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After two decades, WHO FCTC’s methods and effectiveness in achieving its anti-tobacco goal are increasingly being questioned. Photo credit: Irina Iriser, Pexels.
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WHO’s own estimation projects that in 2025 there will be a quarter of a million more tobacco users in the world than just a few years ago. Photo credit: Streetwindy, Pexels.
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Starting out as a treaty to address the perceived harm of combustible tobacco, WHO FCTC is now extending its scope to include new tobacco products as well, treating them in the same ineffectual manner. Photo credit: 2happy, Stockvault.
The World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC), originally designed two decades ago to be the first international treaty to address the perceived harms of combustible tobacco, has been the tobacco control playbook for governments and public health advocates in 182 WHO member states. But, the question of whether it has been successful in achieving its ultimate goal is increasingly being raised, extending also to questioning the logic and real-world implementation of its policies.
Dr. Derek Yach, owner of Global Health Strategies, former director of the Foundation for a Smoke-Free World, former WHO cabinet director and executive director for noncommunicable diseases and mental health, and former WHO lead on the development of FCTC, pointed out in a speech at a global tobacco forum in 2021 that the hostility from those in tobacco control towards the tobacco industry has been around for decades, and that anti-industry sentiments and policies predominated throughout the 1990s and into the new millennium. FCTC, whose implementing guidelines declared in its Article 5.3 that there is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests, is how WHO formalized this position in 2005. These days, he said, an antagonistic attitude toward all things tobacco industry is frequently justified by citing this assumed conflict.
Speaking at another conference in early 2023, Dr. Yach said, “A whole cadre of tobacco control advocates and policymakers were groomed by the FCTC process to follow a set of actions that were felt to be most appropriate at the time…Diplomats and health leaders from many countries took part. Few had prior knowledge of tobacco control. Many are still active today. Most have stuck with the “demonize don’t engage” industry mantra. As we will see later, this is because it is the easiest option but not the best option. It requires no intellectual effort.”
He went on to say, “I believe that the WHO and leadership of tobacco control are trapped in 1998 thinking and driven by 1970s solutions.”
There are many who share Dr. Yach’s perspective on FCTC, including some international public health experts who authored A Pandemic Treaty: Learning From the Framework Convention on Tobacco Control, published in the journal Health Security in early 2023. In the article, the experts pointed out that a global pandemic treaty WHO is working on is doomed for failure if it follows the same pattern as FCTC, which they say is an example of a global treaty that is not fit for purpose due to its disregard for the voices of key stakeholders and its refusal to consider the most recent scientific findings.
In their paper, Dr. Michael De Luca, a disaster and operational medicine fellow, Department of Emergency Medicine, The George Washington University and Dr. Mario L. Ramirez, an emergency medicine physician, Department of Emergency Medicine, Inova Fairfax Hospital, said, “Ultimately, WHO and the global public health community would benefit from understanding and addressing the critiques of the FCTC, which could perhaps serve as the closest structural model upon which to build a pandemic treaty.
According to Drs. De Luca and Ramirez, the three main errors FCTC has are its approach to harm reduction strategies, private sector involvement, and its impact on low- and middle-income countries (LMIC). These two experts are not the only ones with this opinion.
In his 2021 speech, Dr. Yach highlighted the fact that tobacco companies have completed exhaustive clinical and epidemiological research on the development of their reduced risk products to meet the scientific standards set by regulatory bodies. And, the companies have regularly shared their research findings through reports and mono-graphs, contributing to a growing body of scientific evidence that confirms the benefits of these products. However, there are still those who are “attached more to ideology than evidence” who choose to boycott or ban any research by the industry, often citing Article 5.3 to justify it.
“This clause is appropriately intended to prevent conflicts of interests among parties to the FCTC— which is to say, among governments, “ he said. “Yet, it has been invoked time and again to justify the banishment of industry-funded people and organizations from a variety of settings where they might make desperately needed contributions. These misuses of 5.3 persist despite very clear implementation guidelines, which stress the need for accountability and transparency in parties ‘when dealing with the tobacco industry.’ These guidelines do not mention bans, prohibitions, or boycotts. And they certainly don’t endorse the harassment of scientists—an abuse too-often endured by industry funded researchers and others in the field of harm reduction.”
Dr. Yach also provided some historical insight into the matter of FCTC’s impact on LMIC. In his 2023 speech, he explained that the development of most tobacco control policies took place in the 1970s and were led by a small group of countries, namely Canada, Norway, New Zealand, the UK, and Singapore, all of which had a strong regulatory enforcement capacity, high levels of local science competence, and high levels of education and income. The global norms for which the policies were developed were based on case studies from these countries. By doing so, other nations’ weaknesses, especially those in LMIC, be-came obstacles for progress.
“Policies have rarely been adapted to the development reality of LMIC,” he added. “Sitting in Geneva, few understand that ‘law on the books is not law on the streets’.”
Another example of WHO and FCTC’s ham-fisted approach to tobacco control is its most recent call for governments to treat e-cigarettes similarly to tobacco by applying tobacco control measures to e-cigarettes and banning all flavors, claiming there was insufficient evidence that e-cigarettes help smokers quit, that they are harmful to health, and that they could drive nicotine addiction among non-smokers, particularly children and young people. WHO also advocates for stricter regulations on other next generation products.
The recent Framework Convention on Tobacco Control: Challenges and Prospects for WHO report by Formiche also highlighted the failings of WHO’s tobacco control policies and strategies in regards to smoking-related non-communicable diseases (NCD). The report highlighted how harm reduction initiatives have not been considered by FCTC, deviating from WHO’s initial stance. Instead, the report says, the number of smokers worldwide has remained consistent over the past two decades (WHO’s update in January 2023 actually estimated that there will be 1.27 billion tobacco users in the world by 2025, a quarter of a billion more than there were just a few years ago.) The report also said FCTC has not adopted technological innovations that eliminate combustion as an important advancement in tobacco harm reduction, and that it has not taken into consideration the growing amount of scientific data that supports their potential.
Quit For Good, a non-profit organization promoting harm reduction in the Philippines, said strategies that provide smokers with less harmful alternatives to cigarettes are far more likely to reduce smoking than WHO FCTC recommendations to prohibit them while cigarettes remain widely available.
“To remain at the forefront of adopting effective strategies to reduce smoking, countries that have experience regulating these new products, including the Philippines, must continue to advocate at the global stage for science to guide policy response, not vice versa,” Dr. Lorenzo Mata, president of Quit For Good, said at a recent global forum.
Dr. Mata also highlighted that FCTC’s tobacco control strategies are failing as the number of smokers globally is not decreasing.
Prof. David Sweanor of the University of Ottawa said FCTC and WHO failed to acknowledge the merits of using less harmful tobacco and nicotine products. “Failure to do it is this continued carnage—unnecessary death and disease. We also see government bodies, UN bodies, destroying their credibility. When we lose the trust of the public, it affects us on a far broader range of issues than just tobacco and nicotine.”
FCTC has extended its scope to include in its crosshairs new tobacco products such as e-cigarettes, heated tobacco, and nicotine pouches as well, despite these products being less harmful alternatives to combustible tobacco.