Tobacco continues to affect the entire planet. According to the World Health Organization (WHO), the number of smokers is estimated at 1.1 billion smokers in 2025 if recent trends continue. The WHO's Framework Convention on Tobacco Control (FCTC), during its tenth Conference of the Parties (COP 10), is currently examining in Panama the implementation of tobacco control with the 183 member countries of the Convention.
The poor countries most affected
Cigarette smoking is spreading even more in middle- and low-income countries. Tobacco will likely continue to be a global scourge over the next decade due to increasing numbers of smokers in poor countries, particularly in Africa.
Tobacco consumption tends to migrate from low- and middle-income countries in Europe and the Pacific to countries in Africa and the Eastern Mediterranean. So much so that researchers are warning of a "tobacco epidemic" with the explosion in the number of smokers in the countries of these two zones and a significant additional health burden.
According to estimates from the World Health Organization (WHO), around six million people die each year from smoking, the majority in poor and middle-income countries.
More recognition based on evidence and trust might save millions of smokers
Harm reduction is the fourth pillar of the FCTC: risk reduction and the international right to health. Yet the FCTC does not appear to recognize the harm reduction strategies needed to help those who are unable to break their tobacco addiction.
Based on the human right to health in Article 12, the international law supports a harm reduction approach to tobacco control. By analyzing the right to health as an inalienable right, countries must prioritize the promotion of treatments and products most likely to reduce harm among those who are least able to control their own health behaviors. Harm reduction may then involve the use of new, supposedly less harmful tobacco products.
The novel reduced-risk products, even if they do not offer the advantages of total abstaining from tobacco, could nevertheless become a viable strategy in favor of public health.
In the last 10 years, many harm reducing technologies have emerged in the field of smokeless nicotine consumption: electronic cigarettes, heat-not-burn devices, snus...combustion being indeed the primary cause of diseases caused by smoking. Some world-renowned research institutes, such as the UK's Royal College of Physicians, have concluded that these smoke-free alternatives are up to 95% less harmful than traditional cigarettes. Despite that many regulators, a large part of the public health community and the FCTC keep refusing to support harm reduction.
Prevention is necessary but what can be done to save existing smokers?
Although the implementation of the FCTC has been a success in many respects when it comes to tobacco control, it focuses primarily on non-health-related approaches to tobacco control – including tariff and tax measures to reduce demand, strategies to reduce contraband and limits on tobacco advertising – but fails to directly address strategies to reduce harm.
Indeed, the FCTC emphasizes policy and legislative approaches, but offers little direct help to smokers to overcome their addiction through cessation or harm reduction. From punitive taxation to outright bans, FCTC promotes only a prohibitionist approach without giving any choice to the most affected, the consumers.
Innovation should be allowed in the marketplace and consumers should be able to choose alternatives that allow a less harmful way of consuming nicotine.
Parties to the FCTC and in particular African countries should have the opportunity to create national mechanisms for the regulation of novel products. Low-income countries should not remain on the sidelines of this global trend which is enabling many high-income countries to reduce smoking.
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Critics fear that any legitimization of these new products "sends the wrong message" about the best way to reduce harm which the only way for them is: quit smoking. Furthermore, critics warn that introducing a new form of nicotine consumption may be attractive to minors and may act as a gateway to conventional cigarettes and encourage former smokers to return to addiction.
To move this debate forward, research is needed, a different regulatory framework from the conventional cigarettes within which independent research can be carried out, to confirm the claims of part of the international scientific community and the tobacco industry, championing the benefits of freedom of choice and innovation.
New products should therefore benefit from differentiated regulations, while nevertheless maintaining precautionary principles such as conditions of access to products, restrictive marketing for the protection of youth while allowing access to information on these alternatives, to adult smokers who wish to do so and who would otherwise continue to smoke.
