From November 7-12, public health experts and policymakers from the entire world are convening in New Delhi, India for the 7th Conference of Parties (COP7) of the World Health Organization’s Framework Convention on Tobacco Control (FCTC). The FCTC, which was adopted in 2003 and entered into force in 2005, is a global response to a global problem: the smoking epidemic that kills six million people every year and is projected to kill over eight million by 2030. As the United Nations’ primary body tasked with curbing tobacco, the FCTC has enormous clout in terms of the policies on smoking and cigarette use that are put into place worldwide. On the first day of the conference, Mozambique became the 181st country to sign on the Convention.
Just one small problem: instead of saving people from smoking, the talks now taking place in New Delhi might wind up stopping them from kicking the habit. To be more specific, the issue that seems to make the FCTC miss the forest for the trees boils down to whether their job is to fight tobacco or to eradicate nicotine in any form. Tobacco, after all, is a global killer across its many forms. Even if cigarettes are responsible for the vast majority of the damage, cigars and water pipes also incredibly bad for the lungs and for your health. Nicotine, though, can be found in a range of other products, from e-cigarettes to nicotine replacement therapies (NRT) like patches and chewing gums.
When it comes to e-cigarettes specifically, the WHO and the FCTC are toeing a hard line that paints the devices as nothing better than old-school tobacco. Because e-cigarette systems deliver nicotine, the health body has refused to accept them as a valid substitute for people trying to stop smoking tobacco. Instead, the WHO pushes for what its critics have labelled a “quit or die” approach and doubled down on that line of thinking in the run-up to this week’s meetings, telling the United Kingdom to treat e-cigarettes like tobacco cigarettes by banning them from public places. The UK, of course, happens to be the country whose medical community has been the most outspoken about the potential of e-cigarettes to help people quit smoking. The same Royal College of Physicians that clued the world into the dangers of cigarettes over five decades ago has made no bones about the potential benefits of e-cigarettes, declaring them at least 95% safer than cigarettes and recommending “in the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking.”
Many of those meeting under the auspices of the FCTC clearly disagree, and the debate over the merits of e-cigarettes has not been helped by an undemocratic approach at best to the proceedings. Repeating a controversial move it made at the last COP meetings (in Seoul four years ago and Moscow two years ago), the FCTC threw out all of the journalists attending the New Delhi meetings and is now carrying on behind closed doors. It is hard to understand why a public health body that depends on public funds would act so opaquely, especially when its job is something as innocent as saving lives. In what may be a sign of the times as much as anything else, fears of outside influence have metastasised into what looks suspiciously like paranoia. Products that have nothing to do with the tobacco pandemic, like e-cigarettes, have been caught in the fire as dissenting or unorthodox voices are shut out.
Unable to crack the closed doors of the New Delhi meeting, those who disagree with the WHO’s hard-line have looked to other ways of making themselves heard. A Billion Lives, a documentary which came out just a few weeks ago, speaks to this point and features prominent voices opposing the FCTC strategy of employing the same draconian measures used to curb tobacco against completely different products. A Billion Lives insists that e-cigarettes, whose health risks are far lower and potential benefits are lifesaving, should be seen as an opportunity. The film makes its point in the title: a billion people are projected to die because of smoking in this century, and any strategy or tool that lowers that number—especially realistic ones like pushing smokers toward e-cigarettes as a replacement for their habit—is worth pursuing. Maintaining the fiction that vapor and tobacco smoke are equally dangerous isn’t just false. It’s deadly.
Of course, the WHO has long struggled with optics. The agency raised eyebrows and sparked outrage when it challenged an Amnesty International report on famine, poor hygiene, and failing hospitals in North Korea in 2010 as having “no science.” Director-general Margaret Chan, visiting North Korea a few months earlier, had declared its health system the envy of the developing world and had “no lack of doctors and nurses.” Dr. Chan and her colleagues actually have a lengthy track record of praising dictatorial governments while failing to catch health crises in time, in some cases because they take leaders’ promises of having diseases under control at face value (as occurred with polio in Syria or Middle East respiratory syndrome in Saudi Arabia). Other failures, like the Ebola epidemic in West Africa, have had catastrophic repercussions.
With that history in mind, it is less surprising to see the WHO adopt behavior that does not jive with transparency standards but would not make many of its partner governments bat an eye. The WHO’s FCTC will go to great lengths to keep out those it sees as enemies in the fight against smoking, but the question remains: how much will the rest of us suffer for it?