A plea for common sense

The great and good of tobacco harm reduction tackle the World Health Organization—that sworn enemy of innovation—on the eve of the eighth Conference of the Parties.
 By Marina A. Murphy

The World Health Organization (WHO) says it wants to reduce smoking and the death and disease caused by it. But its actions would seem to be contradictory to its goals, as it continues to ignore the huge potential of safer products like e-cigarettes and heat-not-burn devices—a fact not lost on 70 of the world’s pre-eminent experts in tobacco harm reduction, who took pen to paper today in a letter urging the WHO to embrace technology and take a leadership role in regulating tobacco in a way that recognizes tobacco harm reduction and the role innovation can play in achieving it.
“WHO and the anti-tobacco convention have become the sworn enemies of innovation and the result will be more cancer, heart disease and respiratory illness,” says Clive Bates, ex-director of Action on Smoking and Health in the U.K. and a co-signatory of this letter. “We now have technologies like vaping and heated tobacco products that can eliminate almost all the risk faced by smokers, but the WHO seems determined to have these products banned or regulated into oblivion,” he says.
Today marks the first day of the eighth session of the bi-annual Conference of the Parties (COP) of the Framework Convention on Tobacco Control (FCTC), which is taking place in Geneva, Switzerland, this year. From Oct. 1-6, the COP will meet to discuss how governments should regulate tobacco, including newer products like electronic cigarettes and heat-not-burn products—products that these experts point out are “beyond reasonable doubt” safer than smoking and which many thousands of smokers around the world have already successfully used to quit smoking. But, they say, the WHO is not only ignoring the potential of these products, but also excluding anyone (including these 70 experts) who has pro-harm-reduction views from participating in the discussions.
“You would like to hope that WHO and the tobacco convention would welcome new ideas and technologies to tackle the health menace of smoking, but they seem more concerned with sounding tough and fighting the tobacco industry,” says Bates. “They seem to prefer to spend their time doing that than actually dealing with the problem they were set up to deal with in the first place—reducing the death and disease caused by smoking.”
The concept of tobacco harm reduction is coded into the definition of “tobacco control” set out by the FCTC, but according to these 70 experts, there is little to no recognition of this in the WHO’s approach to tobacco control—in fact, the WHO seems to be doing just the opposite.
“It seems to be that they cannot believe that technology can solve the problems they’ve all spend their careers working on. But there are still more than one billion smokers and around six million deaths annually from smoking. Even in Europe, where the dangers have long been understood, more than a quarter of adults still smoke,” according to Bates.
Bates and his co-signatories urge the WHO to embrace the following principles during their deliberations:

• Embrace tobacco harm reduction. Harm reduction is a widely practiced strategy in public health and should be integral to tobacco control—helping smokers quit, greatly reducing their risk.
• Recognize that not all products are the same. The major distinction being whether they are combustible or not. Remove the smoke and you remove a lot of the harm—this distinction should be integral to the design and implementation of the FCTC.
• Recognize that tobacco harm reduction can help improve the effectiveness of conventional measures to reduce smoking.
• Don’t just focus on the negative.
• Policies to address youth nicotine use should be based on an understanding of youth risk behaviors, the interactions between use of different products, and pay due regard for the overall balance of harms and benefits to both adults and youth arising from interventions.
• Uncertainty should not be a reason for paralysis. More information is clearly needed, but we already have sufficient knowledge to be confident that these non-combustion products are much less harmful than smoking.
• Embrace “risk-proportionate regulation.” It makes sense the stringency of regulation or taxation should reflect the product’s risk to health—for example, high taxes on cigarettes, but low or no taxes on vaping products.
• Avoid the harmful unintended consequences of prohibitions or excessive regulation that would make novel products harder to get and less attractive than smoking or inhibit innovation and development of new and improved products.
• Be open to more stakeholders including consumers, the media and public health experts with pro-harm-reduction views.

Will the WHO accept responsibility for those who continue to smoke and perhaps die because they don’t have access to harm-reduced products?
This was the question put to the WHO Secretariat in a previous letter by some of the same experts in September. “We are concerned by the apparent support of WHO and the FCTC Secretariat for outright bans or over-regulation of low-risk alternatives to smoking,” they said. They also say that in their view the “prohibition of these products is unethical, unscientific, damaging to public health and an irrational protection of the cigarette trade.”
This letter also decries the misplaced hostility of the WHO to tobacco harm reduction and points out the inconsistency with which the WHO applies the harm reduction principle. Whereas the WHO backs harm reduction in other areas like intravenous drug use, sexual health and HIV/AIDS, it takes a positively ‘hostile approach’ to tobacco harm reduction. Their position is “negative” and “unbalanced.” By careening down this path, the WHO will continue to deny millions of smokers the opportunity to make a safer choice.
The authors ask: “Given that many millions of smokers are now, as a matter of policy, deliberately discouraged from or denied the opportunity to switch from cigarettes to low-risk products, who will assume responsibility for those who continue to smoke, and perhaps die, as a result? Will the World Health Organization accept this responsibility?”