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Ex-WHO Officials Deliver THR Message

Ex-senior officials from the World Health Organization have written to The Lancet to encourage the WHO to embrace the benefits of tobacco harm reduction

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Robert Beaglehole was the Director of the Department of Chronic Disease and Health Promotion at the World Health Organization. Ruth Bonita used to be the World Health Organization’s Director of Surveillance in the Noncommunicable Disease Cluster. The pair have written to The Lancet to comment on harnessing the benefits of tobacco harm reduction.

The pair of harm reduction experts now work at the University of Auckland and believe that the application of a harm reduction philosophy has worked successfully in a range of public health spheres, notably in reducing the harm of substance abuse.

Tobacco harm reduction should, therefore, be a central strategy of the WHO Framework Convention on Tobacco Control (FCTC) in addition to the measures for demand and supply reduction which are necessary, but not sufficient,” they say.

They argue that the implementation of FCTC measures have failed to bring about a strong association between application and reduced tobacco consumption.

While neither the World Health Organization or the Framework Convention ban harm reduction approaches, the WHO has been vocal against vaping and Beaglehole and Bonita believe the lack of endorsement of tobacco harm reduction has led to reduced options for the world’s smokers.

The pair write: “There is no scientific justification for WHO's position that e-cigarettes and other novel nicotine products should be treated in the same way as tobacco products. This position overlooks a risk-proportionate approach. We believe WHO needs to provide positive leadership and technical support to countries as they consider the use of e-cigarettes and other nicotine delivery devices, including snus, pouches, and heated and smokeless tobacco.”

Beaglehole and Bonita caution that the World Health Organization goes so far as to “reward” countries which ban vapes. While 34 primarily low-income and middle-income countries have banned vaping, the number of vape bans has fallen from 42 in 2019.

They contrast the WHO’s intransigence with the success in countries that have adopted vaping as a quit smoking tool. In New Zealand, “the prevalence of adult daily smoking plummeted from 13·3% in 2017–18 to 6·8% in 2022–23 after e-cigarettes became widely available, a 49% decline in 5 years.”

As a consequence, “New Zealand's Smokefree 2025 goal looks likely to be reached by consent rather than coercion and by further support for switching to smoke-free nicotine products.”

They point out that smoking rates have plummeted in Sweden and Norway thanks to snus, in England thanks to vapes and in Japan thanks to heated tobacco products.

They conclude: “Countries that are reaping the benefit of tobacco harm reduction, such as New Zealand, Sweden, Norway, England, and Japan, should encourage participating countries at COP10 to support proposals that will quickly reduce smoking rates. The world's 1·3 billion people who smoke, half of whom will die early, deserve this leadership.”


Dave Cross avatar

Dave Cross

Journalist at POTV
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Dave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous vape companies to develop content for their websites.

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