The Ninth session of the Conference of the Parties (COP9) to the WHO Framework Convention on Tobacco Control (W.H.O F.C.T.C) is only months away. The F.C.T.C’s stated objective is to progressively reduce tobacco consumption “by providing a framework for tobacco control measures to be implemented by the Parties at the national, regional, and international levels.
Being the first international treaty negotiated under the auspices of W.H.O,It was adopted by the World Health Assembly on May 21, 2003 and entered into force on February 27, 2005, with 168 Signatories, including the European Union, which made it one of the most widely embraced treaties in United Nations history. Currently, there are 181 Parties covering more than 90% of the world population.
It is also seeking “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke” by enacting a set of universal standards stating the dangers of tobacco and limiting its use in all forms worldwide.
15 years after the F.C.T.C came into force, it has not proven to be a stellar success on its own terms, especially in developing countries. Since cigarette consumption has been falling for decades in developed countries, it would seem logical to consider what is causing the decline. Broadly speaking, studies have found that in most countries the main drivers of reduced smoking rates have been some combination of: (1) increased public awareness of the dangers associated with smoking, (2) an increase in the price of cigarettes (including taxes), and (3) the availability of low risk alternatives and cessation products/ assistance.
It is now undeniable that demand for cigarettes has fallen as a result of smokers switching to less harmful products, such as snus , heat-not-burn and vapor products. Harm reduction products are serving as powerful and effective smoking cessation tools. They are providing smokers worldwide with reduced-risk alternatives to cigarettes and other forms of combustible tobacco.
The W.H.O has been strongly supportive of harm reduction in other contexts — for example the use of condoms to reduce HIV transmission — it has been far less supportive when it comes to tobacco harm reduction. Originally,the F.C.T.C recognized harm reduction as an integral part of tobacco control but later changed stance in unclear circumstances. The fact that this secrecy is being used to reinforce an apparent hostility to new, less harmful products in general and vape products in particular is disturbing.
Safer nicotine products should be recommended by the F.C.T.C to smokers unable — or at least unwilling — to achieve cessation through complete nicotine and tobacco abstinence; who continue smoking despite the very real and obvious adverse health consequences. We must not forget that it has been projected that 1 billion people will die from smoking this century despite the F.C.T.C’s efforts.
The W.H.O has acknowledged that “People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health,” yet in the guise of the F.C.T.C it has sought instead to promote only top-down solutions, fundamentally ignoring the potential for people to improve their own health by choosing less harmful alternatives to cigarettes. It seems to have taken this approach in large part because of a presumption that “There is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests.” Yet the evidence suggests this is not correct.
At F.C.T.C COP 9 , policies must continue to dissuade minors, ex-smokers, and non-smokers from using tobacco and nicotine containing products, while making better alternatives to cigarettes available to adults who smoke. The convention’s tobacco control policies should encompass tobacco harm reduction strategies as well as supply and demand measures that encourage smokers who would otherwise continue to smoke to switch to lower risk alternatives.
A multi-pronged approach to tobacco harm reduction in the low-and middle-income countries of sub-Saharan Africa, that incorporates both tobacco consumption and production, is needed.