Harm reduction experts who are keenly watching the developments in the 10th Conference of the Parties (COP) in Panama asked the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) to disclose full and accurate information about smoke-free products.
The experts raised their voices as delegates from 183 countries, including the Philippines, gathered for the COP 10 of the WHO FCTC this past week in Panama. The future of emerging and novel tobacco was one of the topics discussed.
Martin Cullip, an international fellow at the UK-based Taxpayers Protection Alliance’s Consumer Center, said the WHO FCTC showed despotism in their refusal to allow consumers to join the event. “They won’t let us speak directly with delegations. Delegations almost all ignore messages sent to their governments on harm reduction,” he said.
Cullip said the WHO FCTC attempted to redefine “smoke” in violation of its scientific integrity. “The science overwhelmingly supports tobacco harm reduction, so advocacy should be unnecessary. However, when they disregard science, we are compelled to speak out, only to be ignored,” said Cullip.
Clive D. Bates, director of advocacy group Counterfactual, lamented the WHO FCTC’s “unscientific” stance, which deprives 1.3 billion smokers of alternatives. Counterfactual is a consulting and advocate group focused on a pragmatic approach to sustainability and public health.
“WHO and tobacco control activists have been instrumental in denying millions of smokers access to life-saving, low-risk alternatives to cigarettes – this has occurred through prohibition, regulation and misinformation – for which there is no scientific or ethical basis,” Bates said.
He particularly denounced two WHO FCTC papers for excluding scientific evidence and consumer input, and for misclassifying heated aerosol as “smoke”.
“In summary, the primary aim of these two papers is to argue that heated tobacco products are smoking products that do not offer harm reduction benefits and therefore should be regulated similarly to cigarettes. However, this narrative is false and dangerous. These products are, beyond any reasonable doubt, far less harmful than cigarettes and, in some countries, have triggered a dramatic decline in smoking,” he said, referring to Sweden, the UK and Japan.
Bates said heated tobacco products (HTPs) do not involve combustion and are chemically distinct from tobacco smoke. He highlighted their significantly reduced emission of harmful chemicals compared to tobacco smoke, citing research findings.
“In general, HTP emissions contain far fewer compounds than tobacco smoke and exhibit, on average, a 90-percent reduction in HPHCs (harmful and potentially harmful chemicals). The TPM (tobacco particular matter) of HTPs is dominated by water and has a high volatile content, whereas the TPM of tobacco smoke is mostly composed of low-volatile droplets and solid particles,” he said.
Bates also referred to court cases in Germany and Sweden where heated tobacco products were not classified as smoking products due to the absence of combustion. He criticized the WHO FCTC Secretariat paper for failing to acknowledge these rulings and the rationale behind them.
The court explained that the distinction between a “smoking tobacco product” and a “smokeless tobacco product” is based solely on whether a tobacco product is consumed with or without a combustion process; and it is irrelevant whether smoke occurs when the tobacco product is consumed.
Bates said the WHO FCTC Secretariat paper does not mention these cases and the technical and legal reasoning behind the rulings. “The paper also aims to suggest a false and misleading equivalence between HTP aerosol and tobacco smoke, presumably to bolster its argument against tobacco harm reduction and to support regulation of these products as if they were as dangerous as cigarettes, which is far from the case,” he said.
He said that toxic exposures with heated tobacco products are significantly lower, likely reducing health risks for smokers who switch to these products, as recognized by no less than the US Food and Drug Administration. “WHO fails to mention the 2-million-page application and in-depth analysis by the FDA in reaching its authorizing decisions,” he said.
He said WHO FCTC’s recommended extreme bans on communications related to tobacco and alternative nicotine products without sufficient justification.
“WHO has never provided a justification or evidence for this policy (banning a much safer product while allowing cigarettes to be available everywhere). Given ENDS [electronic nicotine delivery systems) are substitutes for cigarettes, we would expect this measure to increase smoking, promote illicit trade in ENDS, and increase harm to health and welfare,” he said.
Regarding claims by the WHO that there is insufficient evidence showing that these products displace smoking at the population level, Bates said there is ample evidence from various sources indicating the opposite.
“There is a wide range of evidence from randomized controlled trials, observational studies, population trend data, quasi-experimental economic studies, market observers and user testimony, all showing that ENDS use displaces smoking. Also, we would expect that innovation with new, safer products should displace incumbent dangerous products,” he said.
Tobacco harm reduction advocates also warned that banning smoke-free alternatives would only exacerbate the underground market for these products.
“India decided two or three years ago to ban cigarettes. What was the outcome of that? From a very small market which was at that time unregulated but not illegal, they illegalized the product and they ended up with a huge 100-percent black market of illicit electronic cigarette products that are available virtually in every corner in all major cities in India with no quality criteria, no quality control, no regulation, no oversight from the government, no rules on marketing and promotion, no one knows where they come from,” said Dr. Konstantinos Farsalinos, a cardiologist and research fellow at the Onassis Cardiac Surgery Center in Athens, Greece. “The government now pretends that e-cigarettes don’t exist because they banned them.”
“It’s a perfect example showing that regulation can sometimes be much worse than just leaving everything alone and applying no regulation at all. Hopefully one would expect countries to learn from these mistakes. They don’t because first of all they don’t admit the mistakes despite the obvious and well understood outcome,” he said.