The World Health Organization estimates that smoking kills nearly six million people a year world-wide, and the death toll has continued to rise since it set up the Framework Convention on Tobacco Control in 2005.
So it’s dismaying that the WHO continues to advocate that vaping products, a technology that could potentially save millions of lives, be regulated as medical products, or even banned. A November meeting of the FCTC will likely continue to advocate stringent regulations.
Tobacco smoking is the world’s largest cause of preventable premature death, and developing countries in Asia are among the hardest hit. If current trends continue, deaths in China alone will reach two million a year by 2030. This suggests that the FCTC’s current approach, which focuses on reducing demand for and supply of tobacco products, isn’t working.
Fortunately, there is another approach that has enabled millions of smokers to quit in many countries. Called “harm reduction,” it acknowledges that many smokers find it very difficult to break their habit. It seeks to ensure that smokers can use less harmful substitutes.
Harm-reduction technologies offer smokers ways to retain the rituals and pleasures of smoking with far fewer risks. One such technology is the “electronic cigarette,” invented by Chinese pharmacist Hon Lik in 2003, and other vaping products developed since then such as refillable personal vaporizers. These vaping products provide a similar experience to smoking, including delivering nicotine, but with far fewer risks.
Vaping products work by heating a solution of nicotine and flavors in a nontoxic solvent to create a vapor that is inhaled. Because there is no combustion, and hence no smoke, the vapor contains very low levels of carcinogens and other harmful chemicals. Nicotine itself is largely benign, contrary to widespread misconceptions. As the U.K.’s Royal College of Physicians put it recently, vaping “is at least 95% safer” than smoking.
Vaping products have proved to be highly effective aids to reducing tobacco use. In the past five years, they have become popular in many countries, especially the U.S., U.K., France and Malaysia. At least 10 million people have quit smoking by switching entirely to vaping, and millions more have dramatically reduced the amount that they smoke. The U.K.’s National Health Service encourages doctors to recommend that patients switch to vaping if they are unable to quit smoking using other means.
Harm reduction has enormous potential to reduce the burden of smoking-related disease in Asia. Given individual differences and cultural norms, experimentation is likely to play an important part in the process of discovering which products are the most effective alternatives to smoking.
But that can’t happen if governments impose undue restrictions on either the development of these products or their use by adults. Unfortunately, the FCTC is resistant to the harm-reduction approach.
Moreover, the FCTC avoids accountability by holding meetings and producing reports in secret. At the two most recent Conferences of the Parties of the FCTC, in Seoul in 2012 and Moscow in 2014, everyone, including every journalist, was removed from the public gallery at the start of formal proceedings. Meanwhile, documents on the potential role of harm-reduction products were produced without consultation of the leading experts on those technologies.
The FCTC also keeps tight control over who is able to participate officially in its meetings. There is essentially no participation by representatives of many affected groups, including users of tobacco and vaping products. It even seeks to exclude representatives from governments that have stakes in tobacco companies. If it is successful, several countries, including China, Cuba, Egypt, Bulgaria, Thailand and even India, host of the November meeting, could face difficulties getting delegates approved to participate in the next Conference of the Parties.