One of the World Health Organization’s (WHO) most important meetings was recently held in Geneva, where the future health of millions of people may have been decided on from behind closed doors.
The meeting was the ninth Conference of the Parties (COP9) of the Framework Convention on Tobacco Control (FCTC), where authorities from all over the world meet to hash out health guidelines regarding tobacco and smoking. The discussions are famously secretive: journalists are not permitted to observe these talks, nor are members of the public. Even the 2018 Internet livestream of the event was cut off early in the proceedings.
Moreover, a key component in tobacco control was essentially missing from the discussions this year. For all the talk about how to curb the ongoing tobacco epidemic—already responsible for some 700,000 deaths a year in Europe, and countless more around the world—the vital role of reduced-risk nicotine products, such as e-cigarettes, in lowering smoking rates was reportedly largely absent from the conference, with the WHO deciding to postpone discussions about tobacco harm reduction until the COP10, which will take place in 2023.
In fact, the WHO has remained staunchly opposed to e-cigarettes for years. As early as the COP4 meeting in Uruguay in 2010, the WHO called on member states to ban vaping in public places and place restrictions on the marketing of e-cigarette products.
In the decade since the WHO’s initial reaction to e-cigarettes, the benefits of harm reduction approaches have been extensively researched and endorsed by a broad range of organizations. Public Health England and Britain’s Royal College of Physicians have both asserted that the risks associated with vaping are at least 95 percent lower than the risks wrought by smoking; the US National Academies of Science Engineering and Mathematics conducted a review of the evidence to ultimately conclude “e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes.”
In light of this, the WHO’s steadfast opposition to even considering the benefits of harm reduction approaches to nicotine use is a public health puzzle at best. At COP7 in New Delhi, India, the FCTC called on member states “to consider applying regulatory measures … to prohibit or restrict the manufacture, importation, distribution, presentation, sale and use of [alternative nicotine products].” The WHO’s policy position on e-cigarettes has been unchanged ever since.
To make matters worse, the WHO has insisted on celebrating efforts to curb the use of e-cigarettes, despite mounting evidence that they may be one of the best ways for adult smokers to give up the habit. According to one review of clinical studies, e-cigarettes are highly effective in helping tobacco users quit smoking. Indeed, they have been shown to be far more effective than the pharmacological nicotine replacement products which the WHO and anti-vaping organisations such as Bloomberg Philanthropies have paradoxically promoted.
Meanwhile, the WHO controversially gave a major award earlier this year to Dr Harsh Vardhan, an official in India’s Ministry of Health and Family Welfare, for “special recognition for tobacco control” after he led the effort to ban e-cigarettes in India. “His leadership was instrumental in the 2019 national legislation to ban e-cigarettes & heated tobacco products,” tweeted Dr Tedros Ghebreyesus, the WHO secretary-general, at the time of the award.
Harm reduction advocates, however, took a different perspective, criticizing the ban as a “self-goal” in the fight against tobacco addiction in India. Some even argued that the true motivations behind the ban had nothing at all to do with the flurry of so-called “health warnings” against e-cigarettes. “The sole beneficiaries of this prohibition appear to be cigarette companies who have found protection from replacement products, which was reflected in the uptick in their share prices on the news of the ban,” slammed activist Samrat Chowdhery.
With more than 100 million smokers and one million deaths attributed to smoking each year, the stakes couldn’t be higher for Indian health officials; overlooking the potential benefits of e-cigarettes will likely only set key health milestones even further out of reach. Indeed, thanks to the WHO’s international influence, the organisation’s short-sightedness on harm reduction is sure to have wide reaching consequences for public health policy across the globe.
This is particularly dangerous in areas where misinformation about e-cigarettes is already widespread. In Europe, for example, surveys have shown that most consumers are woefully ignorant of the facts about e-cigarettes. The percentage of Europeans who believe that e-cigarettes are harmful to their health has gone up alarmingly, rising from 27% in 2012 to 65% in 2020. Even more concerningly, one study found that 59% of Europeans incorrectly believe that vaping is just as dangerous—or even more dangerous—than smoking.
These inaccurate perceptions have consequences—some 47% of European citizens are now in favour of draconian measures such as banning all flavoured e-cigarette liquids, a step which some European countries, such as Hungary and Finland, have already implemented and others, including the Netherlands, are considering carrying out. Evidence from a similar flavour ban in San Francisco suggests that the measure may have led more high school students to begin smoking conventional cigarettes, while it almost certainly would push some adult consumers back to smoking—yet many politicians and consumers seem unaware of these troubling effects.
The adverse impact of these inaccurate perceptions on adults’ health decisions is impossible to quantify. According to recent research, current smokers are deterred from switching to e-cigarettes even after “brief exposure” to misinformation online. The need for carefully considered, research-backed communications from the WHO, then, has never been more important.
Whatever the WHO’s intentions, pushing governments to adopt ill-advised policies and mirror the organisation’s staunch opposition to harm reduction strategies will only backfire. As consumers are driven back to smoking, the public health consequences will be devastating.