The World Health Organization’s (WHO) new Global Trends in Tobacco Use report raises a big question mark over the international community’s push for a smoking free world.
On the face of it, as WHO’s director-general Tedros Adhanom Ghebreyesus maintains, the progress on winning the smoking war seems “very encouraging”.
2025 target unlikely to be met
According to the report, the number of tobacco users worldwide fell from 1.32 billion in 2015 to 1.30 billion in 2020 – and WHO predicts the number will drop to 1.27 billion by 2025. Sixty countries are on track to achieving the voluntary global target of a 30 percent reduction between 2010 and 2025, compared to just 32 countries two years ago.
However, WHO also admits that the voluntary 30 percent reduction target for 2010-2020 is “unlikely to be met in most countries”, and “instead of being on track to a 30 percent reduction target by 2025, a reduction of only 24 percent is likely to be achieved”.
The highly respected journal Lancet warns that “progress will become more difficult and incremental gains will be harder won” and calls for “accelerated advocacy and action”.
Gerry Stimson, Emeritus Professor at Imperial College London, a leading social scientist and adviser to many UN agency including WHO, is withering. He accuses WHO of “trumpeting falling tobacco use” when it is “celebrating failure”. “To see the number fall from 1.32 billion to 1.30 billion users over five years cannot be argued as evidence of a successful strategy”.
Why is the anti-smoking drive stalling?
WHO says evidence shows that the tobacco industry used the Covid-19 pandemic to “build influence” with governments in 80 states.
It points to the new Tobacco Interference Index compiled by STOP, an anti-smoking pressure group, which claims that:
“In many countries governments chose to protect and even promote the industry” during the Covid-19 pandemic.
“Although governments identified tobacco industry interference as a main obstacle to their efforts to implement tobacco control measures, many became vulnerable to the industry’s tactics, succumbed to its interference and compromised on their policies to protect public health from commercial interests.
“Many governments made decisions that benefited the industry, particularly in lowering or not imposing taxes and delaying legislation or its implementation.”
The STOP report just quoted criticises 11 countries for using the pandemic to justify applying lower taxes or deferring rises and at least ten governments for deeming the tobacco industry and cigarettes to be “essential” to be sold during pandemic lockdowns. It alleges the industry “sabotaged” tobacco control legislation in Tanzania, Zambia, Ethiopia, Bolivia, Georgia, and Turkey.
Tricky Tobacco
WHO’s director general warns: “Tobacco companies will use every trick in the book to defend the gigantic profits they make from peddling their deadly wares”.
However, the bosses at Big Tobacco, used to decades of vilification, are by now inured to allegations of trickery and will shrug aside the latest accusations of dirty tricks. They are focusing increasingly on a fight over New Category Products (NCPs) like vaping and e-cigarettes.
The industry is playing a clever tactical game. It is mounting a dogged rear-guard action to defend its existing products and exploit opportunities to expand their sales. Companies are also positioning themselves as champions of a smokeless future “where cigarettes no longer exist”, and painting WHO and allies as the ‘bad guys’ for not embracing NCPs.
British American Tobacco’s chief operating officer Kingsley Wheaton said in a speech in 2021 that:
“If WHO tries to advance further, restrictive measures for New Category Products that could seriously undermine the progress being made in making reduced-risk tobacco and nicotine products widely available to smokers.
“It would be hard to imagine anything more damaging to global tobacco harm reduction efforts than further exclusion of these alternative products.”
Jacek Olczak CEO of Philip Morris International (PMI) the biggest tobacco company says: “Ignoring science and innovation will only hinder progress in our society. We have what’s needed to go smoke free today.
Kingsley Wheaton at British American Tobacco says:
“We know that adult smokers are more likely to switch and replace smoking entirely, if the alternative tobacco and nicotine products deliver comparable satisfaction in nicotine delivery, use, and sensorial aspects.”
New frontiers in nicotine delivery
Big Tobacco is investing billions in NCPs, sales are increasing especially in Europe and the US and bosses are confident this growth will continue to speed up.
Their manoeuvring is being aided by disarray among governments over how to handle NCPs. Unlike smoking, medical experts are sharply divided over whether they are harmful.
Consequently, 41 countries have so far banned the sale of electronic nicotine systems (ENDS), and a further 32 countries have imposed at least one control measure against them, while 66 countries at taken no action at all.
WHO states that “evidence reveals that these products are harmful to health and are not safe. However, it is too early to provide a clear answer on the long-term impact of using or being exposed to them”.
According to the Global State of Harm Reduction in an October 2021 report:
“The WHO and its NGO allies are still engaged in an historic battle against the tobacco industry despite the emergence of new technologies.
“There is a substantial body of global independent evidence that safer nicotine products are significantly safer than any combustible and many types of oral tobacco products. technologies. The evidence shows these products are significantly less risky than combustible tobacco and have a role to play in harm reduction.”
Regulatory roads
WHO suffered a setback in October 2021 when the Food and Drug Administration (FDA) approved the sale of e-cigarettes (the US for the first time, giving the green light to three products under the Vuse brand).
An even heavier blow was landed by the Medicines and Healthcare Regulatory Agency (MHRA) in England in October 2021 when it cleared the way for e-cigarettes to be prescribed on the NHS to help reduce smoking. This would make England the first country in the world to license e-cigarettes as medical products.
Big Tobacco may be on the defensive on one front but is very much on the offensive on the second – NCPs. Backed up by very healthy profits and buoyed by forecasts that the tobacco market, currently worth US$ 818 billion, will increase to over a trillion dollars by 2028, few would bet against it.
The war on smoking continues.
