Alternative Nicotine Products Imperative for Protecting Public Health
Hundreds of countries have signed and ratified the World Health Organization Framework Convention on Tobacco Control (FCTC). Passed and entered into force almost fifteen years ago, the landmark international agreement is genuinely the most crucial global effort to combat widespread combustible tobacco use. Heralding tobacco harm reduction as a public health strategy to reduce the consumption of tobacco products, the framework explicitly outlines the importance of offering legacy smokers the support they need to live healthier lifestyles.
While the FCTC is often considered a global success, I believe that it fails to accomplish a crucial goal: offering a more holistic acceptance of harm reduction strategies that have been proven to reduce combustible tobacco use and lead to cessation. One cannot help but notice the WHO’s failure to accept products like e-cigarettes, vaporizers, and alternative oral tobacco products like Swedish snus as viable harm reduction strategies available to consumers.
A media storm recently erupted when a study published in the acclaimed New England Journal of Medicine found that e-cigarettes are more effective than nicotine replacement therapies, like patches and gums. The study, conducted by the National Institute for Health Research and Cancer Research UK, concluded: "E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support." This new study adds further proof that e-cigarettes are a viable harm reduction strategy. Yet, national governments and the World Health Organization continue to marginalize these products.
In the United States, for example, the argument that e-cigarettes and vaporizers are a public health epidemic among the country's youth are results of misinformation at the hands of Trump administration-backed regulators. A plethora of work has been published by public policy researchers and journalists questioning the viability of the datasets provided to the federal government. The consensus drawn from this body of work is a degree of skepticism founded around the argument that youth e-cigarette use isn't as prevalent as suggested. One of my calculations found that only 5.8 percent of the country's high school-going youth, 15.1 million individuals, actually vape regularly while most of the federal government's numbers consist of merely experimental use cases. As a result, the regulatory threats from Food and Drug Administration Commissioner Scott Gottlieb could potentially lead to unintended consequences that threaten overall public health among the country's smoking populations.
The trends of regulation and public outrage in the United States are not surprising, as many of the proposed regulatory strategies emulate the World Health Organization's public policy platform. WHO is very vocal in the international space when it comes to the advocacy of public health taxes, product bans, and front-facing consumer marketing regulations. Many of the strategies encouraged by the FCTC are non-medical, and overshadow the WHO's role as a public health agency of the United Nations (UN).
A 2006 narrative analysis of the FCTC's acceptance of harm reduction strategies, published by Health Reports, starkly criticized the WHO’s implementation of the Framework Convention on Tobacco Control. Researchers Benjamin Mason Meier and Donna Shelley, both affiliated with Columbia University at the time, concluded: "Harm reduction is not a panacea for the ills of tobacco, but it could be, at best, a synergistic complement to the other tobacco-control approaches employed by the FCTC."
The WHO should focus on supporting health-related tobacco control approaches that include alternative nicotine products while adjusting their global public policy platform to reflect evidence of harm reduction. Upon further analysis, the provisions of the FCTC could be further developed with the joint implementation of the UN's key human rights governance frameworks. At the behest Meier and Shelley's research, I point to the United Nation's Universal Declaration on Human Rights (UDHR) and the International Covenant on Economic Social and Cultural Rights (ICESCR).
The UDHR ensures fundamental and enumerated human rights. "Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including … medical care and necessary social services….," the declaration dictates. ICESCR was legislatively ratified by the United Nations and ensures "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health," based on the provisions of rights granted under the UDHR. Further, Article 12 of the ICESCR requires its signatories to support "(b) [t]he improvement of all aspects of environmental and industrial hygiene; (c) [t]he prevention, treatment, and control of epidemic, endemic, occupational and other diseases; [and] (d) [t]he creation of conditions which would assure to all medical service and medical attention in the event of sickness." Based on the logic of the FCTC and these two cornerstone documents of the UN, access to tobacco harm reduction products is a human right that can't be impeded on by any governmental entity.
It might be presumptuous to some to argue that access to products like e-cigarettes and Swedish snus are imperative for a human’s right to health; however, the justification is there. There are over a billion smokers in the world, according to the WHO. If we allow for the regulatory regimes of national governments to force the misguided sentiment that certain alternative nicotine products are just as harmful as combustible tobacco, then there is a net-negative risk to public health.
Michael McGrady is the executive director of McGrady Policy Research & Public Affairs. He is also a public policy columnist for the Geneva, Switzerland-based Vaping Post and an international journalist covering foreign affairs, economics, and public health issues. An independent researcher, most of McGrady's recent work focuses on tobacco harm reduction and the vaping industry. He submitted this piece on his own accord, and his opinions don't necessarily reflect the views of his publishers or partners.