Tobacco Harm Reduction at FCTC Anniversary

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/06/24

On the 20th anniversary of the WHO Framework Convention on Tobacco Control (FCTC), the Taxpayers Protection Alliance and public health advocates like Martin Cullip are calling out the WHO’s refusal to embrace tobacco harm reduction. Despite overwhelming evidence supporting alternatives such as vaping, nicotine pouches, snus, and heated tobacco, the WHO maintains a prohibitionist stance rooted in outdated ideologies. Critics argue that this blocks progress, wastes taxpayer money, and ignores the lived experiences of millions who have successfully quit smoking using reduced-risk products. They urge governments and civil society to pressure the WHO for reform and evidence-based public health policies.

Scott Douglas Jacobsen: The Taxpayers Protection Alliance (TPA) is also criticizing the World Health Organization (WHO) and its Framework Convention on Tobacco Control (FCTC) on its twentieth anniversary. The TPA argues that the FCTC has failed to adapt over time and has not integrated harm reduction strategies such as vaping, heated tobacco products, and nicotine pouches into its policy framework. Critics—including Clive Bates, Roger Bate, and Martin Cullip, who (Cullins) joins us today—have accused the WHO of clinging to outdated, abstinence-only, prohibitionist approaches while ignoring science-based alternatives that could significantly reduce smoking-related deaths.

From personal experience, I’ve worked in construction, in restaurants, and even with horses—environments where smoking and, increasingly, vaping are everyday habits. This is true in many parts of Western Europe and North America. Many people smoke. Many people vape. Many also feel a sense of guilt or shame around it due in part to social stigma and rising costs. Despite this, harm reduction is gaining traction globally.

I was involved with Canadian Students for Sensible Drug Policy (CSSDP), a youth-led harm reduction advocacy organization. Our focus at the time included urgent issues such as fentanyl contamination in recreational drug supplies. One key initiative was investigating access to naloxone—an opioid overdose reversal medication—on post-secondary campuses. At the time, only a few universities in Canada had naloxone kits available on-site. This was not decades ago—this was within the last several years.

Canada has over one hundred accredited universities, and the vast majority of them are public. Fewer than ten are private, and most of those have religious affiliations. The lack of widespread harm reduction infrastructure was—and in some cases still is—a clear example of policy failing to meet public health needs. Now to the central point. When analyzing the WHO’s Framework Convention on Tobacco Control, how closely does it mirror the language and policy recommendations of traditional prohibitionist frameworks? More importantly, has the FCTC evolved to reflect harm reduction principles?

Martin Cullip: Unfortunately, no—at least not in any meaningful or public-facing way. This is one of the key concerns raised by experts. The WHO has historically resisted harm reduction in the context of tobacco, much as it once did in the context of illicit drug use. While the WHO eventually recognized harm reduction as a legitimate and necessary approach for addressing drug-related harms—including needle exchange and opioid substitution therapy—it was a protracted battle. Many advocates recall that the WHO, for years, acted as a barrier rather than a partner in those efforts.

Over time, with the global recognition that the war on drugs had failed, the WHO came around and now endorses harm reduction for drug policy. However, in tobacco control, the same shift has not yet occurred. Despite mounting evidence that reduced-risk nicotine products can help adult smokers switch away from combustible cigarettes, the WHO continues to prioritize abstinence-based measures and, in some cases, supports bans or severe restrictions on harm-reduction tools.

And that is precisely what they are now doing with tobacco harm reduction. I would say it is the same kind of struggle. You know, nicotine use—according to archaeological evidence—has been going on for over twelve thousand years. That is just what we currently know.

Today, we have around one billion smokers globally out of a population of eight billion. So, you are not going to eliminate nicotine use. The sensible approach is to help people consume nicotine in the safest way possible, and that is through harm reduction: vapes, nicotine pouches, heated tobacco, and snus, which have been used for decades in Scandinavian countries.

However, the WHO remains committed to a prohibitionist stance, despite growing evidence that harm reduction works. In countries where harm reduction is embraced as part of tobacco control, smoking rates are significantly lower than in those that maintain abstinence-only policies.

