Countries that ignore WHO advice show decline in smoking prevalence — expert

Prof. David Sweanor, chair of the advisory board of the Center for Health Law, Policy and Ethics of the University of Ottawa

Countries that ignored the World Health Organization’s (WHO) advice to enforce prohibitionist policies have experienced the most dramatic decline in smoking prevalence when they adopted a tobacco harm reduction approach instead, international public health policy experts said.

Prof. David Sweanor, chair of the advisory board of the Center for Health Law, Policy and Ethics at the University of Ottawa, said smoking rates in countries such as Sweden, the United Kingdom, and Japan saw the biggest decline after these countries allowed the use of vapes, heated tobacco products, snus, and other smoke-free alternatives that are considered less harmful than conventional tobacco.

“The bottom line is that we have known for decades that the reason people die from smoking is because of inhaling smoke, not from nicotine. We know that the countries that have had the biggest declines in cigarette smoking in recent times are countries that are essentially ignoring the advice of the World Health Organization—places that have allowed substitutes to replace cigarettes,” Prof. Sweanor said in a virtual event hosted by Italy’s Formiche and Healthcare Policy on November 24, 2023.

The virtual event, which featured notable public health experts, discussed the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) whose Conference of the Parties (COP) meeting in Panama was postponed at the last minute in November.

“We know that we can eliminate or largely eliminate the smoking problem globally by substituting low-risk products,” said Prof. Sweanor, the first lawyer in the world to work full-time on policy measures to reduce the harm from cigarette smoking.

He is among international experts who wrote a letter to the WHO to point out the problems it is facing because of its opposition to tobacco harm reduction.

Prof. Sweanor said many countries are now ignoring the WHO’s advice because of the latter’s prohibitionist and absolute policies.

“Countries end up ignoring protocols that are anti-health, that are anti-consumer rights. What happens in that is that people also lose faith in authorities. They stop believing the World Health Organization. And that’s a huge cost.  We’re seeing that happening globally now, where authorities are no longer trusted,” said Prof. Sweanor.

He said that contrary to WHO’s dictates, countries “can do things that are in the interest of the health of their own people. I think we’re seeing more of this happening globally, of countries saying we want to do what works here.”

At the same time, he slammed the WHO FCTC for the lack of scrutiny on its part, with members meeting behind closed doors to come up with rules for its members.

“But many of what they were saying really didn’t make sense on the basis of the science that already existed and the practicalities that we know work in public health,” he said.

“I think that this sort of closed discussion by poorly informed people who are driven by ideology, political or religious beliefs, rather than public health principles, is a real problem,” he said.  “That’s what happens when something that should be instructional or should be guidance becomes a dogma that is treated like religious law.”

Anders Milton, a physician and former president of the World Medical Association, said there are a billion plus smokers in the world today.

“Fifty percent of them will die unless we do something. So 500 million will die without us doing anything.  As you know, the World Health Organization wants to forbid everything but cigarettes, really, and I think that’s the wrong way to go. I think we should use harm reduction instead,” he said.

Dr. Riccardo Polosa, professor of Internal Medicine at the University of Catania and founder of the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) in Italy, noted the large body of evidence showing that vapes and heated tobacco products are at least 80 percent to 90 percent less toxic compared to combustible cigarettes.

“In our experience, we are producing excellent science that is completely snowed under by junk science that is constantly being produced, particularly by US-centric narratives and US-centric funded institutions,” Dr. Polosa said.

“Tobacco control policies today need innovation. Beyond advocating the actions like increasing tobacco taxes, implementing public smoking bans, promoting accessible cessation programs for all, these tobacco control policies should also take into account the integration of the principle of risk reduction through the promotion of non-combustible alternative products for adult smokers.  You see this happening already in places like Japan, Norway, Sweden, England, and Iceland,” he said.

Maria Alejandra Medina, coordinator of Corporación Acción Técnica Social in Colombia and Latin America said the Conference of the Parties (COP) meeting of the WHO FCTC was trying to hide the truth.

“I want to say that the COP is not telling the difference between nicotine and tobacco and the alternatives that are potential solutions for too many people. This sows misinformation and confuses users about the profile rates between different products. By not giving information about differentiation between various smoke-free nicotine products, this COP hides too many evidence of developments and this is really bad to new approach to smoke or tobacco use and even for drug use too,” Medina said.

“Not involving nicotine consumers in the regulation process violates their human rights of users, because we are trying to understand new approaches in health policy, new approaches in human rights, and COP,” she said.

“We need to be very aware of the intensified discussion due to COP postponement. And we must emphasize that the current tobacco (control) policies are creating more harm than many products that today represent harm reduction alternatives for many users,” Medina said.

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