World Health Organization needs to see e-cigarettes as part of the solution, not the problem, say leading specialists in nicotine science and public health

Nicotine Science & Policy | 29 May 2014

Over 50 leading scientists from 15 countries have written to Margaret Chan Director-General of the World Health Organization to ask WHO reconsider its intention to classify e-cigarettes the same as regular cigarettes, warning that they risk missing an opportunity to drastically reduce smoking and the illness and death associated with it.

Ahead of the WHO sponsored Framework Convention on Tobacco Control (FCTC) meeting in Moscow this October, the scientists have reacted to a leaked document from a FCTC preparatory meeting indicating that the WHO considers e-cigarettes a “threat” to public health and intends to sideline their use as an accessible alternative to regular tobacco and cigarettes. Snus is already included in the FCTC.

In their letter to WHO Director-General Margaret Chan, the 53 signatories argue that tobacco harm reduction products could play a significant role in meeting the 2025 UN objectives to reduce non-communicable diseases. E-cigarettes and other safer nicotine products are part of the solution, not part of the problem, they say.

At issue is that the FCTC does not differentiate between the risks of different nicotine products. Applying FCTC measures to e-cigarettes would treat them the same as other tobacco products such as tobacco cigarettes and introduce bans on advertising, include them in smoke-free legislation, apply high taxes and large health warnings – all of which will be aimed to reduce their availability, attractiveness and acceptability.

The signatories warn that excessive restrictions on lower risk products will have the unintended consequence of protecting cigarettes from competition from less hazardous alternatives. “If the WHO gets its way and extinguishes e-cigarettes, it will not only have passed up what is clearly one of the biggest public health innovations of the last three decades that could potentially save millions of lives, but it will have abrogated its own responsibility under its own charter to empower consumers to take control of their own health, something which they are already doing themselves in their millions” said Professor Gerry Stimson, Emeritus Professor at the Imperial College in London, a signatory to the letter, and organiser of the upcoming Global Forum on Nicotine.

Globally 1.3 billion people smoke and the WHO estimates that up to one billion tobacco-related premature deaths are possible in the 21st Century – all totally preventable.

Tobacco control policy over the past three decades has successfully communicated the harms associated with smoking, encouraged measures to reduce smoking, and drastically cut smoking in some parts of the world – mainly developed countries (but at the same time that smoking is still increasing in many parts of the developing world).

After a decade of international tobacco control based on restricting and banning products it may be hard for WHO and public health leaders to change their mindsets and see the potential of safer nicotine products to help people shift from smoking: but this is what is needed.

The letter argues that WHO and FCTC must recognise that tobacco products are not all the same with regard to risk. They should recognise the significant reductions in death and disease that are achieved when smokers switch to lower risk nicotine products.

“For the WHO to suggest that e-cigarettes are as risky as other tobacco products would send an erroneous and bleak message to the millions of current e-cigarette users who have used them to quit smoking,” said Robert West, also a signatory to the letter and Professor of Health Psychology and Director of Tobacco Studies at University College in London. “It would discourage smokers from trying them and we would miss out on a major opportunity to reduce smoke related deaths globally.”

Scientists have known for some years that people 'smoke for the nicotine, but die from the smoke'. The death and disease from smoking arises from the inhalation of tar particles and toxic gases drawn into the lungs.

The signatories to the letter strongly believe that tobacco harm reduction tools such as e-cigarettes, and other less harmful products such as snus, could be the solution. People who currently smoke will do much less harm to their health if they consume nicotine in low-risk, non-combustible form.

“E-cigarette use has been a consumer led revolution and grown as a bottom-up public health initiative that could save millions of lives”, said John Britton, Professor of Epidemiology at the University of Nottingham, UK. “It has moved at a speed that shows just how much smokers want and will choose nicotine products that don’t kill. I hope the WHO and all public health decision makers can recognise and harness the health opportunities that e-cigarettes can provide.”

The signatories argue that the WHO`s targets for reduction of tobacco consumption should be aligned with the ultimate goal of reducing disease and premature death. It is counterproductive to include the reduction of low-risk nicotine products, such as e-cigarettes, within these targets - as WHO has proposed - instead these products should have an important role in meeting the targets.

Links

  1. Letter to Dr Margaret Chan: ‘Reducing the toll of death and disease from tobacco – tobacco harm reduction and the Framework Convention on Tobacco Control’
  2. FCTC Bureau meeting minutes: ‘Draft summary record of the second meeting of the fifth Bureau of the Conference of Parties to the WHO FCTC Geneva, 13-14 November 2013’
  3. Media release: ‘World Health Organization must not extinguish e-cigarettes, say leading scientists’
  4. Commentary on WHO position: http://www.clivebates.com/?p=2011
  5. List of signatories and transparency declarations.

Note

The Framework Convention of Tobacco Control was agreed in 2003 and sets out a framework for controlling and reducing tobacco consumption. With the notable exception of the United States, most countries (178) are parties to the convention. The sixth session of the Conference of the Parties is due to be held in Moscow from 13-18 October http://www.who.int/fctc/en/