Seventy leading public health experts and anti-tobacco campaigners have urged the World Health Organization to adopt a more sympathetic attitude to ecigarettes and other alternatives to smoking, “which have the potential to bring the epidemic of smoking-caused disease to a more rapid conclusion”.
Their joint letter to Tedros Adhanom Ghebreyesus, WHO director-general, is intended to influence this week’s conference of the Framework Convention on Tobacco Control in Geneva, which frames international health policy on the issue.
The appeal illustrates what Clive Bates, former head of the UK pressure group Action on Smoking and Health and a signatory of the letter, called a “huge rift in the public health community”.
On one side is the “harm reduction” approach advocated by the 70 signatories. This holds that obtaining nicotine through products that do not burn tobacco, particularly by vaping, is far less dangerous than smoking and should be encouraged to wean people off cigarettes.
The other approach dominates thinking in the WHO and the Framework Convention that it administers. This favours strong regulation or outright bans on what are variously called Ands (Alternative Nicotine Delivery Systems) or Ends (Electronic Nicotine Delivery Systems) because their health effects have not been investigated sufficiently and they may provide a gateway for young people to nicotine addiction and smoking.
According to a report on Ends prepared for this week’s meeting by the convention secretariat, their worldwide sales leapt from $2.76bn in 2014 to $8.61bn in 2016 and are projected to exceed $26bn in 2023. Ends are banned in 30 countries, while their regulation and availability vary greatly elsewhere.
In their letter, the advocates of harm reduction, most of whom are university or medical school professors, urged the WHO not to let uncertainty about long-term effects of ecigarettes block their introduction.
“It is true we will not have complete information about the impacts of new products until they have been used exclusively for several decades — and given the complex patterns of use, we may never,” they wrote. “But we already have sufficient knowledge based on the physical and chemical processes involved, the toxicology of emissions and exposure markers, to be confident these non-combustion products will be much less harmful than smoking.”
Mr Bates said suspicion of ecigarettes inside and outside the WHO was deepened by the fact that their development was carried out almost entirely in the private sector. “We also have the baggage of the tobacco industry going into these products,” he said.
The WHO cannot compel governments to take specific actions to suppress (or promote) ecigarettes but any decisions made by the Framework Convention meeting will play an important part in the public debate.
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