Tobacco Harm Reduction (THR) experts have warned that the World Health Organization (WHO) Framework Convention on Tobacco Control (WHO FCTC), in its current form, is not capable of influencing change as far as Tobacco Harm Reduction is concerned.
The FCTC was the first international treaty negotiated under the auspices of WHO. It was adopted by the World Health Assembly on 21 May 2003 and entered into force on 27 February 2005. By the time the convention was ratified, tobacco-related deaths were ranging between 3 to 4 million, at the back of escalating smoking levels and other forms of tobacco use. By 1998, world data was already estimating that smoking would be the cause of at least 10 million deaths by the year 2030. Today, 2023, which is about seven years away from 2030, tobacco deaths stand at approximately 8 million per year and could breach the 10 million mark if nothing is done.
While Tobacco Harm Reduction was one of the major objectives of the FCTC, fewer nicotine options were available when the FCTC was adopted and this has caused a major setback to the implementation of THR using novel and safer products that have since been introduced on the market.
Speaking to Journalists during a Virtual Ask Me Session on Tobacco Harm Reduction, Dr. Kgosi Letlape said that there is need to create an appropriate framework for regulating nicotine products in accordance with the harm associated with those products.
"E-cigarettes and other nicotine products were introduced onto the market 10 years after the FCTC. When you look at the FCTC, you find that it was basically adopted in 2003. At the time that the FCTC was adopted, there was really only one main non-combustible product on the market which was Snus," said Dr. Letlape.
Around 2015, Heat Not Burn technology came onto the market. He added that there is a need for science-informed regulation of novel nicotine products and other Tobacco Harm Reduction interventions.
"Looking at the FCTC, it is inappropriate to be used as a framework to look at alternatives to combustible cigarettes. In the FCTC, there is Article 1 D, which speaks about Harm Reduction in relation to the challenges presented by Tobacco products. If you fast-track to now, you cannot apply the FCTC as it is to the risk-reduced products. What any well-meaning nation needs to do is to look at a framework for regulating the RRPs appropriately. Regulation of nicotine products must be based on evidence and science."
"One of the things that need to be taken out in terms of the FCTC is section 5.3 which refers to engagement of the industry. We know that there can be no solution without engaging the people that cause the problem. We need to engage the industry and encourage them to switch from producing combustible cigarettes, which are harmful to health, to producing alternatives which are less harmful. We need to create a legislative framework that will create access for people who smoke and will ensure that consumers are well-informed about the effect of these products."
Dr Letlape added that there has been a switch in people and organizations moving from fighting tobacco smoking, to fighting nicotine in any form.
To date, 182 countries have ratified and adopted the FCTC and the treaty has over the years gained widespread popularity and recognition as one of the most embraced international agreements in the United Nations history. Malawi became the latest country to ratify the WHO FCTC.
Meanwhile, Clive Bates, Director of Counterfactual, a consulting and advocacy practice focused on a pragmatic approach to sustainability and public health, urged countries to lobby and push for an FCTC that is in sync with their public health needs and Tobacco Harm Reduction aspirations.
"The FCTC is what the officials make it. Delegates to the COP10 happening on 20-25 November 2023 in Panama, should approach the FCTC with their national interest in mind, as well as Public Health priorities in mind and they should make sure the Convention does what they need it to do. If Malawi or any of the African countries disagrees with it, they can actually stop it. It is really important that delegates to the FCTC don't just go with the flow. The facts are that this convention is very hostile to harm reduction. It is also very influenced by American Funded Non-Governmental Organisations (NGOs) who are very noisy and busy in the negotiations " said Bates.
He added that American NGO's influence in the FCTC is very prominent and delegates need to be aware of such machinations. There are currently a number of novel nicotine products on the market and these either don't use any heat at all or they use electricity to heat an aerosol. These include Vaping products, heated tobacco (heat not burn), unheated nicotine products, and more traditional smokeless tobacco and Snus.
