Political and cultural realities forced the WHO to drop its ideological objections to needle exchanges. However, it is repeating previous mistakes by stubbornly refusing to embrace less harmful nicotine products that have shown a potential to reduce the toll of 8 million deaths yearly from combustible tobacco use. Embracing and promulgating tobacco harm reduction is less controversial than needle exchange and could save more lives. It was right to change course on the drugs policy. The WHO must (and arguably will have to) do so again with tobacco harm reduction, preferably sooner rather than later.