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More than 20 years since the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) was founded to protect public health from the consequences of tobacco consumption, some industry stakeholders say there are reasons to despair as well as celebrate with regard to progress.
Derek Yach (pictured), global public health expert, former WHO executive responsible for the FCTC process, and founder and former president of the Foundation for a Smoke-Free World (now Global Action to End Smoking), told TobaccoIntelligence: “We still have 1bn smokers, who die at a rate of 8m a year. Surely we could have done better by now?”
Yach will be discussing better ways to embrace tobacco harm reduction globally and the barriers to progress at the upcoming Global Forum on Nicotine (GFN) in Warsaw from 18th to 19th June.
“The WHO has failed to embrace harm reduction,” said Yach. “Its prohibitionist stance on next-generation products (NGPs) has caused undue suffering and, when I look at the numbers in terms of lives that could have been saved over the last decade by moving more rigorously in support of tobacco harm reduction, I’ve no doubt that they far eclipse the deaths that occurred even during the Covid-19 pandemic, which is another of the WHO’s colossal failures.”
Cuts to public health
Given the recent, unprecedented cutbacks US president Donald Trump’s administration has imposed on the WHO and other international health agencies, it’s likely that tobacco harm reduction will receive even less attention in the coming years. Yach believes this will give privately funded organisations, such as Bloomberg, disproportionate power. In the past, they have been actively encouraging countries to move ahead with bans on NGPs – such as the ban on vapes in India. This came into effect around the time of the so-called vaping-associated lung injury, or Evali, outbreak in the US and was implemented before it was proved that the outbreak was caused by contaminated products.
“These non-elected US philanthropies will play an even more disproportionate role now that the WHO’s own inter-governmental ability is going to be seriously hampered by cuts,” warned Yach.
He called on the governments who have successfully cut smoking rates to step up and speak up. “The WHO is responsive to governments and – from Japan to Sweden, to the UK, to the US, to Pakistan, to Lithuania – these governments must know they’re seeing faster declines in smoking driven by NGPs than they could have ever anticipated if they’d simply followed the WHO prohibitionist approach.”
UK/US-centric research
Yach believes the industry could do more to to invest in research capacity in lower- and middle-income countries (LMICs) that have very high smoking rates and no access to their own research. Giving these regions funding to develop stronger science and stronger understanding of issues, would empower them to have their own voice, instead of relying on research from industry stakeholders in the UK and US, which tends to focus on the gateway theory and propagating concerns about youth access.
“If manufacturers were to strengthen and invest in research capacity in countries where we have the most smokers, they would build a cadre of informed researchers who would inform policy and government in their own countries,” said Yach. “That would be a strong counter to the WHO approach.”
“Big industry tends to go where the market and profitably will be easiest for them, which is understandable from a purely business point of view,” he added. “But this isn’t a normal consumer product, it’s one that saves lives, so greater effort should be made to expand access and production in countries where male smoking rates exceed 40%.”
Refocusing on older smokers
Yach also called out the industry – both tobacco and pharmaceutical companies – for failing to adapt their products to people over the age of 40 who smoke more than a pack of cigarettes a day. “The vast majority of harm-reduction products are being bought by people under the age of 35 and, in the case of vapes, probably under the age of 25. This will take 50 years to achieve decreased tobacco deaths. Focusing far more on reaching heavier smokers over the age of 40 will see death rates decline within two decades.”
“Twenty years on from the framework convention, we should be asking: how many lives would we save in future if we implemented harm reduction policies today?” He mentioned that research led by himself and Delon Human, leader of the Smoke Free Sweden initiative and former health adviser to three WHO directors-general, showed that millions of lives across the Middle East, several LMICs, and others would be saved by accelerating access to NGPs.
Yach called for a change in the government approach to enable the market forces reach the smokers in the best possible way – which will ultimately save governments money, as well as dramatically improve the quality of smokers’ lives.
Progress fuelled by policy
“We’re already seeing success,” he said. “By the end of this year, for example, the US will have fewer combustible users than non-combustible users, which is a victory – not just for the industry or the government but for the people. The same is true in Japan where there’s been a 50% decline in adult smoking rates, driven primarily by heated tobacco products. Imagine what would happen if governments got behind this?”
Yach said some governments in the Middle East – led by Saudi Arabia – were financially supporting nicotine pouch manufacturing. Countries that supported access to nicotine pouches, vapes and/or heated tobacco products – such as Pakistan, Egypt and the Philippines – were also making progress in this area.
“Many of these countries are large, serious economies that allow NGPs to be sold on their markets,” he added. “China – the largest cigarette manufacturer and user in the world – is manufacturing and regulating harm-reduction products. This makes it impossible for the WHO vision of bans and prohibitions to have a global impact.”
Change of direction
Yach thinks the governments who’ve taken the most prohibitionist approaches will have to reverse those trends in time. “Eventually, the health scientists will have enough data to show that this is killing more people than it is saving. And their customs and excise people will start realising that the illicit trade stirs up nefarious types of activity that their security services don’t want to tackle.”
He is hopeful that a new WHO administration will take a less prohibitionist stance and called for the new WHO director general, who will follow Tedros Adhanom Ghebreyesus in 2027, to be a respected politician on the international political scene rather than a minister of health.
“With global health in such unprecedented despair, we need someone who has experience as a head of state but who also has a health background and a passion for health,” Yach said. “Dr Gro Harlem Brundtland [a former WHO director general and former prime minister of Norway] showed how previously unprecedented progress could happen if WHO was led by someone deeply respected by heads of state. She headed the World Bank and by having the courage to tackle neglected issues, she led the world into a golden age of global health.”
He remained optimistic that globally available NGP use is unstoppable, since it is primarily driven by people who smoke demanding ways to improve their health.
- Yach will be speaking on the Framework Convention on Tobacco Control at the upcoming Global Forum on Nicotine in Warsaw from 18th to 19th June. TobaccoIntelligence’s editorial director Barnaby Page will also be participating in a GFN panel discussion, “Nicotine pouches – what’s the real story?”
– TobaccoIntelligence staff
