The WHO’s Tobacco Control Paradox: Excluding harm reduction proponents bolsters Big Tobacco

 

The World Health Organization Framework Convention on Tobacco Control (WHO FCTC)
Article 5.3 is a cornerstone of global tobacco control, designed to shield public health policies
from the commercial interests of the tobacco industry. By barring tobacco industry
representatives from forums like the Conference of the Parties (COP) and Meetings of the Parties
(MOPs), it aims to prevent the manipulation that historically undermined tobacco control.
However, this exclusionary approach often unjustifiably extends to tobacco harm reduction
(THR) proponents—researchers, advocates, and organizations promoting alternatives like e
cigarettes, oral nicotine pouches, and heated tobacco products—due to perceived or actual
industry ties. This blanket exclusion contrasts with the WHO’s engagement with industries like
soft drinks and automobiles on harm reduction and ignores evidence that THR is not a gateway
to smoking. Critically, banning THR and silencing its advocates inadvertently strengthens Big
Tobacco by driving smokers back to combustible cigarettes, increasing industry profits, societal
costs, and mortality. This Op-Ed examines the justification for excluding THR proponents, the
WHO’s inconsistent engagement, the role of funding, the scientific basis for THR, and the
dangerous consequences of stifling harm reduction voices.

The Justification for Article 5.3 and Its Extension to THR Proponents

Article 5.3 was crafted in response to the tobacco industry’s documented history of deceit,
including denying smoking’s health risks, funding biased research, and targeting youth. The 2000
WHO Report, Tobacco Industries’ Strategies to Undermine Tobacco Control Activities, exposed
these tactics, justifying strict safeguards. Extending exclusion to THR proponents is often based
on their perceived industry ties, as some advocates may have received funding from vaping or
tobacco companies. Public health advocates argue that allowing these voices risks legitimizing
industry agendas, promoting products with uncertain long-term safety, and diluting tobacco
control measures.
However, this approach conflates THR proponents, many of whom are independent researchers
or public health advocates, with Big Tobacco’s profit-driven motives. Unlike the tobacco
industry, which thrives on combustible cigarette sales, THR proponents advocate for evidence
based scientific alternatives that reduce harm for smokers unable or unwilling to quit. Excluding
them may protect against industry influence but silence perspectives that could save lives,
particularly in high-smoking regions where cessation resources are scarce, like in LMICs,
including Pakistan.

The WHO’s Inconsistent Engagement with Industries

 

The World Health Organization’s (WHO) exclusion of tobacco harm reduction (THR)
proponents from its tobacco control strategies contrasts with its willingness to engage other
industries in harm reduction initiatives. For instance, the WHO has collaborated with the food
and beverage sector, including companies like PepsiCo and Coca-Cola, on sugar reduction
strategies to combat non-communicable diseases (NCDs). A 2018 WHO consultation on NCDs,
documented in WHO meeting reports, included private sector representatives to discuss product
reformulation and labeling. Similarly, the WHO’s road safety initiatives, such as the Global Plan
for the Decade of Action for Road Safety 2021–2030, involved automobile industry stakeholders
like the International Automobile Federation to address crash prevention and vehicle safety
standards. These engagements reflect a pragmatic approach, leveraging industry expertise to
mitigate public health challenges despite the industry’s contributions to those issues. Likewise,
the United Nations Framework Convention on Climate Change (UNFCCC) Conference of the
Parties (COP) could benefit from including industries like petrochemical companies to
collaborate on environmental solutions. The 2024 COP29 in Baku highlighted the private
sector’s role in climate finance, with initiatives like the Loss and Damage Fund involving
industry stakeholders. Engaging petrochemical firms—key players in emissions and plastic
pollution—under a transparent framework, such as the WHO’s model for non-state actors, could
harness their expertise for sustainable technologies and carbon reduction, mirroring the need for
inclusive dialogue in tobacco control.
However, WHO’s refusal to engage THR proponents, while engaging soft drink, automotive, and
potentially environmental industries, highlights an inconsistency that fuels debate. Although the
tobacco industry’s history of denying cancer links and targeting youth justifies caution, THR
advocates—often independent researchers or public health experts—are not synonymous with
Big Tobacco. Unlike sugar or road safety, where harm stems from broader societal factors,
tobacco’s harm is intrinsic to its core products, complicating engagement. Adding to this
dilemma, the Bloomberg Initiative, a major WHO partner, exemplifies this contradiction. While
the Bloomberg Initiative to Reduce Tobacco Use strongly opposes THR, advocating for strict
tobacco control measures like taxes and bans, the Bloomberg Philanthropies Initiative for Global
Road Safety actively supports harm reduction by funding road safety interventions in countries,
including in Southeast Asia, such as Vietnam, Thailand, and the Philippines. This funding,
totaling $240 million from 2020–2025, supports measures like speed reduction and helmet use to
minimize road crash harm. By sidelining THR researchers while partnering with industries like
soft drinks and benefiting from Bloomberg’s harm reduction approach in road safety, the WHO
risks undermining its credibility and missing opportunities to reduce smoking-related harm.

