British experts have accused the World Health Organization of risking the lives of millions by urging governments to crack down on vaping, writes Kat Lay, health editor of The Times. The United Nations public health body said last week that e-cigarettes were harmful and risked hooking new generations on nicotine.
This follows the launch of the WHO Report on the Global Tobacco Epidemic 2021: Addressing new and emerging products.
A slightly shortened version of the open access story from The Times runs below, followed by a WHO story on the report, which was launched on 27 July 2021, and a link to the document.
In the report on efforts to tackle smoking globally, the WHO warns that many countries are “not addressing emerging nicotine and tobacco products and failing to regulate them”. It said that vaping risked undoing years of progress to “denormalise” smoking and e-cigarettes, consumed in the style of cigarettes, could “renormalise” the practice.
Dr Tedros Adhanom Ghebreyesus, the WHO director-general, said: “Nicotine is highly addictive. Electronic nicotine delivery systems are harmful and must be better regulated.”
Michael Bloomberg, the former mayor of New York and the WHO’s global ambassador for non-communicable diseases and injuries, added: “As cigarette sales have fallen, tobacco companies have been aggressively marketing new products – like e-cigarettes and heated-tobacco products – and lobbied governments to limit their regulation.
“Their goal is simple: to hook another generation on nicotine. We can’t let that happen.”
However, The Times reported, British experts criticised the message. Public Health England promotes vaping as a tool to help smokers quit.
Responding to the WHO report, Martin Dockrell, tobacco control lead at Public Health England, said: “The best thing that a smoker can do is to stop smoking completely and the evidence shows that vaping is one of the most effective quit aids available, especially for smokers who have tried to quit before and failed, helping around 50,000 smokers quit a year.
“The evidence has been clear for some time that, while not risk-free, vaping is far less harmful than smoking.”
The United Kingdom-based public health agency Knowledge-Action-Change (KAC) accused the WHO of “seeking to distract from years of failure” to tackle smoking globally with “a new war on nicotine”.
The Times story continues; The WHO report says three quarters of countries and 5.3 billion people are protected by at least one of its recommended tobacco control measures, and half by at least two. It described “encouraging progress” seen around the world, with smoking prevalence among people aged over 15 having fallen from 22.7% in 2007 to 17.5% in 2019.
However, KAC said 1.1 billion people continued to smoke worldwide and eight million lives were lost annually to smoking-related diseases, figures that have stayed flat for two decades.
Gerry Stimson, emeritus professor at Imperial College London, and director at the agency, said: “That the [WHO] is now seeking to re-energise lacklustre tobacco control efforts by encouraging nation states to enact bans or overly restrictive policies on safer nicotine products is both irresponsible and illogical.
“It will lead to millions continuing to smoke, millions continuing to die prematurely and millions more cigarettes being sold.”
John Britton, emeritus professor of epidemiology at the University of Nottingham, said: “This report demonstrates that, sadly, the WHO still doesn’t understand the fundamental difference between addiction to tobacco smoking, which kills millions of people every year, and addiction to nicotine, which doesn’t.”
According to The Times, he said the WHO’s position was hypocritical in recommending use of medicinal nicotine products to treat addiction to smoking, but advocating “prohibition of consumer nicotine products which do the same thing, but better”.
The sale of e-cigarette products to under-18s is banned in the UK but a report on vaping in England recommended that enforcement of age-of-sale regulations for vaping and smoking needed to be improved.
That report, commissioned by Public Health England in February, found little change in levels of vaping in recent years. A fifth of the young people who tried vaping said they had done so before they smoked and just over a quarter said they had tried a vaping product and never tried smoking.
WHO reports progress in the fight against tobacco epidemic
Many countries are making progress in the fight against tobacco, but a new report shows some are not addressing emerging nicotine and tobacco products and are failing to regulate them, says the World Health Organization.
More than four times as many people are now covered by at least one WHO-recommended tobacco control measure as compared with 2007.
The six MPOWER measures are: monitoring tobacco use and preventive measures; protecting people from tobacco smoke; offering help to quit; warning about the dangers of tobacco; enforcing bans on advertising, promotion and sponsorship; and raising taxes on tobacco.
Some 5.3 billion people are now covered by at least one of these measures – more than four times the 1 billion who were covered in 2007.
More than half of all countries and half the world’s population are now covered by at least two MPOWER measures at the highest level of achievement. This reflects an increase of 14 countries and almost one billion more people since the last report in 2019.
More than half of the world’s population are exposed to tobacco products with graphic health warnings. However, progress has not been even across all MPOWER measures. Some measures like raising tobacco taxes have been slow to move and 49 countries remain without any MPOWER measures adopted.
Need to tackle threats posed by new products
For the first time, the 2021 report presents new data on electronic nicotine delivery systems, such as ‘e-cigarettes’. These products are often marketed to children and adolescents by the tobacco and related industries that manufacture them, using thousands of appealing flavours and misleading claims about the products..
WHO is concerned that children who use these products are up to three times more likely to use tobacco products in the future. The organisation recommends governments implement regulations to stop non-smokers from starting to use them, to prevent renormalisation of smoking in the community, and to protect future generations..
“Nicotine is highly addictive. Electronic nicotine delivery systems are harmful, and must be better regulated,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General: “Where they are not banned, governments should adopt appropriate policies to protect their populations from the harms of electronic nicotine delivery systems, and to prevent their uptake by children, adolescents and other vulnerable groups.”.
84 countries lack e-cigarette safe-guards
Currently, 32 countries have banned the sale of electronic nicotine delivery systems (ENDS). A further 79 have adopted at least one partial measure to prohibit the use of these products in public places, prohibit their advertising, promotion and sponsorship or require the display of health warnings on packaging. This still leaves 84 countries where they are not regulated or restricted in any way.
Michael R Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and Injuries and founder of Bloomberg Philanthropies, said: “More than one billion people around the world still smoke. And as cigarette sales have fallen, tobacco companies have been aggressively marketing new products – like e-cigarettes and heated-tobacco products – and lobbied governments to limit their regulation. Their goal is simple: to hook another generation on nicotine. We can’t let that happen.”
Dr Rüdiger Krech, Director of the Health Promotion Department at WHO, highlighted the challenges associated with their regulation. “These products are hugely diverse and are evolving rapidly. Some are modifiable by the user so that nicotine concentration and risk levels are difficult to regulate. Others are marketed as ‘nicotine-free’ but, when tested, are often found to contain the addictive ingredient.
“Distinguishing the nicotine-containing products from the non-nicotine, or even from some tobacco-containing products, can be almost impossible. This is just one way the industry subverts and undermines tobacco control measures.”
The proportion of people using tobacco has declined in most countries, but population growth means the total number of people smoking has remained stubbornly high. Currently, of the estimated one billion smokers globally, around 80% of whom live in low- and middle-income countries. Tobacco is responsible for the death of eight million people a year, including one million from second-hand smoke.
While ENDS should be regulated to maximise protection of public health, tobacco control must remain focused on reducing tobacco use globally. MPOWER and other regulatory measures can be applied to ENDS.
See also from the MedicalBrief archives