The World Health Organisation can sound pretty negative on vaping at times.
So it might surprise you that harm reduction (such as switching from smoking to vaping) is embedded in its tobacco control charter.
It might surprise you even more to find that one of the biggest influences on WHO policy is from an individual in a country that has not ratified the WHO tobacco framework.
You’ll also see, at times, a disconnect between the WHO’s statements and its policies. That’s because WHO officials might guide (or at least try to guide) policy, but they don’t actually make it.
For those who want to understand more about the WHO and vaping, we’ve put this guide together. (It also means I can point people towards this article instead of taking an hour to explain it to them ;))
- The strange actions of the WHO
- Harm reduction and the WHO
- What the WHO has said on vaping
- What influences the WHO?
- How the WHO makes policy
- What has the WHO done about vaping?
- How can advocates influence the WHO?
Before trying to understand the words and actions of the WHO, it’s worth taking a look at some of the very strange things they have said and done over the years.
- Praised North Korea for its lack of obesity. (This is a brutal totalitarian state which, at one point, lost 9% of its population to famine.)
- Initially advised that Covid-19 was not infectious, even as China was starting to admit it might be.
- Later dragged its feet on calling Covid a pandemic, which meant early vital funds could not be unlocked.
- Praised China for its response to Covid, even though doctors who tried to raise a warning were silenced by police.
- Tried to make a tyrant who destroyed his own country's health system its goodwill ambassador.
- Spends more on travel expenses than its complete spending on AIDS, tuberculosis and malaria.
The WHO has a potentially valuable role to play. This is the organisation that wiped out smallpox. It virtually eliminated polio. It warned of the possibility of a global pandemic long before Covid struck.
But unfortunately, as with vaping, it has a tendency to put its foot in its mouth. While people take the WHO seriously, it’s damaged its own credibility enough times that, for now, we need to take what it says with a large dollop of salt.
So next time someone says to you “but the WHO doesn’t like vaping”, point them towards this list :)
As you’ll see in this article, the WHO appears to be very anti harm reduction.
Yet harm reduction is embedded into the guidelines to which the WHO is supposed to operate.
..."tobacco control” means a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke.
Despite that, the WHO has been consistently negative on electronic cigarettes.
The organisation talks about the harms of vaping without mentioning the relative harms compared to tobacco products.
For example, they say:
ENDS emissions typically contain nicotine and other toxic substances that are harmful to both users and those exposed to the vapours secondhand.
This ignores that:
- Nicotine (not tobacco smoke) has a similar risk profile to coffee.
- Toxic substances in vapour are at levels of magnitude lower than cigarettes.
They also say:
Both tobacco products and e-cigarettes pose risks to health and the safest approach is not to consume either.
This is correct. However, it ignores the fact that some people are addicted to nicotine and need to use one or the other. When you accept this, it makes sense to recommend the option which is at least 95% safer.
The WHO doesn’t seem to get that, and indeed bemoans the fact that people are switching from smoking to vaping, stating:
Many countries across the European Region have struggled to contain the rising popularity of these products, and instead have simply seen a transferral of nicotine addiction from tobacco products to e-cigarettes.
The WHO also seems to cherry pick evidence to suit their stance. For example, they:
- quoted a key study that showed vaping is harmful to the heart - even after that study was retracted
- linked nicotine vaping to lung disease in the US, even though this was caused by Vitamin E acetate in black market cannabis.
Many of the WHO’s statements on vaping have been thoroughly debunked in an excellent piece by Clive Bates, former head of the UK Action on Smoking and Health (ASH).
One of the biggest influences on the WHO and the FCTC (Framework Control on Tobacco Control) is a man from a country which has not ratified the FCTC.
As we’ve explored before on this blog, the United States benefits from tobacco sales in a unique arrangement. Essentially, the more cigarettes are sold the more money individual states get. This may well be the reason the USA did not ratify the FCTC.
Despite not being not part of the framework on tobacco control, the USA has actively sought to undermine the WHO FCTC. It has:
- opposed a ban on free tobacco samples
- opposed advertising restrictions on tobacco products
- opposed a requirement that cigarette warnings are written in the language of the country they are sold in
- opposed a ban on language that suggests cigarettes are less harmful (such as ‘low tar’ or ‘ultra light’).
Yet one of the biggest influences on the WHO is an unelected American billionaire.
Michael Bloomberg is vehemently opposed to vaping and harm reduction.
In the US his foundation has donated 150 million dollars to fighting vaping. This includes paying mothers to tweet against vaping and funding an advertising campaign that, ironically, may have helped reverse a decline in teen vaping. Charities that receive his funding have changed their stance from a cautious recommendation of vaping for smokers to an anti-vaping stance.
Bloomberg doesn’t just work in the USA. In the Philippines, MPs have accused Bloomberg of illegally donating money to tobacco control organisations to influence policy.
Bloomberg is also the WHO ambassador on non-communicable diseases. He paid for the WHO’s report on tobacco, wrote the foreword to it and his staffers may have had input into the report itself. (Details here.) Bloomberg also funds NGOs that work with the WHO.
A second issue is that vaping is conflated with the tobacco industry.
Ironically, this is partly the result of anti-vaping policies.
The UK continues to have a thriving independent vape industry. However, in countries like the USA, regulations such as the PMTA and PACT are effectively wiping out independent vape companies. This passes control of vaping back to the very industry that is responsible for the problem vaping is trying to solve.
What’s more, and for good reason, nobody trusts tobacco companies. They have a history of lies and manipulation, and it’s no surprise that the instinct of organisations like the WHO is to oppose vaping.
What’s disappointing is that these instincts trump evidence.
The Conference of the Parties (COP) is the governing body of the WHO FCTC.
Policy on tobacco and electronic cigarettes is decided at meetings of the COP and embedded in the FCTC.
The policies themselves are the results of negotiations with members. The WHO proposes regulations, and the members decide whether to accept or reject the proposals.
The FCTC is said to be legally binding, but many of their documents talk about guidelines, suggestions and policy options. However, less wealthy countries, many of which are heavily lobbied by the tobacco industry, may lean heavily on the WHO for guidance on tobacco control.
The need to agree policy with over 160 members is perhaps one reason why, at times, not much policy is created.
For example, the WHO has asked members to consider classifying vaping as a tobacco product, but wasn’t able to get agreement. However, in the 7th Conference of the Parties, it was agreed that vaping (or ENDS, as the WHO calls it) would be banned or regulated. Countries like India have chosen to ban vaping, while the EU and the UK have chosen the regulatory route.
The next Conference of the Parties will be held in November 2021. The WHO is likely to present negative reports on vaping which will be in stark contrast to extensive independent research, including that of Public Health England. Actual policy will depend on negotiations with the different countries involved.
Theoretically, the WHO encourages engagement, at least in some areas. For example, in training documents it states that:
Community engagement is central to any public health intervention.
The reality, at least in tobacco control, is very different. Advocates and journalists have been banned from WHO meetings, and at times even the internet has been shut off to prevent communication with the outside world.
Observers are only allowed if they agree with the WHO’s goals. Current observers include NGOs who are funded by Bloomberg Philanthropies.
However, the key is to remember that policy is formed in conjunction with the members of the WHO. To influence the WHO, advocates need to lobby their governments to represent their interests.
After discussions with politicians in the past, I’m convinced the best way to do this is for individual vapers to speak from the heart and share their stories about how vaping changed their lives.
The UK is an interesting case in point.
The country is currently the largest donor to the WHO and is the most pro-vaping country in the world. Before Brexit, it had to agree a position with the EU. Now, though, the UK can take a direct part in negotiations.
What’s more, the country is ranked the best in the world at resisting tobacco interference and has received awards for its work to reduce worldwide tobacco prevalence.
The country is also a vaping case study, and has seen smoking rates plummet as vaping has gained popularity. It has sensible regulations, carries out an annual review of evidence, and carefully monitors any negative effects from vaping.
This puts the UK in an excellent position to make the case for vaping, and for a sensible balanced approach that balances regulation (to ensure products are safe) with making sure vaping products are available to people currently addicted to smoking.