WHO urged to reevaluate anti-smoking strategies

The Institute for Tobacco Studies (ITS) in Täby, Sweden, has raised a critical question about the World Health Organization’s (WHO) strategies in combating smoking and its impact on public health. In a topical paper, ITS highlights the success of Sweden’s transition from traditional cigarettes to smokeless alternatives, urging the WHO to consider this approach as a means to reduce smoking-related deaths globally.

The paper, accessible on the Qeios platform, was authored by Dr. Lars M. Ramström, the principal investigator of ITS. Dr. Ramström is a renowned expert in tobacco control issues with a distinguished history of international involvement, including roles as a WHO expert and as the secretary general of the 4th World Conference on Smoking and Health.

Sweden’s remarkable success story serves as a compelling example of how non-combustible tobacco products can have a profound impact on public health. The country boasts the lowest smoking prevalence among men in the European Union, leading to the lowest tobacco-related mortality. The ITS paper emphasizes the need for the WHO to implement a comprehensive, science-based strategy to reduce tobacco-related deaths.

While the WHO has provided important recommendations for both demand and supply reduction in tobacco control, the paper argues that the strategy is incomplete without embracing harm reduction, as defined in Article 1 (d) of the WHO‘s Framework Convention on Tobacco Control (FCTC).

The impending COP10 meeting in Panama, where global health leaders will convene in November, represents a unique opportunity for WHO to reevaluate its stance on tobacco control. The paper highlights the consequence of past advice, suggesting that if Sweden had followed WHO‘s recommendations two decades ago and banned snus, a smokeless tobacco product, tobacco-related deaths in the country would have been substantially higher. The unintended beneficiary of such a move would have been the cigarette industry.

At the heart of the debate in Panama lies the question of how governments should handle “novel and emerging tobacco and nicotine products.” The WHO‘s perspective, largely mirrored in FCTC COP10 reports and decisions, is that these products pose a new threat to public health and could potentially undo the progress made in combating smoking over the decades.

However, the paper reveals a growing consensus among scientists and national governments that these innovative products represent an opportunity to expedite the decline of smoking. These alternatives, which do not involve burning tobacco, are estimated to be considerably less harmful. They have the potential to serve as substitutes for traditional smoking, ultimately improving public health.

Dr. Ramström emphasizes a crucial distinction – most “tobacco-related” deaths are, in fact, “smoking-related” deaths caused by the repeated inhalation of smoke produced when tobacco is lit on fire. By removing combustion from the equation, the harm can be dramatically reduced, as people have been known to smoke for nicotine but ultimately succumb to the health risks associated with tar.

The paper strongly urges the WHO to closely examine the experiences of countries like Sweden, Norway, Japan, and New Zealand, where the transition to non-combustible alternatives has played a significant role in reducing smoking rates. Norway is currently on a trajectory similar to Sweden, with daily smoking reaching record lows and nearing extinction in specific population groups, largely due to the use of snus.

In Japan, a significant number of smokers have switched to heated tobacco products, leading to an unprecedented decline in smoking rates, dropping from about 20 percent in 2014 to 13 percent in 2019. In New Zealand, vaping has played a crucial role in reducing daily smoking rates to just 8 percent, significantly benefiting even traditionally underserved populations like the Pacific and Māori communities.

The paper further calls upon COP10 delegates to make decisions based on real-world scientific evidence during the meeting. It emphasizes that in the case of smoking, the WHO need not reinvent the wheel but should instead follow the evidence and take inspiration from Sweden’s example for the sake of the approximately one billion smokers worldwide who do not have the privilege of residing in Sweden.

Link to the QEIOS article