DELON HUMAN | At 20, WHO’s tobacco treaty is failing those who need it most

This week has marked the 20th anniversary of the World Health Organisation’s (WHO) Framework Convention on Tobacco Control (FCTC), a landmark treaty intended to reduce the global toll of smoking.

But after two decades of costly FCTC influence and activities, the reality is grim: smoking still kills 8.5-million people annually, and more than 1.2-billion people continue to use tobacco.

While some countries have made progress, many low- and middle-income regions have seen minimal improvement. Smoke Free Sweden has the evidence to prove that the primary barrier to greater success isn’t lack of resources but the WHO’s ideological opposition to tobacco harm reduction (THR).

THR has helped millions transition to substantially lower-risk alternatives such as nicotine pouches and e-cigarettes. According to the UK’s office for health improvement and disparities (formerly Public Health England), e-cigarettes are about 95% less harmful than combustible cigarettes.

Yet the WHO consistently frames these alternatives negatively, distorting the growing scientific evidence supporting their role in reducing smoking rates. 

This contradiction lies at the heart of the WHO’s approach. Ironically, article 1(d) of the FCTC explicitly includes harm reduction as a fundamental pillar of tobacco control. The treaty defines tobacco control as including “harm-reduction strategies”.

Yet in practice, the WHO systematically disregards this aspect, favouring prohibitionist policies that have failed to curb smoking in many regions where cigarettes remain dominant.

In its anniversary celebrations, the WHO claimed global tobacco use has dropped by one-third since the FCTC’s establishment.

However, this modest decline masks a crucial reality: countries integrating harm-reduction strategies have achieved dramatically better results than those following the WHO’s restrictive guidance. 

Sweden stands as the most compelling example. Through widespread adoption of snus, nicotine pouches and vapes, Sweden has reduced cigarette use by 55% in the last decade. With Europe’s lowest smoking rate at 5.3%, Sweden is poised to become the first smoke-free EU nation, with smoking-related mortality 39.6% below the European average.

Similarly, New Zealand has nearly halved its smoking rate after promoting vapes as a harm-reduction tool, while the UK has seen significant success with a similar approach. These success stories contrast sharply with countries adhering to the WHO’s prohibitionist stance.

The average EU smoking rate remains five times higher than Sweden's, with most member states far behind their smoke-free targets. Nations such as India and Mexico have banned safer alternatives entirely, forcing citizens to either continue smoking or turn to illicit, unregulated markets — neither to the benefit of public health.

If the WHO truly aims to reduce tobacco-related deaths, it must return to the FCTC’s complete mandate, acknowledging harm reduction as essential. It needs to engage honestly with evidence supporting reduced-risk products, include harm-reduction scientists and consumer advocates in policy discussions and allow empirical evidence, not ideology, to guide tobacco control. 

Sweden’s success should be celebrated as a model for effective tobacco control, not dismissed because it challenges conventional wisdom. Smokers deserve access to safer alternatives, and governments should be encouraged to make these options available as part of comprehensive tobacco control strategies.

It’s time for policymakers to reject the WHO’s outdated approach and adopt pragmatic harm-reduction strategies that prioritise smokers’ health over rigid dogma. The evidence is clear: tobacco harm reduction works, and millions of lives depend on the WHO acknowledging this reality. 

• Dr Delon Human is a specialist family physician, global health advocate, published author, international speaker and healthcare consultant 

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