Published:

Christopher Snowdon is Head of Lifestyle Economics at the Institute of Economic Affairs. He is the author of A safer bet: Gambling and the risks of over-regulation, published this week.

The World Health Organisation’s decision last month to give a special award to India for banning the sale of e-cigarettes was proof that the agency has no intention of taking an ethical and evidence-based approach to tobacco harm reduction. This puts it squarely at odds with countries such as the UK and New Zealand which have successfully embraced vaping as part of their tobacco control strategy.

In November, the WHO will hold its ninth Framework Convention on Tobacco Control Conference of the Parties (COP9). The Framework Convention on Tobacco Control (FCTC) is the first and, to date, only international treaty of the World Health Organisation. Adopted in 2003 and signed by 168 countries, it explicitly defines tobacco control as “a range of supply, demand and harm reduction strategies”. Unfortunately, harm reduction is unlikely to feature much at the conference, except as an object of derision and contempt.

The WHO has never pursued harm reduction policies in relation to smoking and in recent years has increasingly worked to stamp out e-cigarettes and other reduced risk nicotine products. It does not discourage member states from banning them outright and it encourages those who had not banned their sale to prohibit or restrict e-cigarette advertising, tax e-cigarettes “at a level that makes the devices and e-liquids unaffordable to minors”, ban or restrict flavours “that appeal to minors”, and ban vaping indoors wherever smoking was banned.

There is no doubt that e-cigarettes are much, much safer than combustible cigarettes. Public Health England and the Royal College of Physicians have both stated that the risks of vaping are likely to be at least 95 per cent lower than the risks of smoking. The US National Academies of Science Engineering and Mathematics concluded, after a thorough review of the evidence, that “e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes”. After more than a decade on the market, with millions of regular users, no deaths have been associated with regulated e-cigarettes.

Despite an ever-expanding body of evidence confirming that e-cigarettes are much less hazardous than combustible tobacco and are more effective than nicotine replacement therapy in helping smokers quit, the WHO has doubled down on its hostility even as real world evidence continues to show smoking rates declining as vaping rates increase.

In January 2020, as Covid-19 spread around the globe, the WHO put out a series of bizarre Tweets about vaping, falsely claiming that e-cigarette liquid burns skin and that secondhand vapour harms bystanders. One Tweet even suggested that e-cigarettes could be “more dangerous than regular cigarettes”. In December 2020, WHO Europe described e-cigarettes and other reduced-risk products as “the next frontier in the global tobacco epidemic” and said that “with rigorous implementation of the WHO FCTC, a path can be built towards a tobacco and nicotine-free future.” A nicotine-free future clearly leaves no room for e-cigarettes.

The WHO’s handling of COVID-19 has tarnished its reputation in the last 18 months, but it is still respected by many people who associate it with the successful campaign to eradicate smallpox in the 20th century. If the WHO says that e-cigarettes are a dangerous product that threaten to derail decades of progress in the fight against smoking, many people will take it on trust. Many countries do not have the resources to carry out the kind of evidence reviews conducted in the UK and the USA. Instead, they rely on agencies such as the WHO and the FCTC, little knowing that they have been captured by a small group of abstinence-only prohibitionists.

As I argue in a new report, the FCTC Secretariat and the COP meetings are not fit for purpose. In their relentless opposition to vaping and other reduced risk nicotine products, they have become a threat to global health. How should vapers and enlightened public health advocates respond? COP meetings are notoriously secretive. Journalists and the public are technically allowed in as observers under strict conditions (e.g. they must have no conceivable connection to the tobacco industry), but are invariably thrown out on the first day (without a vote being held). In 2014, Drew Johnson of The Washington Times was forcibly ejected from the venue in Moscow after being told that “the media is banned”. In 2018, the internet livestream was cut off early in proceedings. This lack of transparency is unacceptable for a UN conference funded by taxpayers.

But there is a phrase in medical ethics that is relevant to this debate: “Nothing about me without me”. Vapers have little chance of being even being allowed to view COP9 online, let alone being permitted to speak at it. Their only hope is to contact their elected representatives and demand that pressure be put on the FCTC to take a more open and evidence-based approach. COP meetings fly under the media’s radar and that is how the FCTC Secretariat likes it. It thrives in darkness.

Journalists should ask more questions about what goes on in these meetings. Governments which recognise vaping’s potential to lower smoking rates and save lives should make that case strongly at COP9. They should pick strong, articulate advocates as their delegates, not bureaucrats. If the WHO continues to spread misinformation about e-cigarettes and if COP9 is held in secret again, these governments should withdraw their funding of the FCTC Secretariat. The FCTC Secretariat should be put on notice. COP9 is the last chance for the WHO FCTC to mend its ways and operate as a transparent and evidence-based organisation. If it cannot be reformed, it should be disbanded.