Nicotine pouches, e-cigarettes and snus should be regulated as strictly as cigarettes. At least if the WHO Secretariat for Tobacco Control has its way. More and more researchers and health scientists are now starting to react to the WHO's hostile approach to harm reduction.
"There is a high risk that excessive restrictions on harm-reducing products will lead to more smokers, rather than fewer," says Swedish tobacco researcher Lars Ramström.
Updated article: January 2024
Ahead of the upcoming meeting on WHO tobacco convention (cop10) at the beginning of February 2024 (postponed from November 2023), it is clear that e-cigarettes, snus and nicotine pouches will be the subject of debate during the conference. And according to many researchers and commentators, the debate has already turned. The WHO Secretariat for Tobacco Control, in its reports for the meeting, has recommended that products should preferably should be banned, or otherwise regulated as cigarettes - resulting in taste bans, marketing bans and other restrictions.
"Several experts have warned that the WHO's scientific advice gives an inaccurate picture of the evidence on harm reduction products," writes Lars Ramström, a Swedish tobacco researcher, who has published many high-profile studies on snus use in Sweden, in an open letter to the WHO Scientific Council.
Has the opposite effect
As previously reported by Vejpkollen a range of researchers, in recent years, invited the WHO Secretariat for tobacco control to rethink harm reduction as a strategy to reduce the harm of nicotine use worldwide.
They are supported by Lars Ramström. According to him, it has even gone so far that some of the measures recommended by WHO scientists for smoke-free nicotine products may have opposite effect when it comes to smoking.
"Significant restrictions on alternative nicotine products, such as e-cigarettes and nicotine pouches but also snus, can have unintended consequences. The risk is that smoking will increase rather than decrease. There is also concern among many researchers that the WHO's dissemination of misinformation will discourage smokers from switching to a much less risky alternative to cigarettes," writes Lars Ramström.
Researching snus and smoking cessation
Lars Ramström has been researching the role of Swedish snus in smoking cessation for several decades. He believes that snus is a likely factor behind Sweden's low smoking rate, including through a high-profile report published in NIH - National Library of Medicine 2016. According to Lars Ramström, there is now clear evidence that harm reduction works to reduce the harm caused by nicotine use.
"The best example of how nicotine products not based on burnt tobacco can benefit public health comes from Sweden. Sweden has the lowest proportion of male smokers in the EU and thus also the lowest tobacco-related mortality," writes Lars Ramström
A unique opportunity
Lars Ramström believes that the parties meeting in November, ahead of the meeting on the future tobacco convention, should study smoking trends in different countries. They should also take into account how access to different nicotine alternatives affects the proportion of smokers. Besides Sweden, he mentions New Zealand, Norway and Japan - where smoking has declined rapidly in recent years as e-cigarettes, nicotine pouches and heat-not-burn products have become popular in the respective countries.
"The meeting of world health leaders in Panama in November is a unique opportunity to evaluate the evidence with an open mind. After all, if Sweden had followed the WHO's advice twenty years ago and banned snus, the number of tobacco-related deaths in Sweden would have been much higher than they are today. At the same time, such a measure would likely have benefited the cigarette industry, albeit unintentionally. The measures to reduce the demand for cigarettes and to reduce the supply, i.e. what the WHO recommends, are valuable tools. But the fight against smoking is not as effective without the third pillar set out in the original tobacco convention." writes Lars Ramström.
WHO warns delegates
The WHO has so far not responded to the criticism of either Lars Ramström or the other researchers who are critical of the organization's unbalanced approach to harm reduction. The organization only recommends medicines as a tool for smoking cessation. In a call for proposals on Tobacco Convention website instead, the Secretariat warns delegates against allowing tobacco companies to influence how the Convention formulates its objectives. According to the Convention text, the tobacco industry's objectives are always in direct contrast to those of the Convention. As a result, the conference is completely closed to the public and the practice is that neither the media nor non-profit organizations representing users are allowed to cover the conference from the inside.
Bribery allegations
The secretariat that administers the work is funded by Bloomberg Philanthropies - foundation that - through support to various organizations - works to prevent smoking, but also various alternatives to cigarettes around the world. Among other things, the Foundation has been criticized for bribing authorities in low- and middle-income countries to influence legislation on e-cigarettes.
About the tobacco convention:
The World Health Organization's Framework Convention on Tobacco Control (FCTC) is an international treaty. Established in 2005, it provides a framework for tobacco control measures to be implemented at the national, regional and international levels. 182 countries have so far signed the Convention and also participate in decisions related to the FCTC. Every two years, the Parties meet at a conference to discuss current issues in the field of tobacco control (known as COP meetings).
Snus has made many people, including myself, stop smoking - it should instead be sold in the rest of Europe to reduce the harmful effects of smoking.
It is not even possible to compare cigarettes with snus. Instead of focusing on nicotine, the focus should be on which products cause harm and to what extent. Cigarettes are far more dangerous than snus and should be taxed and managed accordingly. The WHO's approach is counterproductive and instead increases mortality among tobacco users.
I hope that the Swedish delegation will familiarize themselves with the real facts so that they know what they are talking about. Unfortunately, too many people make statements without having an ounce of knowledge about e-cigarettes versus regular cigarettes.