The Role of Funding and Influence

External funding, particularly from Bloomberg Philanthropies, shapes WHO, the Institute of
Global Tobacco Control, Department of Public Health, Johns Hopkins University (IGTC
JHSPH), and FCTC tobacco control policies. Bloomberg has invested over $1 billion since 2007
in initiatives like the Bloomberg Initiative to Reduce Tobacco Use, which supports WHO and
FCTC activities. This funding aligns with a cessation-focused, anti-industry stance often
skeptical of THR. While no direct evidence proves Bloomberg dictates policy, the alignment
between its priorities and the FCTC’s exclusionary approach is evident. A 2020 FCTC Secretariat
report acknowledged Bloomberg’s role in capacity-building but sidestepped questions of agenda
setting influence.
These dynamic risks marginalize THR perspectives, particularly in low- and middle-income
countries where smoking prevalence is high. Bloomberg-funded groups like the Campaign for
Tobacco-Free Kids have pushed for a strict vaping regulation ban, sometimes overshadowing
local voices favoring harm reduction. Overreliance on such funding may create an echo chamber,
dismissing THR without rigorous debate and prioritizing ideology over evidence.
The Case for Including THR Proponents
Benefits of Inclusion: Excluding THR proponents stifles progress in reducing smoking-related
harm. Products like e-cigarettes and nicotine pouches help smokers quit or switch to less harmful
alternatives. A 2018 Public Health England report estimated e-cigarettes to be 95% less harmful
than cigarettes, and a 2019 New England Journal of Medicine trial found vaping to be more
effective than nicotine replacement therapy for cessation. Contrary to early concerns, evidence
debunks the “gateway” hypothesis: a 2021 study in Nicotine & Tobacco Research found no
significant association between e-cigarette use and subsequent smoking among youth in the UK
and US when controlling for confounding factors. Including THR proponents, especially
independent researchers, could ensure FCTC policies reflect this evidence, particularly in regions
with high smoking rates.
Risks of Inclusion: Critics argue that including THR proponents with alleged industry ties risks
legitimizing Big Tobacco’s narratives. Companies like Philip Morris International promote THR
products like IQOS while selling cigarettes at high volumes, raising doubts about their motives.
The WHO’s 2019 tobacco report warned that THR could delay cessation or renormalize nicotine
use. However, these concerns should not extend to independent researchers, whose inclusion
under transparent conditions (e.g., disclosing funding) could mitigate risks while fostering
evidence-based dialogue.

The Scientific Basis for THR and the Consequences of Exclusion

The WHO’s skepticism toward THR is rooted in a precautionary principle, citing uncertainties
about long-term safety. While short-term studies suggest e-cigarettes are significantly less
harmful than cigarettes, concerns about youth uptake and dual-use persist. However, the
scientific consensus is shifting. A 2020 Cochrane Review found moderate-certainty evidence that
e-cigarettes aid smoking cessation, and a 2023 American Journal of Public Health study
confirmed reduced toxicant exposure in vapers compared to smokers. The gateway hypothesis
has been largely debunked by longitudinal studies, such as a 2022 Addiction analysis showing no
causal link between vaping and smoking initiation among youth.
The FCTC’s rejection of THR appears driven by distrust of industry motives rather than robust
counter-evidence. This stance has dire consequences. Banning or heavily taxing THR products,
as seen in countries like India and Mexico, pushes smokers back to combustible cigarettes,
directly benefiting Big Tobacco. A 2021 Tobacco Control study found that vaping restrictions in
Australia correlated with increased cigarette sales, boosting industry profits. Globally, cigarettes
account for 95% of the tobacco industry revenue, per 2023 Euromonitor data, while THR
products threaten this model by offering cheaper, less harmful alternatives. Excluding THR
voices perpetuates this cycle, increasing smoking prevalence, societal costs (e.g., $1.4 trillion
annually in healthcare and productivity losses per WHO), and mortality (8 million deaths yearly).

Implications of Excluding THR Proponents
Excluding THR proponents’risks entrenches a one-size-fits-all approach that ignores regional
realities. In Southeast Asia, where smoking rates exceed 30% in countries like Indonesia, THR
could complement cessation but is sidelined by FCTC policies. This exclusion bolsters Big
Tobacco’s dominance, as smokers face barriers to accessing safer alternatives. It also sets a
precedent for other public health domains, where silencing dissenting voices may stifle
innovation and erode trust.
A more inclusive approach—engaging independent THR researchers under strict transparency
rules—could balance rigor with openness. The FCTC could adopt models like the WHO’s
Framework for Engagement with Non-State Actors, used for food industry consultations, to
ensure credible voices inform policy without industry capture.

Conclusion
The WHO Framework Convention on Tobacco Control (FCTC) Article 5.3 is a vital bulwark for
shielding tobacco control policies from industry interference. Still, its blanket application to
tobacco harm reduction (THR) advocates is flawed. Evidence consistently debunks the gateway
myth, showing that THR products like e-cigarettes and nicotine pouches do not significantly lead
non-smokers to tobacco use. Instead, banning or overly restricting THR inadvertently bolsters
Big Tobacco by pushing smokers back to combustible cigarettes, inflating industry profits, and
worsening public health outcomes. WHO’s inconsistent engagement with other industries,
funding influences, and precautionary dismissal of THR underscores the need for reform.
Including independent THR voices under transparent conditions could drive evidence-based
policies that save lives while preserving tobacco control achievements.
Moreover, the WHO and FCTC must revisit the outdated MPOWER measures and FCTC
framework, developed decades ago, to align with Article 1(d) of the FCTC, which explicitly
acknowledges tobacco harm reduction as a strategy. MPOWER’s rigid focus on demand
reduction—through taxes, bans, and warnings—ignores the potential of THR to complement
these efforts. By embracing THR in its true letter and spirit, the WHO and FCTC could
modernize their approach, prioritizing the lives of millions of smokers and their families. This
requires updating policies to reflect current science, integrating THR into tobacco control
strategies, and fostering open dialogue with independent experts to ensure balanced, effective
global health outcomes.

Dr Ziauddin Islam
Global Tobacco Control and Harm Reduction Advocate
Ziauddin.islam@gmail.com