GSTHR Press Release
Tuesday 27 July 2021

WHO distracts from decades of failed efforts to reduce smoking 
with misguided war on safer alternatives 

  • No fewer smokers around the world in 2021 than when the WHO’s Framework Convention on Tobacco Control was enacted 
  • Global institution insists safer nicotine products pose threat – when evidence shows they offer significant opportunity to help adult smokers quit
  • Harm reduction long integrated into WHO response on drugs and HIV/AIDS – but not smoking, which kills 8 million a year 

The World Health Organization (WHO) and its single most significant funder for anti-smoking efforts, US billionaire Michael Bloomberg, have today[i] sought to distract from years of failure under the WHO’s MPOWER tobacco control strategy by focusing instead on what UK-based public health agency Knowledge Action Change (KAC) and other observers are calling a new ‘war on nicotine’.[ii]

On publication of the WHO’s ‘eighth annual report on the global tobacco epidemic’, the organisation is continuing its misguided insistence that vapes (e-cigarettes), snus, nicotine pouches and heated tobacco devices, collectively known as safer nicotine products, are a threat. This ignores the growing international, independent evidence that they offer millions of adult smokers the opportunity to quit deadly combustible tobacco.[iii]

1.1 billion people continue to smoke worldwide and 8 million lives are lost annually to smoking-related disease, figures that have remained static for two decades. Unable to demonstrate that its tobacco control strategy has resulted in meaningful outcomes – the most important of which would be substantial declines in smoking – the WHO focuses instead on how many countries implement its ‘MPOWER’ measures (standing for ‘Monitoring tobacco use and preventive measures; Protecting people from tobacco smoke; Offering help to quit; Warning about the dangers of tobacco; Enforcing bans on advertising, promotion and sponsorship; and Raising taxes on tobacco’).

On closer inspection, even progress on the MPOWER measures is underwhelming. The WHO reports that 104 countries have introduced ‘one or more MPOWER measures at the highest level of achievement’ since 2007, but also states that 41 of the 49 countries that have not implemented a single measure are low and middle income countries (LMIC). 80 per cent of the world’s smokers live in LMICs. These are the countries least able to cope with the disease burden of smoking or implement the most expensive and effective of the MPOWER measures – ‘offering help’ to quit.

People smoke to obtain nicotine, a substance which carries a low risk profile. It is not nicotine that causes cancer or other smoking-related disease, but the thousands of toxins released when tobacco burns. Safer nicotine products offer adult smokers who cannot quit ways to use nicotine that are substantially less harmful than smoking. This approach is called tobacco harm reduction.

With this latest release, the WHO has again ramped up its campaign against safer nicotine products. By stating simply that “electronic nicotine delivery systems are harmful” and calling for states to enact bans or restrictive policies, WHO Director-General Dr Tedros Adhanom Ghebreyesus obscures the role that vaping can play if used as a reduced harm alternative to smoking. Vaping is recognised by Public Health England as at least 95 per cent safer than smoking.[iv] No countries currently ban the sale of combustible cigarettes, which are known to kill at least half of all users.[v]

While the WHO has long employed harm reduction across much public health work, including its response to drug use and HIV/AIDS, it has adopted an ideological stand against tobacco harm reduction. One of its biggest donors and WHO Global Ambassador on Non-Communicable Diseases, billionaire businessman Michael Bloomberg, is a staunch opponent of safer nicotine products such as e-cigarettes.

Co-director of the Global State of Tobacco Harm Reduction (GSTHR) project and Emeritus Professor at Imperial College, London, Gerry Stimson said:

“The WHO’s self-congratulatory focus on strategy over outcomes indicates the lack of vision and ambition underpinning the international tobacco control establishment. This report offers no surprises and no hope for the world’s 1.1 billion smokers, who need and deserve better.

“That the organisation is now seeking to re-energise lacklustre tobacco control efforts by encouraging nation states to enact bans or overly restrictive policies on safer nicotine products is both irresponsible and illogical. It will lead to millions continuing to smoke, millions continuing to die prematurely, and millions more cigarettes being sold.”

