New tobacco products such as e-cigarettes seem to have escaped having draconian measures laid on them at COP10. Photo credit: sarahjohnson1, Pixabay.
The Tenth Session of the Conference of the Parties (COP10) to the WHO Framework Convention on Tobacco Control (WHO FCTC) finally took place in Panama City during February 5-10, after being postponed from its original schedule in November last year.
The postponement of the event was either due to political unrest and security concerns in Panama (the official reason given), or, according to the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), the “systemic failure” resulting in the Panamanian government terminating an unfulfilled organizing contract, leading to a situation where the government had no service provider to make sure the meeting could take place. This was the first in-person COP meeting since COP8 in Geneva in 2018, before the pandemic. COP9 was held virtually in 2021 and more or less deferred all decisions to COP10.
Topics covered during COP10 included the regulation of tobacco product contents (Articles 9 and 10), the portrayal of tobacco in entertainment media in connection to advertising, promotion, and sponsorship, forthcoming tobacco control measures, the execution of Article 19 concerning liability, enhancements to the reporting system of WHO FCTC, and the Implementation Review Mechanism. Interestingly, discussions also touched upon the role of FCTC in advancing and upholding human rights.
COP10 vs Harm Reduction
After COP9, it was understood that COP10 would address FCTC’s concerns with new tobacco products such as vapes and heated tobacco, most likely aligning with WHO’s firm position against them like other tobacco products. Documents prepared by WHO and the Convention Secretariat focusing on “research and evidence” and “challenges posed by and classification” of new products for COP9 were supposed to be presented in COP10.
In December, WHO sent out a press release saying nicotine e-cigarettes are “harmful to health” and that “as consumer products are not shown to be effective for quitting tobacco use at the population level.” WHO also claimed that e-cigarettes “generate toxic substances” that cause cancer, increase the risk of heart and lung disorders, and can effect brain development. In the release, WHO stated, “Based on the current evidence, it is not recommended that governments permit sale of e-cigarettes as consumer products in pursuit of a [smoking] cessation objective,” and for countries that do allow their citizens to use vapes as a cessation tool to treat vapes as medical devices only. Dr. Tedros Adhanom Ghebreyesus, WHO director-general, called for countries to implement strict measures that would prevent their people from taking up vaping. This position clearly goes against tobacco harm reduction (THR) and THR advocates, who were also excluded from COP10, continuously highlight this issue.
Dr. Adriana Blanco Marquizo, head of the FCTC secretariat, highlighted in her COP10 opening address what she said was a major concern – the growing popularity of novel and emerging nicotine and tobacco products, going as far to say, “…the increasing availability of novel and emerging nicotine and tobacco products has become a very troubling problem, as we see an alarming increase in the use of these products by young people. Of course, part of this increase is due to disingenuous tobacco industry messages portraying these products as a replacement for real tobacco control measures, as the industry again tries to claim a seat at the table – as part of the solution to an epidemic that the industry created and continues to sustain.”
During the lead-up to COP10, former WHO leaders Professors Robert Beaglehole and Ruth Bonita called on WHO and parties to FCTC to support THR and reject calls to prohibit or regulate smoke-free products the same as cigarettes in a recent article published in The Lancet. Dr. Beaglehole was the director of WHO’s Department of Chronic Disease and Health Promotion, responsible for setting tobacco policy from 2004-2007. In their article, Drs. Beaglehole and Bonita said, “There is no scientific justification for WHO’s position that e-cigarettes and other novel nicotine products should be treated in the same way as tobacco products. This position overlooks a risk-proportionate approach.”
“The critical background papers to COP10 recommend treating nicotine products as equivalent of cigarettes and regulating them in a similar way. This approach is a retrograde step because they are not comparable products in terms of the damage they cause; after all, it is the burning of tobacco that causes harm, not nicotine.”
Dr. Clive Bates, who previously served as the director of Action on Smoking and Health (UK), played a pivotal role in the creation of FCTC, and founded the Framework Convention Alliance (now the Global Alliance for Tobacco Control) also voiced strong criticism against WHO, contending that the organization is relying on deceptive data that, if implemented, could have detrimental effects rather than positive outcomes and that WHO wrongly portrays safer, smoke-free tobacco and nicotine products as a threat.
According to Dr. Bates, WHO’s first paper at COP10 distorts tobacco policy by misclassifying heated tobacco products (HTP) as smoked tobacco products. Furthermore, it misclassifies the heated tobacco aerosol as “smoke,” despite the fact that smoke is a result of combustion and HTP do not involve combustion when used as intended and are chemically, qualitatively, and quantitatively different from traditional cigarettes.
He went on to highlight several flaws in WHO’s second paper, which claims that there is insufficient evidence that proves these products are less harmful. Dr. Bates pointed out that alternative tobacco products’ emission on average exhibit a 90% reduction in harmful chemicals. He also added that the courts in Germany and Sweden examined this issue and concluded that HTP should not be classified as traditional smoking products.
A slightly anticlimactic end
The outcome of COP10 had a greater emphasis on the impact of tobacco on the environment and health, rather than any draconian measures against new tobacco products as expected or a miraculous shift in regards to WHO FCTC’s stance on their application for THR.
“We have taken a historic decision on Article 18,” said Dr. Blanco Marquizo. “The decision urges parties to take account of the environmental impacts from the cultivation, manufacture, consumption, and waste disposal of tobacco products, and to strengthen the implementation of this article, including through national policies related to tobacco and protection of the environment.”
Another important decision was to strengthen guidelines on cross-border tobacco advertising, promotion and sponsorship, and the depiction of tobacco in entertainment media.
In addition, two expert groups were established – one to work on forward-looking tobacco-control measures under Article 2.1 of WHO FCTC and the other to focus on Article 19, which concerns liability.
The parties also agreed to extend by five years the mandate of the Global Strategy to Accelerate Tobacco Control 2019–2025: Advancing sustainable development through the implementation of the WHO FCTC 2019–2025, so that it fully aligns with the 2030 Agenda for Sustainable Development.
COP10 also adopted the Panama Declaration, which draws attention to the “fundamental and irreconcilable conflict” between the interests of the tobacco industry and the interests of public health. The declaration also emphasizes the need for policy coherence within governments to comply with the requirements of Article 5.3 of the WHO FCTC, which “aims to protect public health policies from commercial and other vested interests of the tobacco industry.”
Other decisions adopted by COP10 were related to the promotion of human rights through the WHO FCTC as well as strengthening the WHO FCTC Investment Fund.
What was missing from this list was any decision taken or draconian measures on new tobacco products. This may largely be due to dissent from some national delegations whose statements went against WHO’s stance on THR, stating that it should be part of the approach to tobacco control. Decisions on new tobacco products have now been pushed to COP11 in 2025.