By Munyaradzi Blessing Doma
The 11th Conference of the Parties (COP) to the World Health Organisation’s Framework Convention on Tobacco Control (FCTC) recently took place in Geneva, Switzerland, and resembled the familiar closed-door meeting where science was neglected and the voices of consumers left out yet again. A lot of these experts, including some of those who helped set the stage for the FCTC in its early days, felt that the meeting had drifted very far from its original purpose.
They characterised it as an event powered by predestined stories rather than authentic grappling with evidence. Observers kept wondering about why a meeting that was professed to advance public health was held out of sight and resistant to opposing views.
During COP11, the Taxpayers Protection Alliance convened Good COP 2.0 – a parallel hybrid forum that united relevant representatives from all stakeholder groups in the global tobacco harm reduction agenda. Experts have given the WHO several days to answer questions regarding scientific integrity and the continued neglect of consumers from policy discussions. Day one of Good COP 2.0 opened up another stage of a week of debate around evidence-based harm reduction and the future of the FCTC.
Speakers including David Williams, Kurt Yeo, Professor Tikki Pangestu and Roger Bate discussed how the FCTC’s stance, over the intervening decades, has evolved, and what this means for global public health. Although the WHO has long regarded itself as a major advisor to low-income countries, experts said that it has been hesitant in developing risk-proportionate policies for safer nicotine products and to offer advice to the other countries that follow it where it is considered. Prof Pangestu pointed out that the model used by the FCTC’s template was now being copied and extended to other health domains as well, including the COVID-19 response, in which dissenting scientific voices were side-lined and the exhortation to ‘follow the science’ was turned to slogan, not method.
Some speakers cautioned the WHO’s denial of scientific evidence was harming its credibility. Clive Bates replied that the organisation needed to start concentrating on what was most important, since it was credibility that mattered. The WHO was “burning that credibility under its stewardship of tobacco control,” he warned. The Good COP 2.0 crowd also heard about Sweden’s success in decreasing smoking. “Sweden has effectively created a generation without smoke,” said Carissa Düring, “with only 2.3 percent of young people smoking each day compared to around 20 percent in the rest of the European Union.”
This, she said, showed what evidence-based harm reduction can do. As debates took a page from that book, in Day 2, transparency, scientific integrity and the tension between harm reduction and prohibition were at the forefront. Experts emphasised that restrictive tobacco control measures disregard real consumer behaviour and threaten to harm public health rather than improve it. Countries as varied as New Zealand and Serbia already had to call for more flexibly tailored harm reduction initiatives at COP11, emphasising how much the lines of debate on tobacco control had been pulled further and further away globally.
According to Marina Murphy, however, medical training heavily emphasises the dangers of smoking and is rarely followed by clinicians learning about the benefits of quitting if they have alternative safer options. She said that Good COP 2.0 offered a critical space to scrutinise scientific evidence unfettered. David Williams also added that Good COP 2.0 permitted open discussions unlike COP11, which he criticised for lacking transparency. He said that if safer nicotine products could be available to the public, lives could be changed and the cost to health care systems would be reduced.
Martin Cullip and others noted Serbia’s pursuit of science in FCTC discussions in contrast to what they considered the Secretariat’s commitment to prohibition. Liza Katsiashvili has raised the question of why people are being excluded from meetings that will directly affect them, observing that treating people as if they cannot make informed choices only diminishes public confidence. Maria Papaioannoy said that the WHO needs to admit its errors, stating that doubling down on misinformation only amplifies the credibility gap.
By Day 3, the conversation shifted to the Asia-Pacific region, which consists of more than 600 million smokers. Speakers pointed to the failures of policy rooted in the WHO’s unwillingness to embrace harm reduction, particularly in places with fragile health systems. “Countries should reject prohibition-led models of behaviour and advocate for holistic approaches,” Williams said. Gabriel Oke pointed out that Africa has a large number of smokers, but not a heavy percentage of them are represented in the decision-making process, even as the WHO plays a major role in the continent’s health systems.
Prof Pangestu underlined the importance of coordination of research in the region and observed that there is insufficient data on the health and economic consequences of e-cigarette use. Regional voices generally agreed that innovation should be accepted as a part of public health, and not seen as a danger. On Day 4, Sweden’s triumph once more became an important touchstone. As Bengt Wiberg explained, Swedish progress came after motivating smokers to change to less risky options such as snus and regulated nicotine products. Data indicates that smoking rates have plummeted, leading to improved health outcomes. Mark Tyndall cautioned that strict prohibitions could lead consumers to illegal markets and that people will ultimately choose products they want despite regulations. A number of speakers said countries in Asia, Africa, and Latin America are starting to cast aside prohibition-based models championed by billionaire-affiliated groups and institutions in their industries. Experts also said anti–tobacco harm reduction plans fuel black markets and criminal activity, contradicting assertions made by some regulatory agencies.
The last day of Good COP 2.0 looked on the international scope of illicit trade, gang activity and a muscular approach towards enforcement that has been driven by tight controls on tobacco. Speakers condemned the WHO-backed programs that included heavy taxation and complex pre-market approval procedures and said these disregard scientific data and consumer behaviour. The panellists called for humane, consumer-centred regulation over nicotine and the harm caused when people are penalised for using nicotine products. Rohan Sequeira likened these punitive measures to punishing people for wearing seatbelts, noting that law enforcement was exploiting the restrictions to solicit bribes. The forum ended with appeals on the basis of structural reform by global health institutions, including by the WHO, as well as national regulatory bodies like the U.S. FDA.
