Two former Directors at the World Health Organisation have called for a radical overhaul of the Framework Convention on Tobacco Control – the WHO’s International Treaty on tobacco control policy – in an exclusive op-ed for Clearing the Air.
Derek Yach, a key figure in creating the WHO’s tobacco policy in the 1990s, joined forces with Tikki Pang, who ran the WHO’s Policy Research function, to pen the piece alongside leading economist Chris Snowdon and Clearing the Air’s co-founder Peter Beckett.
“This is a moment that requires courage”, the piece concludes. “Courage for governments to challenge old dogmas, courage for industry to align its resources with public health, and courage for civil society to uphold science over ideology”.
Doctors remain a “key barrier to adoption”
Yach and Pang specifically call out scientific journals and societies for failing doctors and medical professionals.
“Scientific societies and journals must recognize their ethical responsibility to ensure that the benefits of harm reduction are widely understood among healthcare professionals. Uninformed or misinformed clinicians remain a key barrier to adoption” they write.
“The very same societies and journals speaking out against the global spread of vaccine hesitancy need to review their policies and act accordingly”.
A renewed focus on the developing world
The group also lays out, in stark terms, what failing to embrace harm reduction means for poorer countries.
“Low and middle income countries face decades of immense health and economic strain if urgent measures are not taken” they argue. “It is in this sobering context that we believe COP11 must confront a pressing reality: harm reduction for tobacco is not a theoretical debate but a proven strategy with lifesaving outcomes”.
They go on to contrast progress in more developed nations with that of the global South, where WHO tobacco policy is often taken on unquestioned.
“Heated tobacco product use has surged in Japan, South Korea, Italy, Poland, and Germany…vaping has fast gained ground in the United States, United Kingdom, Russia, and Romania, where cigarette prevalence is falling rapidly as millions transition to lower-risk alternatives”.
“Meanwhile, in Sweden, Norway, Denmark, and Iceland, the widespread use of snus and nicotine pouches has pushed smoking and cancer rates to some of the lowest levels recorded globally. These countries demonstrate that human behavior can be redirected in safer ways when consumers are presented with viable alternatives”.
“By contrast, in countries such as Indonesia, China, Egypt, and Jordan, male smoking rates still exceed 45 percent—levels that Britain last saw in the 1960s”.
Radical overhaul needed
“For many delegates [to the WHO’s Framework Convention conference] and advocates, the call to rethink harm reduction will be uncomfortable” they conclude.
“Decades of justified distrust of tobacco companies created an environment in which it was safer—politically and morally—to reject any alignment with industry. But this rigidity risks entrenching harm where greater flexibility could save millions of lives. Just as public health eventually embraced needle exchange programs, opioid substitution therapy, and more recently harm reduction in alcohol use, it is time to apply similar pragmatism to nicotine”.
