Two former World Health Organization officials identified harm reduction as the missing link in the global body’s tobacco control policy, as the number of tobacco users has barely changed since the treaty was implemented 17 years ago.
Prof. Robert Beaglehole and Prof. Ruth Bonita, who both worked with the WHO, said the missing strategy in WHO Framework Convention on Tobacco Control policies is harm reduction.
“Most people smoke because they are dependent on nicotine. Tobacco harm reduction reduces the harm caused by burnt tobacco by replacing cigarettes with much less harmful ways of delivering nicotine; these alternatives have great potential to disrupt the cigarette industry,” they said in a correspondence entitled “Tobacco control: getting to the finish line” which was published in The Lancet on May 14, 2022.
In its definition of tobacco control, the FCTC includes harm reduction as one of the strategies. The two experts noted, however, that the WHO and the FCTC Conference of Parties reject harm reduction.
“This opposition is not grounded in 21st century technological advances, and is unduly influenced by vested interests who promote nicotine abstinence. This opposition privileges the most harmful products―cigarettes,” the experts said.
“Tobacco control is not working for most of the world,” they said, noting the current strategy has failed to drastically reduce smoking rate in most countries. “Four out of five of the world’s smokers are in low-income and middle-income countries. In these countries where most of the eight million deaths caused by tobacco occur each year, rates of tobacco use are falling only slowly,” they said.
Beaglehole is professor emeritus of the University of Auckland and chairs the Lancet NCD Action Group. He was director of the WHO Department of Chronic Disease and Health Promotion from 2004 to 2007. Bonita is professor emeritus of the University of Auckland. She served as director of surveillance in the WHO Noncommunicable Disease Cluster from 1999 to 2005.
The FCTC is the first international treaty negotiated under the auspices of WHO. Adopted by the World Health Assembly in 2003 and entered into force in 2005, it aims to provide a framework for tobacco control measures to be implemented by the Parties at the national, regional and international levels in order to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke.
The two experts said despite the FCTC implementation, only 30 percent of countries are on track to achieve the WHO adult tobacco use target of a 30-percent reduction in prevalence by 2030, while most countries are not on track to achieve the Sustainable Development Goal 3.4 for non-communicable diseases. Its achievement will require a much more ambitious tobacco target, they said.
“The FCTC is no longer fit for purpose, especially for low-income countries. Neither WHO nor the FCTC are grounded in the latest evidence on the role of innovative nicotine delivery devices in assisting the transition from cigarettes to much less harmful products. Equally, the focus on youth vaping, most of which is experimental, detracts from the crucial public health goal of reducing cigarette-caused deaths in adults,” the experts said.
Responding to the report, Dr. Lorenzo Mata, Jr., president of Quit For Good, a local organization promoting awareness about the grave consequences of smoking tobacco as well as creating solutions to the tobacco smoking epidemic, said it is abundantly clear that current tobacco control strategies are not working and the FCTC is failing spectacularly to achieve its objective.
“The WHO must listen to this truthful assessment from two respected public health practitioners who once worked to further the agency’s non-communicable diseases prevention and control programs,” Mata said.
Mata supported Beaglehole and Bonita for speaking about the state of the FCTC. “On behalf of tobacco harm reduction advocates around the world, I thank Professors Beaglehole and Bonita for speaking the inconvenient and glaring truth about the WHO and FCTC. Harm reduction has an important role to play in tobacco control, particularly in the Philippines where almost a quarter of the adult population are smokers and the smoking cessation rate is very low,” he said.
Dr. Fernando Fernandez, the secretary general of the Asia Pacific Dental Federation, also agreed, saying, “the blunt but honest critique of the WHO and FCTC by two genuinely qualified and dedicated public health experts is a wakeup call to the WHO and other tobacco control advocates who still blindly follow the agency’s ‘outdated approach in addressing the smoking problem”.
Fernandez, who is also the past president of the Philippine Dental Association and the Philippine College of Oral and Maxillofacial Surgeons said, “It’s high time that the WHO allow an independent review of its tobacco control policies and look objectively at the evidence supporting harm reduction.”
“Science has significantly advanced in the past decade and has provided smokers with better alternatives that can actually save their lives. Public health policies should keep up with these developments instead of stunting their potential to help smokers avoid the harms of cigarettes,” he said.
Tobacco harm reduction or THR is a public health strategy that aims to reduce the health risks to individuals and wider society associated with using tobacco products. THR aims to provide safer alternatives to reduce harms caused by smoking and to provide nicotine to people who cannot or do not want to quit smoking by themselves or with currently-approved methods. The use of e-cigarettes or vaping and heated tobacco products are forms of THR.
Beaglehole and Bonita asked The Lancet to actively endorse THR as a crucial strategy for reducing the health burden caused by tobacco, and add its voice to calls for an independent review of WHO’s tobacco control policies in order to save the millions of lives that are at stake.
Data show that in the Philippines, about 17 million (23.8 percent) of adults are smokers, according to the Global Adult Tobacco Survey. The prevalence of current tobacco use among all Filipino adults in urban areas was 22.1 percent and 25.3 percent in rural areas.
The global survey also showed that Filipino adult smokers smoked an average of 11 cigarette sticks per day. It also revealed that the Philippines has a dismal 4% smoking quit rate, which reflects the ineffectiveness of currently approved smoking cessation strategies such as “quitting cold turkey” and nicotine replacement therapy.