Take Sweden, for example. It has just reached the European Union’s “smoke-free” target of less than 5% adult smoking prevalence—sixteen years ahead of the EU’s 2040 goal. That demonstrates harm reduction’s effectiveness. It mirrors the earlier battle over drug policy, where advocates eventually convinced the WHO to recognize harm reduction measures like needle exchange programs and opioid substitution therapy.

Jacobsen: So it is the same sort of conversation. The available evidence—at least the last time I checked—strongly supports harm reduction as an effective way to reduce the harm associated with virtually any substance. Prohibitionist or punitive approaches, on the other hand, tend to either have no impact or make the situation worse.

What tends to happen is this: people who are going to use a substance still do, and sometimes use it even more dangerously. So prohibition can be counterproductive, but if health authorities know this and still promote such policies, it borders on misinformation.

Over time, what we see is not only increased use but increased trauma—whether through financial penalties, incarceration, or other consequences. Smoking is, of course, a somewhat different case than illicit drug use, but this is still a broad pattern that applies across substance use policy. Has any of the evidence changed recently to support prohibitionist tobacco policies?

Cullip: No, if anything, the evidence has grown stronger to support harm reduction. One of the classic prohibitionist arguments is that “we do not yet know the long-term effects” of these newer products. But that argument never ends. I read a piece just last year from someone in Sweden claiming we still do not know enough about snus.

Snus has been used in Sweden since at least the 1800s and has contributed significantly to the country’s low smoking rates. At what point is the evidence considered sufficient? That kind of argument is used to delay policy reform indefinitely.

Meanwhile, because of the WHO’s anti–harm reduction stance, some countries have begun adopting punitive measures against people who use safer nicotine alternatives. France, for example, has passed legislation to ban nicotine pouches—arguably the safest form of nicotine delivery currently available. That is deeply concerning.

I mean, nicotine pouches work in much the same way as pharmaceutical nicotine replacement therapies like patches and gum. But now they are banning these products. In France, for example, they have proposed a five-year prison sentence simply for possession—not sale, not use, just possession—of nicotine pouches.

If this trend of prohibition continues, it will inevitably harm people—just as we now understand the war on drugs did in the United States. That approach criminalized millions, disproportionately affecting marginalized communities, for behaviours that are, frankly, human. People have always sought out psychoactive substances, whether for relief, stimulation, or recreation.

Someone needs to be realistic about this. People are going to use these products. The best approach is to guide them toward the safest possible options, which is the essence of harm reduction. As you mentioned, we do not ban driving because cars can cause fatal accidents. Instead, we mandate seat belts. And yes, cars damage the environment, but the solution is to shift toward electric vehicles—not to ban all cars. These are examples of harm reduction.

In nearly every other area of public policy, harm reduction is accepted as common sense. But for some reason, when it comes to psychoactive substances, there’s a block—institutional resistance. That is why the WHO opposed drug harm reduction for so long and now, similarly, opposes tobacco harm reduction.

Hopefully, history will positively repeat itself, and the WHO will eventually shift. These are not unintelligent people at the WHO. Many are extremely capable. The problem is institutional inertia. It is not that someone needs to make a radical change overnight—it is that the system needs a push toward rational, incremental reform.

Jacobsen: Especially when a country like France is taking these hardline stances. France is often stereotyped in North America as a liberal country, at least socially. So, it sends a strong message even when they are adopting such prohibitionist policies. Of course, some Americans dislike the French for reasons they cannot even articulate. I’m Canadian, but I understand that sentiment exists. I know many British people feel similarly.

Cullip: Yeah, I’m British—and yes, a lot of Brits seem to dislike the French, but I actually really enjoy France. I have been there many times and love the country.

Jacobsen: For the WHO to maintain credibility in global health governance, what specific, targeted reforms should come first?

Cullip: I think they need to be more realistic. Part of the issue is that many at the WHO see themselves as having fought and won a decades-long battle against Big Tobacco. That fight has shaped their worldview. The logic goes: smoking is dangerous; therefore, it must be stopped entirely.

