The 11th Conference of the Parties to the WHO Framework Convention on Tobacco Control (FCTC COP-11) will be held in Geneva in a few days. The preparatory documents prove once again that FCTC leaders have abandoned any pretence of a scientific approach and have fallen into an anti-tobacco harm reduction (THR) cult. They reject scientific evidence and instead promote a creed that is disconnected from reality. Examples abound in these preparatory documents. For example, one of these documents states that:
the tobacco industry and its allies have been using unproven health claims of “harm reduction” (or “reduced risk”) to further the marketing and commercialization of novel and emerging nicotine and tobacco products.
In reality, the science is very clear: non-combustible products such as snus and e-cigarettes are undoubtedly less harmful than combustible tobacco products. To claim otherwise is simply dishonest. It is misinformation on the part of the WHO and the FCTC.
The same document also states that there are…
… concerns regarding the threat posed by novel and emerging nicotine and tobacco products, and the use by industry and those working to further its interests of a “harm reduction” or “reduced risk” narrative
These products may be a threat to never-users, but they are also an opportunity for current smokers, who should be encouraged to switch to lower-risk alternatives. Instead the document implies that there is no such thing as a reduced risk product, which again is misinformation.
The same document also presents…
…“harm reduction” as an Article 5.3 industry interference issue.
By presenting tobacco harm reduction (THR) as an industry ploy, FCTC leaders are falling into the trap of conspiracy theory, as THR existed long before major tobacco manufacturers began marketing heated tobacco products or e-cigarettes. In fact, THR has its roots in the FCTC itself, as its article 1d states that:
“tobacco control” means a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke;.
The objectives of any tobacco control policy should be to reduce the number of cases of disease and death, the vast majority of which are caused by combustible products. Instead, FCTC leaders are pushing delegates to strengthen their actions in favour of another objective, set out in Article 5.2b of the FCTC: to reduce nicotine addiction. No one wants to see a new generation become addicted to nicotine, but this should not come at the cost of increased smoking-related morbidity and mortality in current smokers. FCTC leaders do not seem to realise that by rejecting non-combustible alternatives, they are protecting the cigarette market.
Protecting young people is essential, and this is the main argument behind the rejection of new products. But it is important to understand that almost all smoking-related deaths over the next 40 years will affect people who already smoke today. Therefore, current smokers should be our priority, and they should be encouraged to quit or otherwise to switch to non-combustible products. Health policy should be guided by science, and the science is clear: non-combustible products are less harmful than cigarettes, and vaping increases the chances of successfully quitting smoking.
WHO and FCTC leaders are spreading misinformation, but in this field, misinformation kills. This is a betrayal of the mission of the WHO and FCTC by their leaders. In a context of popular mistrust of elites, the attitude of WHO and FCTC leaders contributes to confirming the popular belief that ‘the elites have betrayed us’. This is extremely damaging, not only in the field of tobacco control, but also more broadly in political terms, as it gives populists more ammunition.
Exclusion of anti-THR NGOs from COP-11
Another major problem is the lack of transparency in the COP-11 process and the exclusion from the conference of many NGOs that support tobacco harm reduction. With dissenting voices excluded, delegates at COP-11 will not have access to a diversity of viewpoints, and the conference will reinforce groupthink.
The reason given for excluding NGOs that support THR is that they have conflicts of interest. Aside from the fact that many excluded NGOs do not have such conflicts of interest, this argument ignores the elephant in the room and fails to recognise that opponents of THR often have serious conflicts of interest. Today, largely because of the crusade led by the WHO and the FCTC against THR, it is virtually impossible for individuals who do not share the anti-THR credo to pursue careers in tobacco control within certain public health institutions, to obtain grants from certain funding agencies to study reduced-risk products, to create prevention projects involving these products, or for researchers to publish work on THR in certain scientific journals. This situation encourages adherence to the anti-THR credo and the WHO’s anti-science position. As Upton Sinclair said, ‘It is difficult to get a man to understand something when his salary depends upon his not understanding it.’
Change is needed
The problem here is not only scientific, it is primarily political and ideological. No new scientific research or additional reminders from scientists will solve a problem that is fundamentally political and ideological. Calls for reason and pragmatism over ideology are no longer enough; they will not bring about the necessary change. A shake-up is needed, and it can only come from outside pressure, and probably not from within the FCTC apparatus or the COP. What is needed now is a complete overhaul of the leadership of tobacco control at the WHO and the FCTC. The pressure for change must come from WHO Member States, with the help of a broad range of stakeholders, including scientists, doctors, public health professionals, opinion leaders, smokers, users of reduced-risk products, and politicians of all parties. They should unite and develop a clear and effective strategy to bring in new people who will put science back at the centre of the WHO and FCTC’s priorities.
Many times, consumers have asked to be heard. If anyone knows what helps, ex-cigarette users such as myself and many others should have an idea. Including asking them to implement Art. 1D in full and employ harm reduction measures.
We have tried to help, since 2009, in my case. That is the year vaping saved my life from 35 years of 60 cigs/day. I decided that I will spend at least some of the time I have gained to pass the idea of vaping and other THR forward.
Sadly, the WHO is getting worse, and I think it is now doing more harm than good, tragic for those in LIMC, where safer alternatives might be the only realistic option; there is no subsidised NRT or treatment.
I don't know if replacing the leaders will do, the whole thing is captured in an echo chamber of paranoia and adopting the evil tactics of the (past) tobacco industry. Even consumers are refused entry to the COP meetings, so we have no idea what is being done, supposedly for our benefit.
Public health has a duty to uphold morals, such as truth-telling and presenting options in an unbiased way. It harms the field as a whole when that isn't the case.
In full agreement with your passionate plea for truth-telling and an immediate change in tobacco control tactics. Lying about safer forms of nicotine delivery to those who cannot or will not quit cigarette smoking, is tantamount to blocking the fire escapes for people in a room on fire.