Has the World Health Organization been operating in secret to limit access to new technologies that have enabled millions of people all over the world to quit smoking?
US think tank Reason Foundation published a brief on September 14 essentially critiquing the WHO’s “hostility” to tobacco harm reduction and outlines its consequences generally as a threat to public health.
The brief contrasts the WHO’s opposition to less harmful nicotine-containing products with its support for harm reduction in other contexts. It also questions the legitimacy of this approach in view of the agency’s commitment to empowering people to improve their own health.
Authored by Julian Morris, Reason Foundation’s vice president for research, the document analyzes the work of the Framework Convention on Tobacco Control (FCTC), a treaty created by the world body in 2004 “to protect present and future generations from devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke.”
Morris argued that a key problem with the FCTC is that it is beholden to the idea that the only way to reduce smoking is for smokers to “quit or die”.
“The FCTC has not been a stellar success on its own terms,” he stressed, and is “highly sceptical of the potential for new technologies, such as vape devices (also known as “electronic cigarettes”), to reduce smoking-related harms.”
Morris believes that one reason for the hostility is that “many people in the public health community seem to believe that harm reduction is not possible when it comes to tobacco”, citing earlier unsuccessful attempts to produce “safer cigarettes”. In the 1960s, several tobacco companies sought but failed to develop cigarettes that would deliver the smoking experience with fewer adverse effects, and the efforts were abandoned towards the 1990s.
Another reason, Morris continued, is the WHO might be responding to pressure from vested interests. “Tobacco companies that have not developed harm reduction products would be at a competitive disadvantage if smokers switched to less harmful alternatives,” he pointed out. “Pharmaceutical companies selling drugs that help smokers to quit would likely experience lower sales if smokers choose to continue consuming nicotine. And pharmaceutical companies selling nicotine replacement therapy might experience lower sales as a result of smokers having a wider range of substitutes available.”
Morris also mentioned a 2008 Report on the Global Tobacco Epidemic where the WHO considers tobacco as a disease, with references to “the tobacco epidemic”, and views the tobacco industry as a disease vector.
“Tobacco companies have long targeted youth as ‘replacement smokers’ to take the place of those who quit or die,” Morris expounded. “Thus, the WHO has chosen to focus its efforts on eliminating tobacco use, rather than reducing the harm done by tobacco.”
Morris cited a newly released FCTC report, which he said was commissioned in secret from unknown authors referring to unpublished evidence from meetings held in secret, advocating that vape products should be heavily regulated.
“Yet, a recent report from the Royal College of Physicians concluded that vaping is at least 95 percent safer than smoking, that vape devices should be widely available and that doctors should encourage smokers to use them instead of smoking,” he said.
“Moreover, millions of people have already stopped smoking by using vape products. And where vape products are legally available, rates of smoking initiation have fallen faster than in locations where they are not available,” Morris added.
He also believes that if governments follow the FCTC’s advice, vape products would become less readily available and more people will smoke, with far worse health consequences. “The WHO’s opposition to tobacco harm reduction is dishonest and threatens public health,” Morris says.
The Reason Foundation brief reported that since the FCTC came into force in 2005, the number of smokers in the world has increased, mainly in China and other poor countries that were the FCTC’s primary target.
Morris suggests that many of the problems with the FCTC stem from the fact that it violates all the precepts of good governance, especially transparency. He notes that at the two most recent Conferences of the Parties (COPs) of the FCTC, in Seoul in 2012 and in Moscow in 2014, all journalists were kept out of the public gallery and the meetings were held in secret.
The brief also reported that FCTC excludes many groups whose input would be highly relevant, pointing out that it currently lists only 20 NGOs as Observers on its website in contrast to the 2,000 Observer NGOs listed by the Framework Convention on Climate Change.
Moreover, Morris notes that “there is essentially no participation by representatives of many affected groups, including users of tobacco and vape products, vendors, and farmers.”
Avoidance of conflicts of interest is given as the primary justification of the FCTC for restricting participation and operating in secret. But the real reason, Morris argues, is that the FCTC doesn’t want to allow anyone into the tent who disagrees with its assumption that the only option for smokers is to “quit or die.”
Morris observes that if the FCTC is genuinely committed to the ‘right to health’, then “it must listen to those who are taking control of the things that determine their health and to those who are helping them to do so. In other words, it should open itself up to participation by groups representing vapers, snus users, and companies producing these and other less harmful nicotine-containing products.”