Historically, the only way to consume nicotine outside of pharmaceutical products was through smoking—rolling up dried tobacco leaves in paper and lighting them. That was it. So the narrative became: all tobacco is harmful, and no tobacco is good. From there, the assumption followed: ban all tobacco.

In that framework, the vector of harm is not just the product—it is the industry. So now the WHO is focused on attacking both, sometimes without distinguishing between combustible tobacco and much safer alternatives.

They want to attack smoking, and they want to attack the tobacco industry. So when that same industry introduces something completely different—reduced-risk products—they have difficulty accepting it. Sorry, someone was calling me; I declined it.

When alternative products emerge, the WHO faces two significant challenges. First, its institutional mindset is built entirely around opposing smoking, and it seems unable to shift to a harm reduction framework. Second, some of these alternative products—though not all—are produced by the same tobacco companies it has spent decades fighting. The WHO and its allies have been conditioned to oppose anything tied to the industry, regardless of scientific merit.

So, they are facing two entrenched barriers: a focus on abstinence rather than harm reduction and deep-rooted hostility toward the industry. Much of the global tobacco control network was built around this dual opposition. It is difficult for them to acknowledge that the landscape has changed and that new products and approaches now exist.

Keep in mind that vaping was only invented a little over twenty years ago, and nicotine pouches only came onto the market around 2016. More people are now discovering snus, which has been used safely in Scandinavian countries for decades. Yet snus has been banned throughout the European Union since 1992—without good justification. That is another debate altogether, but it illustrates the point.

Jacobsen: That ban belongs to a very different era.

Cullip: Exactly. Heated tobacco products are also relatively new. They were introduced in Japan around 2016, and since then, cigarette sales in Japan have fallen by about 50%. That is an enormous public health achievement in a short time.

If these harm-reduction products are allowed to thrive, they can drastically reduce smoking rates. But if your institution has spent years attacking only one product—combustible cigarettes—and that product finally begins to decline due to innovations you had no part in creating, what is your role? What does the tobacco control movement become when people can walk into a vape shop and quit smoking without any involvement from WHO-backed programs?

There is also a sense that because these products were not invented or endorsed by the public health establishment, the WHO does not feel ownership over them. And therefore, they are dismissed or ignored.

It is probably difficult for the WHO to shift direction. But it must begin listening to the science. That is where the core issue lies.

We are now at the twentieth anniversary of the WHO’s Framework Convention on Tobacco Control (FCTC), a global treaty ratified by 183 countries. But it has strayed from its original mission: to reduce the harms caused by tobacco smoke.

Today, it is attacking nicotine itself, which was never the intent. Even some of the original architects of the treaty have expressed concern, saying that the FCTC has turned into an ideological crusade. It is no longer focused on harm reduction. It refuses open debate, avoids engaging with dissenting views, and only admits carefully vetted media to its conferences. In fact, it once even banned Interpol from attending a session—Interpol!—because it had previously spoken with a tobacco company about curbing illicit trade, which is literally part of Interpol’s mandate.

This is the problem: the WHO is stuck in a 1990s-era battle against Big Tobacco while we live in a 21st-century world with innovative, demonstrably safer nicotine products. Instead of adapting to the evidence, they are clinging to outdated narratives.

And there are glimpses that the WHO occasionally acknowledges the potential of harm reduction. For example, in 2016, during the Seventh Conference of the Parties (COP7) held in India, there was an admission in one of their official documents that if every smoker were to switch to vaping, it would represent a significant public health gain.

However, their subsequent actions did not align with that statement. Instead of loosening restrictions, they have imposed more prohibitions over time. So, while there was recognition on paper, their policies have only become more restrictive in practice.

Jacobsen: Right. And that creates a contradiction—because, in theory, taxpayer funding should lead to effective public services. That is the whole point: taxpayers pay into the system to deliver services effectively and based on evidence. But if those services are, in fact, ineffective or even harmful—particularly when based on outdated or punitive policies—then taxpayers are not only undermining their present investment in public institutions but also ensuring higher future costs through continued inefficiency and avoidable health burdens. So what role do taxpayers have in redirecting harm reduction policy?

