PRESS RELEASE
By Professor Praneet Valodia, Director Praneet Valodia Consulting
The Eleventh session of the Conference of the Parties (COP11) to the WHO Framework Convention on Tobacco Control (FCTC) will be taking place in Geneva, Switzerland, 17-22 November 2025. This governing body will discuss updates to the FCTC with 183 parties which include 182 countries and the European Union. I am wondering whether COP 11 will be considering the scientific evidence with regards to tobacco harm reduction. Tobacco harm reduction involves using safer non-combustible nicotine products such as heated tobacco products, e-cigarettes, snus and nicotine pouches instead of combustible cigarettes.
It is concerning that cigarette smoking still claims about 8 million lives each year considering that smoking is a preventable cause of disease. Harm reduction is a public health strategy that is compassionate, people-centred, choice-focused, and rights-based. In addition, there is a 60-99% reduction in toxicants in non-combustible nicotine products relative to combustible cigarettes (U.S. FDA). Non-combustible nicotine products show greater efficacy than nicotine replacement therapy (NRT) and are similar in adverse events to NRT (Cochrane Report, 2024). Based on these results, smokers should be switched to these products. We have a moral obligation to advise smokers to use these safer products.
Smokers’ choice of an intervention for smoking cessation is key. Nothing is 100% risk-free. Tobacco harm reduction products are not without risk, but it is beneficial for smokers, particularly those who are unable or unwilling to quit smoking, to switch to a lower-risk nicotine product. COP, should like the U.S. FDA, evaluate the relative risk between combustible cigarettes and non-combustible nicotine products. Has COP evaluated the benefits and risk of non-combustible nicotine products to determine the net benefit to public health? It does not appear to be so. Taking isolated factors into account, such as youth uptake only, is not an optimal approach.
I am hoping that COP11 will bring about transformative change in assisting over a billion smokers throughout the world. There is a lack of evidence in South Africa to show a reduction in cigarette smoking because of interventions promoted in the FCTC. Considering the low adoption of the interventions in the FCTC and MPOWER measures, and the fact that the global smoking trends have not changed substantially after the FCTC’s adoption in 2003, it is time for tobacco harm reduction to become even more important. This is the paradigm shift in mindset that is required. Real-world evidence shows that the FCTC has failed to make an impact. Hence, it may not be fit for purpose. In vulnerable low-and-middle-income countries (LMICs), like South Africa, small incremental changes may not be effective. For example, increasing the nonsmoking area in a restaurant. This is an effective measure for affluent people who can afford to eat in restaurants; however, the majority of South Africans cannot afford to eat in restaurants. Although such a measure is in place in South Africa, the prevalence of smoking has still increased according to the Global Adult Tobacco survey (2021). Transformative change will involve introducing tobacco harm reduction with greater access to non-combustible nicotine products. Sweden and New Zealand are on the brink of becoming smoke-free due to the wide acceptance of tobacco harm reduction despite FCTC policies.
In South Africa, a significant number of fires, including those in homes and vegetation, are attributed to discarded cigarettes. Smoking is also a leading cause of residential fires, with incidents like people falling asleep while smoking or cigarettes igniting furniture. A huge proportion of South Africans live in shacks made from pieces of wood or other materials in informal settlements that burn due to fires as a result of combustible cigarettes. It is believed that switching to non-combustible products will also save lives due to the absence of fires. Has COP considered this for LMICs?
It is hoped that COP11 will allow open discussions where differing opinions could be heard unlike the previous COP meetings. New evidence has emerged since the last COP meeting and this should be considered. Policies should be evidence-based, well planned and resourced, implementable and impactful in addressing socio-economic challenges. Will COP11 adopt this approach?
There are about 120 million users of non-combustible nicotine products throughout the world. The presentation of experiences of the users of non-combustible products at COP11 should be encouraged. It is important that users of non-combustible products are provided with reliable and accurate information. COP unfortunately has not been facilitating this. Consumer acceptance has also not been focussed on. Similarly, health experts in tobacco harm reduction have also been excluded from previous COP meetings.
There is a need for an independent scientific committee to evaluate the evidence and the reports should be available to the public for comment. This involves a selection process of publications to be evaluated, a meeting held to debate the findings and the publication of the findings with recommendations. This is a process used for medicines and there is no reason why the same approach cannot be used for non-combustible nicotine products. However, there also needs to be an independent review of the FCTC’s policies and practices.
It is hoped that COP 11 will consider these factors in its deliberations to save lives. It is also hoped that the COP 11 will give effect to Article 1d of the FCTC in its definition of ‘tobacco control’ to incorporate harm reduction strategies that aims to improve the health of a population. It is hoped that COP 11 will not disregard local policymaking processes and the impact that these policies may have on local populations.
REFERENCES
U.S. FDA: Scientific Review of Modified Risk Tobacco Product Application (MRTPA) under Section 911(d) of the FD&C Act – Technical Project Lead – 5/12/2016.
Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Livingstone-Banks J, Morris T, Hartmann-Boyce J. Electronic cigarettes for smoking cessation (Review). Cochrane Database of Systematic Reviews. 2024.
Fire Protection Association of Southern Africa. Informal settlement Fires 2018.
