WHO should embrace tobacco harm reduction to save lives, says global health advocate

Ali Anderson
Ali Anderson
April 8, 2024
5 min read
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The World Health Organisation (WHO) should embrace tobacco harm reduction tools such as vaping to save lives, a leading global health advocate has said.

Writing in scientific journal The Lancet, Derek Yach - a former Executive Director at the WHO - accuses the organisation’s Framework Convention on Tobacco Control (FCTC) of failing to adapt to “scientific and technological advances that can help smokers to quit”. 

He says this has “destined more users of toxic tobacco products to live shorter, less healthy lives.”

Yach’s letter is in response to a Lancet article by Kelley Lee and colleagues describing the “hard won progress” of the FCTC over its 20 years, and calling for harder action to be taken against vapes and other nicotine alternatives. 

Yach says: “Lee and colleagues acknowledge slow progress in ending smoking, yet they advocate for more of the current FCTC actions without considering tobacco harm reduction.

“This is even though continuation of the FCTC actions would cost over US$400 billion (£317 billion) - a figure they must know is unattainable. Instead, we should be asking what can be done differently.”

Yach says tobacco harm reduction is integral to the FCTC definition of tobacco control, but it instead pushes bans, prohibitions, and regulations. This, he says, undermines access for millions of people to safer alternative products, such as vapes and nicotine pouches. 

“Crucially, well over 120 million people use such alternatives and they seem to improve quit attempts compared with nicotine-replacement therapy,” he writes.

Yach says the article by Lee and colleagues stereotypes global tobacco companies as purely being out to expand the market. He says they do not consider “the complexity and delicacy of extensive negotiations,” which led to all major tobacco producers except the USA and Indonesia becoming signatories to the FCTC. 

He says they should consider how these legacy companies are moving away from traditional cigarettes towards safer alternatives as technology evolves.

“We need not wait for a miraculous $400 billion to accelerate the end of smoking,” he says. “Under careful regulation, the power of industry could ensure that adult smokers have access to safer products as a route to quitting tobacco. 

“Yes, tobacco companies who transform and offer safer alternatives will profit but that profit comes with potentially 100 million fewer premature deaths between 2025 and 2060.”

DY served as the first Director of the Tobacco Free Initiative, WHO. He founded and led the Foundation for a Smoke Free World and has spent 35 years in tobacco control.

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