The World Health Organization was once implacably opposed to harm reduction related to drug use, instead preaching abstinence as the only policy approach. It was steadfastly resistant to the practice of needle/syringe exchange programs to reduce infection. Today, the WHO website has a page extolling these programs’ benefits to public health. It states, “the risk of transmission of HIV is mainly linked to the injection of drugs.” Yet, the WHO once not only dismissed needle/syringe programs to control HIV but campaigned against them.
Political and cultural realities forced the WHO to drop its ideological objections to needle exchanges. However, it is repeating previous mistakes by stubbornly refusing to embrace less harmful nicotine products that have shown a potential to reduce the toll of 8 million deaths yearly from combustible tobacco use. Embracing and promulgating tobacco harm reduction is less controversial than needle exchange and could save more lives.
It was right to change course on the drugs policy. The WHO must (and arguably will have to) do so again with tobacco harm reduction, preferably sooner rather than later.
In the 1990s, the WHO attempted to stifle discussion of harm reduction despite HIV being rife in many parts of the world. Alex Wodak , former president of the International Harm Reduction Association (IHRA), recalls how the WHO worked to undermine its 1997 conference in Geneva while HIV was out of control in Sub-Saharan Africa.
“The WHO sent a memo to its Geneva staff saying they were not to attend the IHRA conference,” a tactic now used toward conferences to discuss tobacco harm reduction. “We were the ones going to low- and middle-income countries begging them to start needle/syringe programs and other harm reduction interventions. We were doing the WHO’s work for them.”
Wodak describes how, with half of the world’s population in Asia at high risk, HIV becoming established there “was the nightmare we all feared most.” Because of this, he “was always confident that WHO would have to accept harm reduction because the costs of ignoring it were so colossal.”
Real-life threats meant the WHO had to abandon its moral stance and switch to supporting needle/syringe programs and harm reduction. The policy has been successful.
Sadly, the WHO is repeating the same mistakes it made on drug policy by rejecting tobacco harm reduction on ideological grounds. The same organization that recognizes the health, social and economic benefits of policies to reduce harm from drug use is now driving an anti-nicotine, prohibitionist approach against tobacco harm reduction, with consumers excluded from any policy discussion.
The WHO notes “that there will always be people who continue to use drugs, either temporarily or forever,” but seems unable to concede that the same is true of nicotine, which has been used by humans for millennia.
Unfortunately, much of the opposition boils down to money and self-interest. Entire careers have been dedicated to tobacco control and the destruction of the tobacco industry. The funding and power of numerous groups and the WHO tobacco control operation are threatened by reduced risk products such as vaping, heated tobacco and nicotine pouches, which consumers can buy themselves.
However, arguments and evidence favoring tobacco harm reduction for public health are becoming impossible to ignore. Tobacco harm reduction opponents often use contrived, flimsy or asinine arguments such as the discredited gateway theory that vaping leads to youth smoking, wrongly attributing lung injury deaths to nicotine vaping, and the myth that vaping causes popcorn lung.
Switching from combustible cigarettes to safer nicotine products is a better prospect for many of the world’s 1.1 billion people who smoke than stopping nicotine use.
Business pressures also drive change. In just a few years, safer nicotine products account for 30 percent of tobacco company Philip Morris International’s revenue. The world’s biggest cigarette manufacturer, the Chinese National Tobacco Co., owns many tobacco harm reduction patents. It will not be long before it monetizes its investments.
Opponents of tobacco harm reduction are gambling on overcoming fast-growing evidence in favor of safer nicotine, eradicating a psychoactive substance for the first time in history, and hoping to resist powerful market forces.
The WHO had to admit defeat with its prurient objections to reducing drug harm. It is time for the agency to learn from the past and do the same with alternatives to smoking.
