Clive Bates | 14 September 2014

A new paper is published today: WHO position on ENDS: a critique of the use of science and communication of risk (PDF) written and researched by Clive Bates at Counterfactual
We have grown accustomed to WHO and the FCTC Secretariat taking a negative approach to tobacco harm reduction - seeing only risks and threats, and little of the real world potential, while covertly planning an offensive against e-cigarettes through the Framework Convention on Tobacco Control. Yet the evidence is steadily moving against that position, leaving WHO looking more extreme, unscientific and ideologically motivated as the data accumulates.
On 26 August 2014, WHO published its long-awaited paper on 'ENDS' Electronic Nicotine Delivery Systems, the term it uses to describe e-cigarettes and vapour products. This is published in advance of the Framework Convention on Tobacco Control, Sixth Conference of the Parties (FCTC COP-6) in Moscow 13-18 October 2014.
This WHO paper (FCTC/COP6/10) has been developed to inform and provide direction to the Parties to the FCTC (179 Countries) on the subject of ENDS. Given there is a strong body of expert opinion that sees these products as part of the solution, not part of the problem - then it is vital that WHO handles the issue objectively and with great care.
Alas, in that mission it has failed. The detailed analysis of the WHO paper and the associated public communication through twitter concludes:
  • WHO provides misleading analysis based on selective and biased portrayal of the science (discussed at length in the report). Even if statements made are not always literally false, they will have the effect of misleading with partial truths or statements made without appropriate context or caveats.
  • WHO has no coherent framework for discussing relative risk – to smokers, vapers and non-users and appears to place little weight on the health of smokers or nicotine users, or on the ethics of denying or obstructing access to much safer products.
  • WHO has a pronounced focus on minor or implausible risks while underplaying potentially large benefits. A further consequence is to understate the risk that benefits will be foregone because of restrictive policies. None of WHO’s communication would leave the reader with the impression remotely similar to that offered by a more straightforward expert assessment of risk, stating at least 20 times lower risk than smoking.
The report makes six recommendations:
  1. WHO should restore an objective approach to science and evidence
  2. WHO should take formal independent scientific advice from its specialised TobReg committee, due to report next in January 2015
  3. Parties should not bring ENDS into the FCTC - it is technically and strategically inappropriate
  4. Parties should insist that WHO improve the quality of its policy making and advice - with proper assessment of evidence, options appraisal, impact assessment and consultation
  5. All stakeholders should treat WHO policy recommendations with caution - they are built on weak evidential and analytical foundations
  6. WHO should apply much stronger quality control its public risk communications, which have on occasion been blatantly misleading and dangerous.
This new analysis follows criticism published in the journal Addiction on 4th September of the scientific assessment commissioned by WHO to inform the paper for COP-6.
If WHO wants to be serious about tackling non-communicable diseases and the potential one billion tobacco related deaths deaths it expects in the 21st Century, then WHO needs to do much better than this.
Open letter to delegates to the WHO FCTC COP-6 to be held in Moscow 13-18 October: http://www.clivebates.com/?p=2436