The World Health Organization recently held its 10th Conference of the Parties (COP10) to the Framework Convention on Tobacco Control (FCTC). Delegations from over 140 countries convened in Panama City, Panama, from February 5-10. COP10’s purposes included implementing and strengthening the first global health treaty intended to “reduce the growth and spread of the global tobacco epidemic.”
Yet by the time COP10 closed, it had demonstrated how the FCTC has traded this focus on reducing harms of combustible tobacco for an obsession with youth who do not even smoke. The needs of the 1.3 billion adults who do smoke, and who die in their millions each year, are the casualty.
Since the 2003 treaty, our nicotine landscape has dramatically transformed.
The notion of a global health treaty to combat the “tobacco epidemic” grew from the early 1990s. The FCTC was first adopted in 2003, and came into force in 2005. Back then, there were far fewer noncombustible alternatives to cigarettes, although traditional nicotine replacement therapies and forms of smokeless tobacco like snus were available in parts of the world.
Reducing the harm caused by smoking is vital, and international action was overdue. But since the 2003 treaty, our nicotine landscape has dramatically transformed.
It was that very year that Hon Lik, a Chineses pharmacist, developed the first nicotine vape, as he sought to quit the heavy smoking that had killed his father. Not only vapes, but heated tobacco devices and nicotine pouches have rapidly proliferated and improved since then—all of which deliver the largely harmless drug nicotine without combustion.
The broad international response to this should have been easy. Nearly three decades prior, esteemed tobacco researcher Michael Russell had famously stated, “People smoke for the nicotine, but die from the tar.” Now, we had a wide range of enjoyable nicotine options that people could use instead of cigarettes, losing the deadly smoke.
The WHO’s target has morphed from the severe global toll of death and disease to the nebulous concept of “nicotine addiction”—above all, among youth who vape.
Yet the WHO has taken an adversarial stance on tobacco harm reduction products and repeatedly doubled down—even though these are no longer novel or emerging products, but have a decades-long history of consumer use.
In an attempt to justify this, the WHO’s target has morphed from the severe global toll of death and disease to the nebulous concept of “nicotine addiction”—above all, among youth who vape. This doesn’t in itself pose serious harms, making the “addiction” designation highly questionable.
What has been the outcome of this shifting target? Worldwide, the total number of people who smoke is essentially unchanged since the FCTC was first implemented in 2005.
Yes, population increases are at play here, and smoking rates have fallen. But if the WHO promoted use of commercially available tobacco harm reduction alternatives—instead of urging prescription-only access or supporting outright bans—we would be doing so much better.
Even with restrictions or bans across much of the world, at least 112 million people already use safer nicotine products. But thanks to messaging from the WHO and its many allies, most people who smoke still don’t know that these alternatives are safer.
The United States is among a minority of countries that aren’t parties to the FCTC. But the 2009 Tobacco Control Act contains many similar provisions, and some similar dynamics play out.
Despite various states’ restrictions, nicotine vapes are commercially available in the US. And since this has been the case, smoking among young adults has plummeted. Between 2012 and 2022, the rate for US adults aged 18-24 fell by a whopping 65.9 percent.
Yet it was in 2018 that the US surgeon general declared a youth vaping “epidemic,” a concept that has dominated media and political discourse ever since. As in much of the world, many Americans vape, but most nicotine users still smoke. And after scaremongering from US health authorities, most Americans believe vapes are as harmful as cigarettes.
The youth narrative that’s inexplicably erased is how youth smoking has all but vanished.
In 2023, 1.5 percent of US high school students reported current combustible cigarette use—a decline of 89.3 percent from 2012.
The pattern is the same in other countries that have both commercially available vapes and panics around youth vaping. In the United Kingdom, the smoking rate among 16- and 17-year-olds decreased by 66.5 percent from 2007-2019. Canada saw a 50 percent reduction in smoking among 7th-12th graders between 2012-2013 and 2021-2022.
Yet the WHO refuses to center the eradication of disease and early death in its messaging on youth. Objections from some national delegations at COP10 saw plans for further crackdowns on tobacco harm reduction pushed back to COP11 in 2025. But organizers’ goals couldn’t be clearer.
It was no surprise, but it still felt like she said the quiet part out loud.
In her closing address to COP10, Dr. Adriana Blanco Marquizo, head of the WHO’s FCTC Secretariat, praised how youth activists—they opposed tobacco harm reduction, of course, when pro-THR advocates were banned from the event—had joined the COP “for the very first time.” She called them “guardians of the future.”
Marquizo went on to endorse the words of these coveted youths in her speech: “The interests … of smokers, should never serve as justification for legitimizing products that could send even a single child down the path of addiction.”
It was no surprise, but it still felt like she said the quiet part out loud. Youth who are not smoking are the priority for the world’s foremost health agency. And accordingly, despite an annual toll of 8 million lives lost, 1.3 billion adults who smoke should be denied harm reduction, and left to quit or die.
Photograph (cropped) by Afshin Taylor Darian via Flickr/Creative Commons 2.0
The Taxpayers Protection Alliance, the author’s employer, 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.