Yesterday former WHO leaders Robert Beaglehole and Ruth Bonita published a powerful comment in the leading medical journal The Lancet, calling on WHO and parties to the FCTC to support tobacco harm reduction and reject calls to prohibit or regulate smoke-free products the same as cigarettes.

(From 2004-07, Dr Beaglehole was the director of the WHO’s Department of Chronic Disease and Health Promotion, responsible for setting tobacco policy.)

I encourage you to read the full piece and share it with stakeholders. Key points:

“Tobacco harm reduction should…be a central strategy of the WHO Framework Convention on Tobacco Control…”

Current measures and focus are not enough: “[I]t has been challenging to show a strong and consistent association between the implementation of FCTC measures and smoking prevalence and cigarette consumption outcomes.”

“WHO’s lack of endorsement of tobacco harm reduction limits healthier choices for the 1.3 billion people globally who smoke and who are at an increased risk of early death.”

“There is no scientific justification for WHO’s position that e-cigarettes and other novel nicotine products should be treated in the same way as [combusted] tobacco products. This position overlooks a risk-proportionate approach.”

Relevant to agenda items 6.1 and 6.3: “We believe WHO needs to provide positive leadership and technical support to countries as they consider the use of e-cigarettes and other nicotine delivery devices, including snus pouches and heated and smokeless tobacco.”

Impact is greatest on LMICs: “WHO’s current approach to these lower-risk products is to reward countries, such as India, for banning e-cigarettes… 34 countries, primarily in low-income and middle-income countries now ban e-cigarettes.”

…while developed countries [New Zealand, Sweden, Norway, England, Japan] have not prohibited SFPs and are benefitting from THR: “In some countries substantial reductions in smoking prevalence have coincided with the update of novel nicotine products…”

“The WHO FCTC Conference of the Parties 10 (COP10), the governing body of the FCTC, will be held in Panama on Feb 5-9, 2024. The critical background papers to COP10 recommend treating nicotine products as equivalent to cigarettes and regulating them in a similar way. This approach is a retrograde step because they are not comparable products in terms of the damage they cause; after all, it I the burning of tobacco that causes harm, not nicotine. Worse, such a strategy would ultimately favour the global cigarette market and may discourage vaping.”

“The focus must remain on the central public health problem – the damaging health effects of tobacco consumption. Reducing cigarette smoking is the most effective way to prevent tobacco-related deaths and tobacco harm reduction is the fastest and fairest way to lower smoking prevalence. The WHO needs to embrace these innovations in nicotine delivery.”

“Countries that are reaping the benefit of tobacco harm reduction, such as New Zealand, Sweden, Norway, England and Japan, should encourage participating countries at COP10 to support proposals that will quickly reduce smoking rates. The world’s 1.3 billion people who smoke, half of whom will die early, deserve this leadership.”

The Lancet Comment