The World Health Organisation’s (WHO) Framework Convention on Tobacco Control (FCTC) – a landmark treaty intended to reduce the global toll of smoking – marked its 20th anniversary last month.
But far from stamping out the scourge of smoking, the framework is “failing those who need it most,” a leading global health expert has warned.
Dr Delon Human, an author, family physician and expert in tobacco harm reduction (THR), said: “..after two decades of costly FCTC influence and activities, the reality is grim: smoking still kills 8.5 million people annually, and more than 1.2 billion people continue to use tobacco. While some countries have made progress, many low and middle income regions have seen minimal improvement.”
The WHO’s stance is ‘barrier to cutting smoking’
Dr Human said campaign group Smoke Free Sweden has the evidence to prove that the primary barrier to greater success in cutting smoking rates isn’t lack of resources – it’s the WHO’s “ideological opposition to THR”.
Writing for South African newspaper TimesLIVE, Dr Human explained how THR has helped millions of smokers worldwide switch to much lower risk nicotine alternatives such as vapes, pouches and snus.
“According to the UK’s Office for Health Improvement and Disparities (formerly Public Health England), vapes are about 95 per cent less harmful than combustible cigarettes,” he said.
“Yet the WHO consistently frames these alternatives negatively, distorting the growing scientific evidence supporting their role in reducing smoking rates.
“This contradiction lies at the heart of the WHO’s approach. Ironically, article 1(d) of the FCTC explicitly includes harm reduction as a fundamental pillar of tobacco control. The treaty defines tobacco control as including ‘harm-reduction strategies’.”
However, Dr Human said that in practice, the WHO chooses to ignore this aspect, instead favouring “prohibitionist policies that have failed to curb smoking in many regions where cigarettes remain dominant”.
He said: “In its anniversary celebrations, the WHO claimed global tobacco use has dropped by one-third since the FCTC’s establishment.
“However, this modest decline masks a crucial reality: countries integrating harm-reduction strategies have achieved dramatically better results than those following the WHO’s restrictive guidance.”
Sweden a compelling example of THR success
Sweden, Dr Human said, is the most compelling example of how THR can help the fight against smoking. Last year Sweden became the first country to be officially declared as ‘smoke free’ by the WHO. This means it has an adult smoking rate of less than five per cent.
“Through widespread adoption of snus, nicotine pouches and vapes, Sweden has reduced cigarette use by 55 per cent in the last decade,” Dr Human said.
Similarly, New Zealand has nearly halved its smoking rate after promoting vapes as a tool to help people quit. The UK has also seen significant success with a similar approach, where the NHS encourages smokers to “swap to stop”. These success stories contrast sharply with countries that are following the WHO’s guidance of imposing strict regulations on THR products.
Dr Human said: “The average EU smoking rate remains five times higher than Sweden’s, with most member states far behind their smoke-free targets.
“Nations such as India and Mexico have banned safer alternatives entirely, forcing citizens to either continue smoking or turn to illicit, unregulated markets – neither to the benefit of public health.
“If the WHO truly aims to reduce tobacco-related deaths, it must return to the FCTC’s complete mandate, acknowledging harm reduction as essential. It needs to engage honestly with evidence supporting reduced-risk products, include harm-reduction scientists and consumer advocates in policy discussions and allow empirical evidence, not ideology, to guide tobacco control.”
Putting the health of smokers first
Dr Human argued that Sweden’s success should be held up as a model for effectively cutting smoking rates. “Smokers deserve access to safer alternatives, and governments should be encouraged to make these options available as part of comprehensive tobacco control strategies,” he said.
He called on policymakers to reject the WHO’s “outdated approach” and instead adopt practical harm-reduction strategies that put the health of smokers first.
“The evidence is clear: tobacco harm reduction works, and millions of lives depend on the WHO acknowledging this reality,” he said.
