Kelly Li and colleagues describe the difficult progress made on the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). As a member of the FCTC from its conception to its adoption, I provide insights that highlight how this treaty has failed to adapt to scientific and technological advances, dooming more people to live shorter and less healthy lives using toxic tobacco products.
Kelly Lee and colleagues acknowledge that progress toward ending smoking has been slow, but they advocate for more current FCTC actions without considering tobacco harm reduction. Although continued FCTC actions will cost more than $400 billion, they must know that this number is unattainable. Instead, we should ask what could be done differently.
Tobacco harm reduction is part of the FCTC’s definition of tobacco control, but it emphasizes bans, prohibitions and regulations that undermine millions of people’s access to safer alternatives such as electronic nicotine delivery devices and nicotine pouches. Some of these alternatives have received sales and marketing authorization from the U.S. Food and Drug Administration and support from various governments. Crucially, these substitutes, used by more than 120 million people, appear to improve quit attempts compared with nicotine replacement therapy.
Kelly Lee and her colleagues characterized multinational tobacco companies as purely aiming to expand their markets, but failed to take into account the complexities and subtleties of the extensive negotiations; this resulted in all major tobacco producers except the United States and Indonesia becoming signatories to the FCTC. Instead, I suggest Kelly Lee and colleagues consider how these legacy companies may evolve away from combustible tobacco and toward safer alternatives as technology evolves.
In addition, multinational tobacco companies are being joined and promoted by new, highly innovative tobacco harm reduction companies. We don’t need to wait for the magic $400 billion to accelerate the end of smoking. Under strict regulation, the power of industry can ensure that adult smokers have access to safer products as a route to quitting.
Yes, tobacco companies that pivot and offer safer alternatives will profit, but that profit could come with the potential to prevent 100 million deaths between 2025 and 2060.
DY served as the first director of the World Health Organization’s Smoke-Free Initiative. He founded and led the Foundation for a Smoke-Free World and spent 35 years working on tobacco control.