It is concerning that this release likely indicates the direction that the WHO hopes to take tobacco control policy in November at the Ninth Conference of the Parties (COP9), a meeting of signatories to the WHO Framework Convention on Tobacco Control (FCTC).[vi] Speaking from the UK, where vaping is promoted by health authorities and has already helped millions of smokers to switch, Professor Stimson called on countries which favour tobacco harm reduction to ensure that it forms part of the global response to smoking. 

Professor Stimson continued: 

“Recent Global State of Tobacco Harm Reduction research has revealed that there are an estimated 98 million consumers worldwide who have already quit deadly combustible tobacco and switched to safer nicotine products.[vii] Yet none of these consumers will be represented at the COP9 meeting this November.

“The WHO persist in seeing safer nicotine as a threat and not a public health opportunity. Its unwarranted and misguided mission creep towards a ‘war on nicotine’ must be halted. Harm reduction, as named in the FCTC itself,[viii] must be instated as a core tobacco control strategy, taking its place alongside efforts to reduce demand and supply.”

The GSTHR estimates that worldwide, there are 68 million people who vape, 20 million who use heated tobacco products and 10 million who use snus. However, compared to the 1.1 billion people still smoking, this amounts to only nine users of safer nicotine products for every 100 smokers.[ix]


Notes 

[i] This KAC release responded to a press release from the World Health Organization issued under embargo until Tuesday 27 July at 14:00 CEST titled WHO reports progress in the fight against tobacco epidemic - highlights threats posed by new nicotine and tobacco products. An embargoed copy of the full WHO report was requested by KAC but never received.

The full WHO press release can now be accessed here:
https://www.who.int/news/item/27-07-2021-who-reports-progress-in-the-fight-against-tobacco-epidemic

The full WHO report can now be accessed here:
https://www.who.int/teams/health-promotion/tobacco-control/global-tobacco-report-2021

[ii] See Chapter 5 of Burning Issues: The Global State of Tobacco Harm Reduction 2020:
https://gsthr.org/report/2020/burning-issues/chapter-5

[iii] For specific country case studies demonstrating the positive impacts of safer nicotine products on smoking prevalence for Japan, the UK and Iceland, see Chapter 2 subsection ‘Windows of opportunity’:
https://gsthr.org/report/2020/burning-issues/chapter-2#windowsofopportunity
For a broader explanation of the rise of safer nicotine products and their use in tobacco harm reduction, see Chapter 2 of Burning Issues: The Global State of Tobacco Harm Reduction 2020:
https://gsthr.org/report/2020/burning-issues/chapter-2

[iv] Public Health England – E-cigarettes: an evidence update (2015) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/733022/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England_FINAL.pdf

Public Health England blog (2020) – 8 things to know about e-cigarettes
https://publichealthmatters.blog.gov.uk/2020/03/05/8-things-to-know-about-e-cigarettes/

[v] Country level data from the GSTHR shows that at present 36 countries have banned vaping devices/e cigarettes, 39 have banned ban snus and 14 countries have banned heated tobacco products. By contrast, just one country (Bhutan) has enacted a ban on the sale of combustible tobacco – a ban that is currently lifted due to the COVID-19 pandemic in an effort to reduce cross-border illicit tobacco smuggling.

[vi] WHO Framework Convention on Tobacco Control (FCTC) Ninth Session of the Conference of the Parties:
https://fctc.who.int/newsroom/news/item/21-05-2021-ninth-session-of-the-conference-of-the-parties-(cop9)-to-the-who-fctc-and-the-second-session-of-the-meeting-of-the-parties-(mop2)-to-the-protocol-to-eliminate-illicit-trade-in-tobacco-products

[vii] See Chapter 2, subsection ‘An unrealised public health story’ in Burning Issues: The Global State of Tobacco Harm Reduction 2020:
https://gsthr.org/report/2020/burning-issues/chapter-2#unrialisedpublichealth

[viii] Harm reduction is named in Article 1d of the WHO’s Framework Convention on Tobacco Control (FCTC) as one of three core strategies of tobacco control: “tobacco control” means a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke.”

https://www.who.int/tobacco/framework/WHO_FCTC_english.pdf

[ix] See Chapter 2, subsection ‘An unrealised public health story’ in Burning Issues: The Global State of Tobacco Harm Reduction 2020:
https://gsthr.org/report/2020/burning-issues/chapter-2#unrialisedpublichealth