By Munyaradzi Blessing Doma
While there is broad evidence that tobacco cessation is achievable through several approaches, including tobacco harm reduction, it remains unclear why the Secretariat of the World Health Organisation Framework Convention on Tobacco Control (WHO FCTC) continues to insist that all nicotine products are the same or that they all pose equal harm.
Despite evidence showing that non-tobacco nicotine products play a key role in smoking cessation, the WHO has spent decades attempting to establish tobacco control measures that have delivered limited impact.
The tobacco epidemic remains one of the largest public health threats globally. An estimated 1.3 billion people use tobacco products and more than 8 million people die annually as a result. Necessity often drives innovation and the introduction of harm reduction products such as vapes and nicotine pouches has offered new options for smokers seeking to quit.
Speaking on the second day of the Taxpayers Protection Alliance’s Good COP 2.0 panel titled ‘A Dangerous Game: Is Stubborn FCTC Secretariat Ideology Eroding Trust in Public Health?’, the Director of Operations for the World Vapers’ Alliance (WVA) said one of the ideas promoted by the Secretariat is that some nicotine alternatives do not work.
“So I think the fact that only consumer voices and very select organisations are allowed in those meetings means there is little diversity in opinion. It is not scientifically driven because the WHO often communicates in ways that mislead the public about less risky nicotine alternatives. If you look at their FAQ, for instance, they treat all nicotine products the same. That is not scientific evidence. It ignores any form of risk proportion or risk assessment,” she said.
With evidence showing that quitting is possible, Liza Katsiashvili added that consumers should be recognised as people capable of making informed decisions.
“The more ideological they become, the more they try to silence consumers and the more this erodes trust in public health. Many institutions follow this lead and it is happening in my country and likely in many of your countries too. Consumers should not be treated as people who cannot make decisions,” she said.
Hinaj Mitchell, Act Asia Founder who switched to nicotine alternatives in 2016 after more than four decades of smoking, said it was unfortunate that the FCTC Secretariat continues to exclude people with lived experience.
“I can mention a few issues. One is the misinformation. Two is the rejection of science. Three is the exclusion of principal stakeholders. The very reason these processes exist is because of us,” he said. “We are not allowed in. We have never been allowed in. This is a conversation about our lives and our health, yet we are excluded and decisions are made without our participation.”
Katsiashvili, reflecting on the situation in Georgia, said smoking prevalence is around 26 percent and has remained stagnant partly because public health authorities still ignore nicotine alternatives.
“In Georgia we have very high smoking rates, close to 30 percent, and it has been stagnant for years. The same applies to Armenia, Azerbaijan, Turkey and Russia. The region is struggling. Consumers in my country are trying to figure things out for themselves. They have found less harmful nicotine alternatives such as vapes, heat-not-burn devices and pouches. They observe that they feel better compared to when they used combustible tobacco,” she said.
She described it as restrictive for authorities to deny citizens information about nicotine alternatives when the information is widely accessible.
“If you approach public health institutions like the National Centre for Disease Control and Public Health and ask for help with cessation, they will not provide advice on harm reduction. It is ignored. This is confusing for consumers who have real-life evidence that these products help them. Public health institutions give contradictory messages and sometimes moralise the issue without offering practical support,” she said.
Nicotine replacement therapy (NRT), which includes gum, patches, lozenges, sprays and inhalers, as well as electronic cigarettes, has been used for decades in many countries to support cessation.
Dominika Mastalerz, a psychologist specialising in addiction, said there are positive examples in Scandinavian and Western European countries where access to addiction treatment is better organised because of stronger funding and a wider range of programmes.
“Nicotine replacement therapy can be a bridge to complete cessation but it should be part of a comprehensive quit plan that combines psychological therapy, physician support and health education. Nicotine substitutes such as gum, sprays, patches and sachets can help reduce withdrawal symptoms and cravings. More modern forms of nicotine delivery have emerged in recent years, including nicotine sachets, e-cigarettes and tobacco warmers,” she said.
A PubMed study analysing the International Tobacco Control Four Country Survey (Australia, UK, Canada and the US) showed that in 2020, about 28.8 percent of people used NRT in their most recent quit attempt. About 57.2 percent of smokers or ex-smokers used some form of pharmacotherapy or a nicotine vaping product.
