries such as Japan, South Korea, Italy and Lithuania. HTP are significantly less harmful than smoking, and one brand has been authorized by the United States Food and Drug Administration to be marketed as “modified risk.”
The WHO has also moved aggressively to cut the chances of COP10 parties being swayed by evidence-based opposition to a crackdown on harm reduction.
The WHO concedes that levels of Harmful and Potentially Harmful Constituents (HPHC) in heated tobacco aerosol are “typically lower than those found in the smoke from [combustible cigarettes].” But it still recommends that policymakers tax HTP as heavily as cigarettes, ban public use and mandate “large graphic health warnings and plain packaging … as for any other smoked tobacco product.” Here, the significance of the WHO’s “smoke” definition kicks in.
But perhaps the bluntest signal of the WHO’s intent came from a report made public on July 17, four months after the relevant meeting of the WHO Eastern Mediterranean region. With no substantive justification, the WHO pronounces that “there is a need to regulate novel and emerging tobacco products by applying traditional tobacco control measures.” The report recommends that governments “strengthen tobacco product legislation by regularly updating laws to include novel and emerging products.”
The WHO has also moved aggressively to cut the chances of COP10 parties being swayed by evidence-based opposition to a crackdown on harm reduction. It has now belatedly made public a report on how evidence on alternative nicotine products will be gathered to inform COP debates.
A working group, open to all signatories to the FCTC, used to compile up-to-date science on testing and reporting of product content and emissions. It was suspended in 2018. Administrators surveyed WHO members in 2020 and found that “60% of the Parties that responded indicated that they would like the Working Group to continue its work.” A second survey in 2021 also found that a majority of respondents favored reactivation of the working group—rather than replacing it with “an advisory group of experts and relevant partners … invited by the [FCTC] Secretariat” (read: carefully handpicked by the WHO).
Yet the WHO considers that these majorities “suggest little support at present for the reactivation of the mandate of the Working Group.” Siding with the minority, its report recommends that “an expert group be established to consider and make recommendations to the COP.”
It is vital that COP10 parties recognize these tactics for what they are, and make decisions based on robust evidence, rather than a steady stream of propaganda.
There appears to be no room for objective evaluation of the science in advance of COP10. Instead, the WHO is dishonestly railroading delegates toward a preordained outcome of heavy restrictions and prohibition when they gather in Panama.
In reviewing these concerted and gratuitous attacks on safer substitutes, you could be forgiven for concluding that the WHO wished to protect the incumbent cigarette trade.
For the good of global public health, it is vital that COP10 parties recognize these tactics for what they are. It is vital that they make their decisions based on robust evidence, rather than a steady stream of propaganda.
Photograph via Pxfuel