"Harm reduction must be a priority for WHO"
The WHO's strategy to reduce the harm from smoking is not working. That's according to Derek Yach, who helped design the tobacco convention 15 years ago.
"The focus must be on preventing disease and death. We can't just look at how many people use tobacco or nicotine"
It has been 15 years since the WHO launched its guidelines to reduce smoking worldwide. The Tobacco Convention is a treaty through which 160 countries commit to promoting public health by limiting access to cigarettes. At the same time, they commit to reducing the harm caused by tobacco use.
But despite great efforts, smoking remains by far the biggest cause of premature death in the world. This is according to Derek Yach, one of the key figures behind the Tobacco Convention. He now works on tobacco harm reduction through the A Smoke Free World Foundation. The organization is independent, but was founded with the help of a grant from Philip Morris. Its aim is to reduce the harm caused by smoking worldwide by providing information, supporting research and innovation in tobacco harm reduction.
"In the run-up to the WHO tobacco convention, we actually met with the tobacco companies and their scientists. We wanted to know what they were planning for the future. Partly to reduce the harmful effects of their products, but also what new products were in the pipeline. Of course, they weren't completely open at the time, but they gave us a hint. At the same time as the pharmaceutical industry was developing alternative, consumer-friendly nicotine products, it was clear that tobacco companies were doing the same." Says Derek Yach in the context of "15 year conference" - a public discussion on the Tobacco Convention.
Harm reduction works
Derek Yach says nicotine patches, snus and e-cigarettes are innovations that have the potential to improve global public health enormously. Something that needed to be reflected in the Convention when it became an official document in 2005.
"As health workers, we had seen what a harm reduction philosophy could achieve. Particularly in dealing with AIDS/HIV in the 90s, with clean needles for drug users and sex education for young people. It was natural to include a section on promoting harm reduction in tobacco control." says Derek Yach.
Higher death rates if nothing changes
But after 15 years, the WHO's harm reduction strategy has proven to be very limited. Today, the WHO only recommends nicotine medicines to help smokers quit. At the same time, the WHO is campaigning against e-cigarettes and other smokeless nicotine products. The official motive is to prevent young, non-smokers from taking up the products. But according to Derek Yach it is devastating in the long run.
"Even if not a single young person started smoking today, the death rate from tobacco smoking would continue to rise for another 10 years. Smoking-related diseases take time to develop, and the effects of regulations and the like are not really visible even after 40 years. If WHO chose to focus on harm reduction, helping smokers to stop using cigarettes, the number of deaths would fall faster. We would probably have half as many deaths in 40 years, compared to if we continue with the current strategy," says Derek Yach.
Focus on smoking-related diseases
He believes that it the only way to stop the development is to make harm reduction products (such as e-cigarettes and snus) more accessible. This applies worldwide, but particularly in countries where smoking is most prevalent. At the same time, smoking cessation methods need to become more effective.
"The focus must be on preventing disease and death. We can't just look at how many people use tobacco or nicotine. We need to look at how we reduce the cases of lung cancer, COPD, turbercolosis and cardiovascular diseases, all linked to smoking specifically" says Derek Yach.
At present, the WHO campaigns to strongly regulate harm reduction products such as e-cigarettes. Next year, the Organization will start work on revising the Tobacco Convention.
