By Own Correspondent
As the 11th Conference of the Parties (COP11) to the WHO Framework Convention on Tobacco Control (FCTC) concluded last week, experts on the sidelines raised concerns about the misuse of Article 5.3, which has increasingly hindered engagement with diverse stakeholders.
The World Health Organisation’s (WHO) restrictive interpretation of this article has effectively limited meaningful dialogue between governments and non-state actors, including researchers, harm reduction advocates and industry representatives. Experts argue that this approach stifles evidence-based policymaking, prevents countries from exploring safer alternatives and reinforces a one-size-fits-all prohibitionist agenda instead of allowing policies tailored to local contexts and public health realities.
The WHO has frowned upon any participants who lean towards harm reduction, while some anti-smoking groups have mischaracterised sceptical countries as ignoring COP11 guidance. Countries such as North Macedonia, Serbia, Tajikistan and Gambia have emerged as progressive voices, openly supporting harm reduction and pushing back against blanket prohibition. This stance is unusual within the FCTC process, where most countries traditionally follow the WHO’s restrictive position.
These countries have questioned proposals that would criminalise or heavily restrict low-risk alternatives, particularly when such measures ignore local realities. In their plenary statements at COP11, they urged delegates to follow science and real-world evidence rather than ideology or donor-driven agendas. Gambia highlighted that it is neither fair nor practical for low-income nations to adopt harsh restrictions copied from wealthy Western jurisdictions. It stated, “Reaffirming our commitment to the convention does not preclude openness to scientific evidence, evolving innovations or new regulatory approaches. Being pragmatic and evidence-informed is not contradictory to strong tobacco control; rather, it strengthens our credibility and effectiveness.”
New Zealand, another progressive country, received a symbolic “Dirty Ashtray Award” at COP11 for openly supporting tobacco harm reduction, despite having some of the lowest smoking rates globally and some of the strictest tobacco laws. The award, issued daily during the conference by the Global Alliance for Tobacco Control, a Bloomberg-funded NGO bloc within the FCTC process, is given to countries it claims are “blocking progress.” New Zealand was cited specifically for supporting vaping as a smoking cessation tool.
These examples point to a shifting tide. Many low- and middle-income countries are increasingly rejecting billionaire-driven prohibitionist models in light of mounting evidence. The FCTC, however, remains firmly opposed to harm reduction, often viewing such countries as dissenters, hence the rationale behind the award. Even when a country like New Zealand demonstrates strong public health outcomes and exceptionally low smoking rates, support for safer alternatives is framed as defiance rather than evidence-based policymaking.
At the core of this stance lies not the realities on the ground, but a scorched-earth approach that prioritises prohibition above all else. As Gambia noted, this position must loosen and open itself to new ideas and innovative strategies. Failure to do so risks enforcement challenges and policy irrelevance.
Anti-harm reduction policies have been shown to fuel criminal activity through black markets, while evidence continues to contradict narratives promoted by major regulatory bodies. Given the growing body of evidence, the evolution of the tobacco and nicotine industry, and the reality that more nations are recognising these changes, it is time for the WHO to return to the drawing board. The organisation must re-evaluate its strategies and adopt a pragmatic, evidence-based approach that addresses key concerns, particularly the protection of children from nicotine-related harms, while embracing innovative harm reduction measures aligned with current scientific understanding and proven national experiences.
The WHO must also acknowledge that segments of the industry share concerns about these risks and are willing to collaborate with public health authorities to minimise harm. It can no longer afford to ignore the Swedish case study, which demonstrates that harm reduction strategies can succeed without undermining public health goals. Dismissing this evidence risks prolonging ineffective policies and missing opportunities for pragmatic, science-driven solutions. It also risks alienating countries that support the FCTC, as well as civil society organisations backed by powerful advocacy networks that have long resisted harm reduction and continue to frame the industry solely as an adversary.
The time has come to develop strategies that bridge divides between public health authorities, policymakers and industry, fostering collaboration grounded in evidence rather than ideology. By doing so, pragmatic harm reduction approaches can be advanced that protect vulnerable populations while promoting solutions already proven to work elsewhere. Increasingly, it is no longer the WHO alone calling the shots, but member states declaring that they have had enough of philanthro-colonialism.