Cullip: That is a fundamental question. I have often argued that anyone who uses nicotine is, by extension, a taxpayer—either directly, through income and consumption taxes or indirectly, by participating in a system funded by taxes. And a portion of that funding goes to support institutions like the World Health Organization.

The fact that the WHO holds its key meetings in private and refuses to allow consumers to observe the process—let alone contribute—is simply unacceptable. It is fundamentally wrong. There is no democratic input. The WHO is not elected, yet it receives public funding from taxpayer-supported governments while systematically excluding those same taxpayers from discussions.

It was not always this way. In the past, some public access to proceedings was permitted. I have personally attended a few. But increasingly, the WHO is shutting out dissenting voices—consumers, scientists, industry experts—anyone who might question their approach.

Jacobsen: This makes the work of groups like the Taxpayers Protection Alliance (TPA) essential.

Cullip: That is why TPA is hosting its own event in Geneva during the same week as the WHO’s Conference of the Parties (COP10). The goal is to demonstrate that there are other voices—consumers, taxpayers, and experts—who believe the WHO’s approach is flawed and out of touch with both science and public accountability.

It is not just consumers. We have doctors, policy specialists, and health economists at our event. The message is simple: there is a better way, and it is time the WHO listens.

As you noted, embracing harm reduction can also reduce healthcare costs. In countries that have adopted harm reduction for tobacco and nicotine, smoking prevalence has declined, and so have associated healthcare burdens. The WHO often talks about how much smoking costs health systems. So, if we know that safer alternatives reduce smoking, why are they not encouraging those alternatives?

We do not have a clear answer. But we can amplify the message that science, policy, and financial responsibility all point in the same direction: toward harm reduction.

This exclusion of public voices is truly unique. You do not see this in other international policy spaces. At UN climate change conferences, for instance—COP meetings on climate—the public can attend. Civil society is present. Even industry representatives are involved because the understanding is that we must solve the problem together.

So why is the WHO’s approach to tobacco and nicotine the only significant public health space where transparency is actively avoided?

Climate change is recognized globally as a serious issue, and the consensus has been that all stakeholders—governments, scientists, civil society, and even industry—need to be involved to address it. No one thinks we can solve the climate crisis by locking decision-making into a small echo chamber and excluding everyone who disagrees. But that is precisely what the WHO is doing with tobacco harm reduction.

Jacobsen: So, how does the WHO typically respond to criticism? I do not mean supporters who offer gentle suggestions—I mean policy-level public statements or rebuttals to outside critiques.

Cullip: Almost universally, they respond by dismissing anyone who advocates for tobacco harm reduction as being aligned with, or influenced by, the tobacco industry. That is the default accusation. And they ignore you after that.

I have dealt with this personally for years. I ran a transport company for twenty-six years, specializing in taking children with disabilities to and from school. Writing about harm reduction was a side interest—something I did because I was a nicotine consumer and saw the value in products like vaping. But I was accused of being on the tobacco industry payroll.

I was supposed to have been running a full-time business employing 50 people while secretly serving as a tobacco industry operative. It is absurd. But this happens to anyone—whether they are scientists, journalists, or consumers—who speaks positively about harm reduction.

All over the world, there are people who say, quite sincerely, “Vaping saved my life” or “Snus was the only thing that helped me quit smoking.” Their motivations are personal and authentic. They advocate not for the industry but for the products that finally worked for them after everything else failed.

Yet nearly every one of them has been labeled a tobacco industry shill at some point. This is a convenient tactic—meant to delegitimize the individual and shut down the conversation without actually engaging with the evidence or the policy argument.

It is not very kind, frankly. Especially considering that these are taxpayers who help fund organizations like the WHO. They have a right to a voice and to be included in public health policy debates, particularly when the policy in question affects them directly.

