From Local to Global

African countries tend to formulate health policies based on advice from the World Health Organization, a strategy that is problematic when it comes to tobacco harm reduction (THR) aspects of tobacco control, participants at the 2021 Global Tobacco and Nicotine Forum (GTNF) were told. The nub of the problem is that tobacco control advice is filtered through the WHO’s Framework Convention on Tobacco Control (FCTC), which was written toward the end of the last century in an attempt to deal with the ill effects of combustible tobacco. Consequently, since no attempt has been made to write a new framework relevant for the innovative noncombustible products developed this century, the WHO has no adequate framework with which to help governments regulate these new products appropriately.

These points were made during the plenary panel “From Local to Global: Regulatory Policy Trends.”

Of course, there is something odd here because the direction of policy travel—or, at least, the policy-advice travel—is in the opposite direction to that suggested in the session’s title: It goes from global to national. But that should not be interpreted as the reason for its failings. Things can fall apart just as easily when traveling in the other direction.

In the U.S., states and other jurisdictions have imposed restrictions on reduced-risk products that have caused increases in smoking, which they were designed to reduce, and increases in sales of illicit products. But at least there is something of a bright side here if you believe that government policymaking is evidence based. In not working, these restrictions provide evidence to use against suggestions that they should be applied more widely, even at a national level.

I’m not sure that I’m convinced in this matter, but then I come from the land where a lot of people still cleave to the idea that Brexit was a good move: the idea that by becoming more insular we would become more global.

There is no doubt, however, that the interactions between the local and the global are complex. One presentation made the point that a main principle in respect of environmental issues was that there was a need to think globally while acting locally, something that was applicable in respect of tobacco harm reduction. The FCTC had a floor but no ceiling, so it was up to individual countries to adapt the convention’s articles to suit national, regional and local circumstances. While countries had circumstances that differed one to the other, there existed, too, internal differences. The U.K. had seen a significant reduction in the consumption of combustible tobacco products but not among its marginalized communities. And in Brazil, while tobacco smoking had fallen significantly in urban areas, this phenomenon had not been reflected in the countryside.

One question that arises from this is, how local do you go? If you return to the title of the session, it is obvious that there is a glaring omission: smokers. OK, you might argue rightly that smokers aren’t involved in policymaking; we’re not debating in ancient Athens, but surely, they should get a look in—even a walk-on, nonspeaking part? No. The session was told it was obvious from the documents released ahead of the FCTC’s Conference of the Parties (COP9) in November that smokers, who were not at the center when the FCTC was developed, were not meant to be at the center of the upcoming debates. It seemed as though it was easier to ignore them, and this raised a social justice issue.

Many of the presentations at the session tended toward simply describing the counterproductive nature of much tobacco and nicotine regulation, especially, but by no means exclusively, in Canada and the U.S.—counterproductive, that is, given the original objective was to drain the harm caused by the consumption of combustible tobacco products. Such regulation was focused largely on flavors and nicotine and justified often on the need to protect young people, even though there was little credible justification for such actions.

Things are different in China, where, it was said, optimists in the electronic cigarette business broadly welcomed a move by the Ministry of Industry and Information Technology to bring these products into line with regulations governing combustible cigarettes. It was hoped that such regulation, designed in part to protect consumers, would bring clarity to the operation of an industry that had so far been largely unregulated while growing rapidly and imposing its own standards in such areas as youth protection and recycling.

We live in interesting times, and the most interesting regulatory issue on the horizon has to be that concerning synthetic nicotine.