“To protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption, and exposure to tobacco smoke”. These are the rather lofty aims of the Framework Convention on Tobacco Control (FCTC), a treaty created by the World Health Organisation in 2004 to combat the use of cigarettes globally. Given these lofty aims, healthcare professionals are somewhat puzzled by its opposition to e-cigarettes, as a new paper from The Reason Foundation explains.

From a regulatory standpoint, the FCTC wants is for governments to treat e-cigarettes in the same way they treat other tobacco-based products, despite the very obvious differences in their chemical compositions, and the fact there is a limited evidence base for e-cigs being harmful. Indeed, a report from Public Health England states that e-cigarettes are “around 95% safer than smoking” and “release negligible amounts of nicotine into the environment”. They offer, the report says, a “low cost, effective intervention that could help England’s eight million smokers to quit the habit for good.” Similarly, a report in the British Medical Journal showed that “changes in prevalence of e-cigarette use in England have been positively associated with the success rates of quit attempts”, while the Guardian reports that randomized trials show that e-cigs help people quit. In short, the more available e-cigarettes are, the more likely people are to try to stop smoking, and moreover, succeed.

So why is the FCTC so against e-cigarettes? The answer, it seems owes more to dogma than data. As the Reason Foundation’s paper explains, the organization is basing its policy proposals around the idea that nicotine and tobacco-related products should be given up entirely, an attitude that has been described as “quit or die”. Given that the number of smokers globally has increased since the FCTC came into being in 2005, especially in China and developing nations, this almost puritanical attitude is clearly not working out.

And this isn’t the only area where the evidence shows that the FCTC’s behaviour around tobacco demand reduction is a little murky. In November, the organization will hold the 7th Conference of Parties (COP7) in Delhi, India –  an event at which decisions about international tobacco control efforts are made. Not everyone is welcome at this event, however. The FCTC has stated its wish to “ensure the exclusion of representatives and officials from…fully or partially state-owned tobacco industries, including state tobacco monopolies.” In practice this means that representatives of countries such as China, Cuba, Thailand, Egypt, Bulgaria and even India itself could be banned, because their governments own or partially own the means for tobacco production in these countries. The fear is that these representatives may have the potential to “[prevent] public health interests from prevailing in the policy discussions”.

Worryingly still, the FCTC’s hard-line agenda does not stop at excluding policymakers. The Reason Foundation study notes that at “the two most recent Conferences of the Parties (COPs) of the FCTC, in Seoul in 2012 and Moscow in 2014, all journalists were thrown out of the public gallery, and the meetings were held in secret.” This, it contends, “violates all the precepts of good governance – especially transparency.” It also goes on to detail that the FCTC also “excludes many groups whose input would be highly relevant”, has only 20 NGOs listed as Observers on its website and excludes many of those who are even slightly affiliated to the industry, such as vendors, farmers and the users of tobacco and vaping products.

The reason for its rather cloistered manner of operations is, according to the FCTC to avoid “conflicts of interest” between its aim – tobacco reduction – and the aims of those who benefit from continued demand for these products.

But as is so often the case, what will work is very different to what is desirable from an ideological point of view. Since a world with zero demand for cigarettes is unlikely to happen, a more reasonable focus should be to concentrate on harm reduction products (such as e-cigarettes). Compromise is what is needed, especially as the FCTC’s adherence to an ‘all or nothing’ approach is yielding weak results thus far.

Unsurprisingly, then, the Reason Foundation’s paper calls for a complete overhaul of how the FCTC should work. It should become more transparent by allowing journalists into its sessions and shift its focus from the lofty ideal of “demand reduction” and pay more attention to what it can do to support “harm reduction”. In the short term, it probably can’t stub out the allure of nicotine products worldwide, but it can work towards reducing the nicotine levels in the bloodstream by promoting viable alternatives that will help smokers reduce their tobacco intake or quit altogether.

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