Friday 20th June 2025
Panel Discussion #4
Evaluating WHO tobacco harm reduction science
Thomas Nahde, global head of harm reduction and engagement at Imperial Brands, said, ‘Smoking is not a communicable disease, it’s a consumer behaviour. A narrative of war on a behaviour is misapplied, I believe. I’m conscious that it’s about urgency, but it demonises smoking, and stigmatises people who smoke. It also substantially limits the options, if you’re using a narrative of eradication rather than control. We need way more focus on the consumer, to really understand the behaviour of people who smoke.’
Riccardo Polosa, founder of the Center of Excellence for Accelerating Harm Reduction (CoEHAR – University of Catania, Italy), said, ‘It’s not true that the WHO is doing everything wrong. But in tobacco control, it is doing badly, in my opinion, particularly in the way it is creating misinformation. And unfortunately, most of the time WHO is doing this on purpose: it is actively misleading. They select their references, they distort evidence. They use tactical omission. There is one single objective in my opinion, which is to create their own science that supports the abstinence-only narrative and paradigm. But this has terrible consequences for millions of smokers who would otherwise switch to much less harmful products. In the clinical world, this would be called negligence.’
Summer Hanna, head of scientific regulation at BAT, said, ‘I believe that [when the FCTC was being drawn up], WHO recognised that progress and technology transformation would evolve to change and transform smokers’ lives, and that harm reduction strategies would then become the third leg of their approach. That’s why harm reduction is reflected in the FCTC. Unfortunately, over the last 20 years, we’ve seen that scientific mindset and curiosity erode. We now have leading jurisdictions of tobacco control – countries like the UK or New Zealand – with progressive regulatory frameworks and remarkable declines in the rate of cigarette smoking. Meanwhile, the FCTC is still reporting, 20 years later, over one billion smokers. To me, that’s a failure of creativity and scientific process.’
‘There might be many views on the best approach to tackling smoking, but it is in everyone’s interest to be a part of the solution. That’s only possible through open dialogue, a robust scientific exchange that includes all viewpoints and collaboration to truly end cigarette smoking.’
‘We think a lot about FCTC, but we also should think about other specialist agencies within the WHO that develop scientific insights for their use, for example the International Agency for Research on Cancer (IARC). ENDS are listed as a priority for evaluation with the IARC. This is a tiny specialist agency in France, but you see the impact of their work regularly in the media – the idea that Diet Coke and aspartame causes cancer, grilled meats cause cancer, aloe vera causes cancer — all these are insights from the work of IARC. But the agency does not contextualise the risk of cancer, only the hazard of it. And so the utilisation of science in the specialist agencies, uncontextualised but with wildly outsized media and public influence, is also a huge threat to the [safer nicotine] category and the public health opportunity they offer.’
Roberto Sussman, senior lecturer at the Institute for Nuclear Sciences of the National University of Mexico, said, ‘We essentially have to recognise the FCTC as the first international treaty on a health issue. It was a great victory at the time, that encoded years of struggle against the spreading harms from smoking. And at that time, the tobacco industry played a role that was not honourable. But now it has become a war on the industry. The COP meetings are closed because [WHO believes] industry might disrupt the whole thing. So it’s become a parallel situation: an old narrative, and a reality that completely denies that narrative, and a technocracy that resists the change. My hope is that the growing market in [safer nicotine] products will lead to a point where things will have to change, and that will also include at the WHO.”
Clive Bates, director of The Counterfactual, said, ‘What matters is how harmful and how safe or unsafe [safer nicotine products] are compared to the other risks that people bear, either as smokers or in society in general. We don’t have a zero risk appetite, and the evidence suggests these products are much less harmful than smoking.’
From the floor, in response to a WHO statement that ‘Nicotine is highly addictive’:
Lynne Dawkins, Dawkins Analytics and Pinney Associates, said, ‘It’s more nuanced than this [statement]. It depends on how the nicotine is delivered, and in the form of cigarette smoke, yes, it’s highly addictive, I would agree. But hardly anybody gets addicted to nicotine in the form of a patch, for example. There’s also the issue of a distinction between addiction and dependence. Addiction causes harm. Maybe we should be using the word dependence when we’re not talking about addiction in relation to cigarette smoking. When you talk about physical dependence, that is linked to experiencing withdrawal symptoms when you stop. Addiction comes with that unique extra bit about causing harm. Of course, that’s not the way it’s used among the general public.’
Discussing the statement ‘There is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests’ from the WHO FCTC Article 5.3:
Clive Bates, director of The Counterfactual, said, ‘When this was agreed in 2008, I remember saying “who’s thinking about the snus experience?” By then, we had a tobacco product made by a tobacco company, which was responsible for the lowest rate of smoking in Europe. It also had a measurable impact on cancer, which was much lower in Sweden than it was in the rest of the European Union, where snus products were banned. If you have a principle, and you say it’s fundamental and irreconcilable, what happens when you have a counter case like that? What happens is the principle needs to change.’
‘Most people, including in the WHO, including in the industry, do not get up and go to work saying “I’m going to tell lies all day”. What they do is form a set of beliefs that are reinforced by the influences around them. One of the reasons people interested in tobacco harm reduction and consumers are excluded from the FCTC COP is that they don’t want dissonant views in the room, because that breaks the bubble of thinking. I think most people are trying to be honest and form a view that is reinforced by everything around them, but, as a professional, you have to listen to other points of view – or you’re going to miss things.’
Roberto Sussman, senior lecturer at the Institute for Nuclear Sciences of the National University of Mexico, said, ‘It’s part of a combat narrative. When you are in war, the enemy is bad. Today, being more pragmatic, the industry should be part of the discussion. It cannot be excluded. And to keep this as a timeless, eternal, absolute proposition is in the end itself defeating, because the industry is not the same. The conception of this type of statement is that industry is like a monolith. What is the biggest of all Big Tobacco? It’s the [state-owned] Chinese tobacco industry. The Chinese industry is not alluded to. It goes into the COP meetings, sits down there, and nobody says anything. This is the real Big Tobacco.’
Summer Hanna, head of scientific regulation at BAT, said, ‘I’m not confident how many of the people who are working in [the tobacco control] space actually know any smokers. As smoking becomes less of a middle class or upper class phenomenon, people who sit and learn at institutions do not ever interact with these people in their personal lives. They become an abstract entity. In the same way that the tobacco industry becomes a monolith, the smoker also becomes a monolith in this.’
Watch the day’s proceedings here: