The World Health Organization (WHO) has published the documents that will form the outline of discussions this year by the countries that are part of its tobacco control convention. They will meet in November to discuss and agree on priorities and strategies for tobacco and smoking policy.
The Framework Convention on Tobacco Control (FCTC) is the WHO’s tobacco control arm. 180 nations are parties to the convention (the US is not a party, by the way), which is a treaty. The meeting is called the Conference of the Parties (COP). The last meeting — in 2014 in Moscow — was the sixth (COP6). This year’s meeting, COP7, will be held in Delhi.
This year, for the first time, they have produced a document dedicated to specific discussion of e-cigarettes. “Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS),” it’s called. Don’t worry, the content is even worse than the title.
What's on the agenda?
Some people will probably consider it progress that they have recognized the potential of vapor products to reduce the burden of smoking death and disease. But their acknowledgement is so conditional it’s barely there at all.
“If the great majority of tobacco smokers who are unable or unwilling to quit would switch without delay to using an alternative source of nicotine with lower health risks, and eventually stop using it, this would represent a significant contemporary public health achievement. This would only be the case if the recruitment of minors and non-smokers into the nicotine-dependent population is no higher than it is for smoking, and eventually decreases to zero.”
“Without delay” means that any so-called “dual use” — smokers who vape or vapers who smoke — ruins the whole proposition. Why? Who knows? They just don’t like vaping. And their position that the nicotine consumer must eventually stop using nicotine for there to be a real health benefit is mysterious. Why?
Because, “In addition to dependence, nicotine can have adverse effects on the development of the foetus during pregnancy and may contribute to cardiovascular disease. Although nicotine itself is not a carcinogen, it may function as a ‘tumour promoter’ and seems to be involved in the biology of malignant diseases, as well as of neurodegeneration. Foetal and adolescent nicotine exposure may have long-term consequences for brain development, potentially leading to learning and anxiety disorders.”
That last “may” comes from a rodent study, and is used regularly by every nicotine hater on earth, including the FDA and CDC. The rest are from studies of smokers. Their fear of nicotine isn’t widely shared by actual scientists, but it is influential in public health circles, especially in developing countries.
There are financial and reputational incentives for countries to implement FCTC recommendations, and poorer countries especially tend to dance to the WHO’s tune.
Nothing new to see here
It doesn’t get better. What the WHO has done is exactly what the FDA did in its deeming reguations. It’s even added a new and hideous acronym — ENNDS — to the tobacco control lexicon, perhaps in preparation for matching the FDA’s bizarre attempt to control zero-nicotine e-liquids. It has cherry picked evidence to support a preordained position, and framed each argument as a polar choice between safe and unsafe.
Use of vapor products, of course, is relatively safe. The major reviews of evidence on vaping — by Public Health England and the Royal College of Physicians — have looked at all of the evidence, weighed it, and estimated the risk to be very, very low (95-100 percent safer than smoking). Absolute safety is the demand of people who want the product demonized, damaged and – they really, really hope — gone.
The concern is entirely about “the recruitment of minors and non-smokers into the nicotine-dependent population.” As it is for the ban-happy FDA, there is no other issue for the WHO.
Six million smokers die prematurely each year. But smokers just don’t factor into the FCTC’s priorities. They don’t even consider that children depend on those smokers. The WHO’s concern is strictly about some hypothetical kids who may become “nicotine dependent.” They use boilerplate fear mongering, and quote surveys that measure last-30-day use and imply habitual use.
“Use among non-smoking youth in Florida, USA and Poland has increased by a factor of five and eight respectively in three years, to reach a prevalence of 6.9% and 13% in these jurisdictions.” Scary, right? Nothing about the Monitoring the Future survey that shows few regular teen vapers, and few that use nicotine.
When the worry is children, what are the first targets of attack?
“Flavour is one of several significant product appeal factors that influences people’s willingness to try ENDS,” they write. “Certain flavours, such as fruit and confectionary or candy-like aromas, appeal to children, younger never-smokers and young ENDS/ENNDS beginners and may therefore play a role in motivating experimentation among them.”
Objective: prevent the initiation of ENDS/ENNDS by non-smokers and youth with special attention to vulnerable groups. Although the debate about whether the use of ENDS/ENNDS is a gateway to smoking is unresolved, preventing this eventuality requires making the initiation and persistence of smoking as difficult as possible. Parties that have not banned the importation, sale, and distribution of ENDS/ENNDS may consider the following options:
a. Banning the sale and distribution of ENDS/ENNDS to minors;
b. Banning the possession of ENDS/ENNDS by minors;
c. Banning or restricting advertising, promotion and sponsorship of ENDS/ENNDS;
d. Taxing ENDS/ENNDS at a level that makes the devices and e-liquids unaffordable to minors in order to deter its use in this age group. In parallel, combustible tobacco products should be taxed at a higher level than ENDS/ENNDS to deter initiation and reduce regression to smoking;
e. Banning or restricting the use of flavours that appeal to minors;
f. Regulating places, density and channels of sales; and
g. Taking measures to combat illicit trade in ENDS/ENNDS.
Anything jump out at you? Restricting advertising, taxing to reduce use, banning flavors, regulating sales outlets…which is your favorite prohibition?
Coming soon: controversy
Remember, this document is just a frame for discussion by the delegates in November. The final recommendations could be better for vapers and other nicotine consumers. Or they could be worse. They could even be a lot worse.
But they are recommendations, not regulations. All the FCTC can do is agree that member states should try to follow the WHO guidelines in making and implementing tobacco policy. Still, many countries will make their own policy based on the FCTC’s agreed priorities. We owe it to smokers and vapers around the world to challenge the FCTC to be sensible, and to consider all stakeholders.
This is going to get a lot of attention in the coming weeks. You’ll be seeing a lot written about it, including here. For the first time, vapers and advocates for consumer nicotine use will be pushing back at the FCTC in a serious way, and in real time. Is it possible to persuade them to act responsibly? Or will the FCTC double down and show the FDA just who’s the most paranoid and insular agancy in the tobacco control world? Tune in.