Leading economists and former WHO senior staff call for governments, industry, and civil society to embrace tobacco harm reduction and save 100 million lives in advance of the WHO FCTC’s COP11 meeting this month in Geneva
Derek Yach – former Executive Director for Noncommunicable Diseases and Mental Health at WHO
Tikki Pang – former Director of Research Policy and Co-operation at WHO
Christopher Snowden – Head of Lifestyle Economics at the Institute of Economic Affairs
Peter Beckett – Co-founder of Clearing the Air
WHO acknowledges that 1.3 billion people still use cigarettes and toxic oral tobacco products, with more than eight million lives lost annually. On the eve of COP11, it is time to raise our ambition and give greater support to the full range of tobacco harm reduction (THR) products, potentially saving 100 million lives by 2060.
For two decades, the global tobacco control agenda has focused on reducing demand for combustible cigarettes and toxic traditional smokeless products. Yet despite progress in some regions, the world still faces a staggering burden of disease, addiction, and premature death caused by tobacco.
The experience in multiple countries demonstrates that wellregulated harm reduction strategies offer a powerful complement to traditional approaches. Heated tobacco product use has surged in Japan, South Korea, Italy, Poland, and Germany, displacing large shares of cigarette consumption. Vaping has fast gained ground in the United States, United Kingdom, Russia, and Romania, where cigarette prevalence is falling rapidly as millions transition to lowerrisk 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. Low and middle income countriesface coming decades of immense health and economic strain if urgent measures are not taken. 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.
Urgent actions for COP11
On the eve of COP11, governments, industry, and civil society must act with urgency and clarity. We propose priority areas for immediate adoption.
1. For Parties to the FCTC
• Embrace tobacco harm reduction as envisioned in the FCTC text, applying regulation proportionate to product risk. The treaty already establishes the principle of “comprehensive measures,” but implementation has lagged in relation to THR. Excise taxes should be applied to all tobacco and nicotine products to provide a legal basis for their use however, the tax differential we believe should be about one hundred (for combustibles) to 2.5 for THR products, this makes the healthier option the easier option for smokers. We recognize the COP11 is too early to define a coherent path forward and therefore see the need for Parties to accept the bioethics principle of nonmaleficence or do no harm by maintaining the current status quo.
• Prepare for a highlevel expert review of the benefits of THR, drawing from scientists across academia, the pharmaceutical industry, the ecigarette and heated tobacco sectors, and independent research groups. This review should be launched after the appointment of the next WHO DirectorGeneral to ensure credibility and political renewal. Preparatory work could be launched at COP11.
• Countries where THR adoption has sharply reduced cigarette smoking should present their experiences at COP11. Sweden’s neareradication of daily smoking, Japan’s dramatic cigarette declines, and the UK’s dual emphasis on vaping and cessation services must be studied closely for lessons adaptable elsewhere. Even if the USA is not present, the importance of FDA authorization of many THR products needs to be placed on record.
2. For tobacco, vape and nicotine pouch companies
• Increase transparency by publishing independent, peerreviewed research on who is quitting, switching, or reducing consumption through THR products. Public trust depends on rigorous science and full disclosure.
• Pivot investment and marketing toward low and middleincome countries where most tobacco users live, instead of primarily advanced economies where smoking rates are already declining. Without this strategic shift, the global tobacco epidemic will persist in its most lethal forms. The reality remains that over 70% of all tobacco users live in countries without access to research, advocacy messages, and THR products that could cut their future death rates. A more concerted effort to address this is long overdue.
• Develop medically licensed products targeted specifically at older and heavier smokers, as well as those showing early signs of tobaccorelated disease. These groups are the hardest to reach but carry the highest burden of illness. Physician support for THR policies depends on this.
3. For civil society and scientific institutions
• 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. The very same societies and journals speaking out against the global spread of vaccine hesitancy needs to review their policies and act accordingly.
• The Society for Research on Nicotine and Tobacco (SRNT) should end prohibitions on the full participation of scientists with industry experience. Similarly, the BMJ group should revisit blanket bans on industryrelated research. These policies were conceived when the interests of public health and tobacco companies were viewed as “irreconcilable.” But today, product authorization processes such as those of the US FDA demand evidence that new THR products are “appropriate for the protection of public health.” This regulatory standard represents a shift that should guide a pragmatic reevaluation of FCTC’s Article 5.3 implementation.
Rethinking the status quo
For many delegates and advocates, the call to rethink harm reduction will be uncomfortable. 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.
A call to courage
This is a moment that requires courage. 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. Tobacco harm reduction is not a concession—it is an advance. If applied with vision and commitment, it could be the singular measure that accelerates declines in global smoking prevalence and prevents tens of millions of premature deaths in the coming decades.
