Scorecard exposes WHO's big fail in curbing tobacco use

By Derek Yach, global health consultant and previous WHO Cabinet Member.

When delegates gather in Panama for the World Health Organization's (WHO) latest summit on tobacco control this month, they would be unwise to indulge in self-congratulatory backslapping.

A key objective of the 10th Conference of the Parties (COP10) to the Framework Convention on Tobacco Control (FCTC) is to assess progress made by Parties in meeting their agreed obligations to end smoking and the use of toxic smokeless tobacco products in the fastest possible time in order to prevent deaths and disease.

On the WHO's own evidence, the Parties are failing badly. And that is not solely because the bald figures state that still there are 1.2 billion tobacco users in the world and 8.5 million people die prematurely from tobacco-related causes every year.

How badly the Parties are going wrong is spelled out in a 'scorecard' compiled by a group of experts, including myself, who analysed the Global Progress Report released by WHO ahead of COP10.

Inspired by the report card published by The__Economist on the eve of the COP28 climate conference last year, we assessed progress across eight domains – ranging from trends in tobacco use to support for technology innovation, and from UN sustainability goals to R&D capacity in LMICs.

Our scorecard is bleak: five Fs (fails), an E-, a D- and a solitary B+.

With millions of lives at stake, this massive underperformance can only be truly appreciated through a full reading of our report. But it is important to highlight here how the Parties are wilfully – and in contravention of their own mandate – failing to use technological innovation to curb the deadly toll of tobacco.

The FCTC includes tobacco harm reduction (THR) in its definition of tobacco control and highlights the importance of research in several places. Despite this, and in the face of rapid industry-led innovation, the WHO progress report only refers to THR in negative terms and does not reference, for example, the US FDA's recent authorisation of all THR categories as being "appropriate for the protection of public health."

Neither is there reference to the evidence showing that, in countries where smoking is decreasing fastest, use of THR products such as vapes, heated tobacco products, snus and nicotine pouches is increasing and displacing cigarettes.

Instead, the WHO report describes bans and prohibitions as the desired policy response to a wide range of THR products. It is evident that lifesaving technologies are being actively opposed by WHO, leaving millions of smokers unable to quit or switch to less harmful alternatives.

Instead of proper research and education, there has been widespread dissemination of disinformation about THR, the overstated risks of nicotine-based products and the alleged dangers of vapes for children's health. The most recent example of this comes from a survey of 15,000 physicians in eleven countries which showed that approximately 70% of them believed, incorrectly, that nicotine causes lung cancer.

The rapid increase in innovation and availability of THR products demands that priorities be set for research to inform policies. Yet 20 years after the adoption of the FCTC, there is still no FCTC-supported list of priority research areas, including those needed to assess the benefits and risks of THR.

These failures are compounded by the lack of stakeholder engagement and partnering, another domain that earned an F on our scorecard. In stark contrast to the multi-stakeholder engagement during COP 28 on Climate Change, COP 10 is effectively a "closed shop". In fact, there have been active measures to exclude leading scientists, THR experts and nicotine users from COP10. These groups have expertise and/or valid life experiences related to ending tobacco use and their exclusion severely limits the ability of Parties to make fully informed decisions.

It is evident that the stance being taken against THR products is hindering implementation of the FCTC and squandering an opportunity to prevent unnecessary deaths. Greater emphasis needs to be placed on actual health outcomes and hopefully, our pre-COP10 scorecard will serve as a wake-up call to member states who are committed to improving the health of their people.

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