Jacobsen: What actions can civil society, healthcare professionals, and consumers take to push for the inclusion of harm reduction in global tobacco policy?

I understand that in some countries, harm reduction may be politically impossible or suppressed due to cultural norms or authoritarian regimes. But from a U.K. standpoint, and perhaps more broadly across liberal democracies, what can people do?

Cullip: That is a great question. First, civil society needs to be vocal. Organizations that advocate for public health must stand up and say that harm reduction is a legitimate, evidence-based approach. That is already happening in places like the U.K., where the government supports vaping as a tool for smoking cessation. However, more can always be done to raise awareness and keep the conversation evidence-based.

Healthcare professionals have a vital role. Doctors, nurses, and public health experts all have authority and access to platforms that consumers often do not. They must speak up, present the data, and challenge the misinformation.

Consumers should not underestimate their power either. Their stories—real, lived experiences—are powerful. They need to organize, speak at public events, write op-eds, engage their MPs or representatives, and demand that international institutions like the WHO listen to the people most affected by their policies.

Finally, all of this needs to come together. Conferences, petitions, and side events—like the one we are holding in Geneva during COP10—are crucial. They show the WHO that there is a broad, informed, and evidence-driven coalition of people—taxpayers, experts, and advocates—who demand a more humane and effective public health strategy.

The WHO cannot ignore this forever. The science, the economics, and the ethics all point in one direction: harm reduction. Well, this is precisely my territory. I often tell consumers not to give up just because people are not listening to them. Make yourselves louder. Keep writing letters. Keep petitioning if you can. Yes, some countries are more autocratic and do not allow that sort of civic engagement. But if you are in a democratic country, contact your elected representatives. Let them know you exist. Tell them this works. It worked for you.

Just in terms of vaping alone, the last global estimate suggested there are at least 20 million vapers worldwide. And there are likely at least another 20 million using nicotine pouches, snus, or heated tobacco. That is a vast number of people who have managed to quit smoking through these products—and their voices should matter.

Because the WHO is comprised of its member nations, the pressure must come from national governments. In my case, that is the U.K.; in your case, it is Canada. Push your government to speak up for harm reduction at WHO events. The WHO does not unilaterally dictate what countries do at these meetings. A secretariat tries to steer discussions, but ultimately, decisions at the Framework Convention on Tobacco Control (FCTC) Conference of the Parties (COP) are made by the countries themselves.

National delegations are responsible for telling the WHO, “Our citizens are using these products. They work. You need to adapt your approach.” At COP10, which just took place, between 30 and 40 countries stood up and said, in effect, “Harm reduction deserves a seat at the table.” Now we wait to see what the WHO’s FCTC Secretariat will do at COP11 in Geneva, but we hope that even more countries will push the dial forward and challenge the prohibitionist status quo.

Tobacco harm reduction works. It worked for drugs—though the WHO resisted that for decades, too. They were eventually forced to admit that drug harm reduction saved lives. Now, they need to do the same with tobacco.

But right now, they are becoming more extreme. And that tells me something. When an institution starts to issue more extreme statements and starts spreading information that gets fact-checked or community-noted online, it means it is starting to lose the argument.

The science is building in favour of harm reduction. The WHO needs to stop cherry-picking studies that confirm its biases and start listening to the totality of evidence—and to the voices of consumers, the people who fund the organization through their taxes.

That is only going to happen if governments start attending these meetings and saying, “We want a new approach. We want the WHO to acknowledge that these alternatives are saving lives.”

Yes, it is political. But to consumers, you are civil society. You are the voices that matter most because you are the most affected. You need to stand up for yourselves, stand up for harm reduction, and demand that your governments carry your message to the WHO. Tell them to wake up.

Jacobsen: Excellent. Martin, it was nice to meet you. Thank you for your time, and I appreciate your sharing these critiques.

Cullip: That is fine. I hope the answers were what you were looking for.

Jacobsen: Excellent. Nice to meet you. Take care.

Cullip: It was lovely to meet you, too. Thanks a lot. Bye.

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