By Munyaradzi Blessing Doma
When it came into effect in 2005, the World Health Organisation’s (WHO) Framework Convention on Tobacco Control (FCTC) was hailed as a landmark global health treaty. Two decades later, however, health experts say the treaty has largely failed to deliver on its promise to significantly reduce global smoking rates.
The FCTC urged governments to adopt taxation, advertising bans, and other restrictive measures to curb smoking. Yet, despite widespread adoption, global tobacco use remains stubbornly high.
Studies indicate that the FCTC has struggled to keep pace with changing industry tactics, the rise of new nicotine products, and inconsistent enforcement across countries.
According to data from the U.S. Centers for Disease Control and Prevention (CDC), of the 1.3 billion adults who smoke, 67 percent say they want to quit. “Half of the adults who smoke cigarettes report trying to quit in the past year. In 2022, 53.3 percent of adults who smoked said they had tried to quit, yet fewer than one in ten succeeded,” the CDC report stated.
When the FCTC came into force, the WHO estimated tobacco-related deaths at four million annually. Two decades later, WHO figures show that tobacco kills more than seven million people every year, including an estimated 1.6 million non-smokers exposed to second-hand smoke.
Global health expert and former WHO Cabinet Director, Dr Derek Yach, said during a recent Taxpayers Protection Alliance webinar titled ‘The Insider’s View’, that the FCTC has failed to adapt to real-world challenges.
In 2014, I warned that the treaty was becoming ideological and introverted, failing to move with the times,” said Dr Yach. “We recognised early on that to make real progress, we needed to engage tobacco industry scientists to understand what they were doing in harm reduction. That was always part of the treaty’s definition.”
He explained that meaningful progress in other UN treaties came from inclusive dialogue between governments, private industry, and civil society, something the FCTC process eventually shut down.
“Unfortunately, much of that openness was closed off by the treaty process,” he said. “We also understood that success would require major financial support for low- and middle-income countries to build research capacity so that they wouldn’t rely entirely on imported data from the U.S. or Europe. That funding never materialised.”
Dr Yach added that one of the most worrying aspects of the FCTC’s implementation has been “the total neglect of Harm Reduction and innovation.”
“Science and technology have moved rapidly inside the industry, yet the WHO continues to ignore these developments,” he said. “The treaty relies heavily on one particular philanthropist for funding, rather than diversifying its financial base.”
Still, Dr Yach believes elements of the treaty remain valuable. “What we need to strengthen is the role of Harm Reduction. Regulations should be proportionate to risk. If you tax traditional cigarettes at 100 units, e-cigarettes and other harm reduction products should be taxed at one,” he explained.
“In terms of messaging, we must focus on the real harms of combustible tobacco while being careful about what we say regarding vaping, given that it’s now the most common method people use to quit smoking. We should keep what works but put greater emphasis on the power of harm reduction, especially for adults who still smoke. If we do that, we could save 100 million lives over the next few decades.”
Dr Yach also questioned how much the WHO FCTC has done to expand access to treatments for smoking-related diseases such as lung cancer, chronic obstructive pulmonary disease (COPD), and tuberculosis.
“The answer is zero,” he said bluntly. “There’s no progress report on these fronts. Unlike other international treaties that monitor measurable outcomes, the FCTC produces guidance but rarely assesses whether its strategies are actually working.”
He also faulted the WHO for its narrow focus on reducing tobacco use while ignoring product toxicity and Harm Reduction strategies. “The WHO doesn’t focus on making products less toxic. It ignores Harm Reduction entirely. They say we must stop people from smoking, but they overlook population growth and the persistence of addiction,” he said.
Similar sentiments have been echoed by Professor Robert Beaglehole, another former WHO Cabinet Director, who argued in ‘The Lancet’ (2022) that “The FCTC is no longer fit for purpose, especially for low-income countries.”
“Neither WHO nor the FCTC is grounded in the latest evidence on the role of innovative nicotine delivery devices in helping smokers transition to much less harmful products,” Beaglehole wrote.
Beaglehole and public health expert Ruth Bonita further told ‘Tobacco Reporter’ that while the FCTC had inspired a global response to tobacco control, evidence of its effectiveness remains inconsistent.
“Although the FCTC has encouraged action, there’s no strong or consistent link between implementing FCTC measures and reducing smoking prevalence,” they said. “The treaty doesn’t prohibit Harm Reduction but leaves it up to member states to decide how to regulate e-cigarettes and other nicotine products. The WHO’s lack of endorsement of Tobacco Harm Reduction denies 1.3 billion smokers access to healthier alternatives.”
They argued that WHO’s current stance, treating e-cigarettes and new nicotine products as if they were traditional tobacco, lacks scientific justification.
“This position ignores a risk-proportionate approach,” they said. “We believe WHO must provide positive leadership and technical support to countries considering the use of e-cigarettes and other nicotine delivery systems.”
Beaglehole and Bonita also pointed to examples where Tobacco Harm Reduction has produced dramatic results.
“In New Zealand, adult daily smoking fell from 13.3 percent in 2017–2018 to 6.8 percent in 2022–2023, a 49 percent decline in just five years, following the widespread availability of e-cigarettes,” they noted.
“Sweden, with its long tradition of snus use, now has the lowest adult daily smoking rate in the world, just six percent in 2022, and correspondingly low rates of tobacco-related mortality.”
Ahead of COP11, Beaglehole and Bonita urged the WHO to embrace innovation in nicotine delivery.
