As global health officials in Geneva for the World Health Organization’s international tobacco-control conference, public health experts and consumer advocates are warning that one potentially life-saving strategy — tobacco harm reduction — may again be left on the sidelines.
The weeklong session of the WHO Framework Convention on Tobacco Control, known as COP11, convened on Nov. 17. The treaty, adopted in 2003, is the world’s first global public health agreement aimed at reducing tobacco use and preventing the millions of deaths it causes each year. The Conference of the Parties (COP) brings together representatives from more than 180 countries to assess progress and set future policy.
Among the agenda items is one that references “the tobacco industry’s narrative on ‘harm reduction.’” The quotation marks and the focus on industry have alarmed some delegates and researchers, who say the wording signals that harm reduction will be treated with skepticism rather than as a legitimate part of tobacco-control strategy.
The cost of cigarette smoking is no secret. Smoking kills, on average, 1,200 Americans every day. The debate is between advocates of abstinence — who want all tobacco products banned — vs. supporters of harm reduction, who say the goal is to get as many smokers to give up cigarettes as quickly as possible, even if that means switching to other, lower-risk tobacco products.
“The WHO is pushing an abstinence-only approach and punishing those who oppose that view,” said University of Ottawa adjunct law professor David Sweanor, who has spent nearly 40 years working to reduce smoking around the world. “We have known for at least 50 years that smokers get sick from the smoke, not the nicotine.”
Critics note that the issue is being discussed under sections of the treaty related to industry interference, not under articles that focus on disease prevention or cessation.
Supporters of harm reduction say that because most smoking-related illness stems from combustion — not nicotine itself — providing safer nicotine options could dramatically reduce the toll of smoking-related disease. Opponents, including some in the public health community, argue that such products may perpetuate nicotine addiction, attract nonsmokers, or lead young people to develop a nicotine dependency.
A growing body of research suggests that some harm-reduction products can help smokers quit or reduce cigarette use.
In Sweden, where smokeless tobacco use is common, smoking rates are the lowest in Europe. Studies have found that smokeless tobacco users are less likely to become daily smokers and more likely to quit. A 2013 review reported that 12.4 percent of smokers using smokeless tobacco quit within four weeks, compared with 6.6 percent using a placebo.
E-cigarettes have also shown promise. A 2024 study published by BioMed Central found that smokers were more likely to remain cigarette-free for at least six months when using e-cigarettes with nicotine compared with nicotine-replacement therapies or e-cigarettes without nicotine. Another study, published in The American Journal of Medicine in 2023, found that smokers who used nicotine e-cigarettes had higher abstinence rates than those using conventional cessation treatments.
Experts caution that the evidence remains mixed. Researchers also warn that harm reduction is only beneficial when smokers switch entirely to alternative products; dual use — smoking and vaping simultaneously — offers little health advantage.
Observers say the agenda’s language and the history of recent WHO tobacco meetings suggest harm reduction will be discussed primarily as part of a strategy to counter industry influence rather than as an independent public health issue.
Advocates for harm reduction say their organizations have faced barriers to participation in the COP process, including limited access and delays in obtaining observer status. Meanwhile, countries such as the United Kingdom, Sweden, and New Zealand — all of which have incorporated harm-reduction strategies into national policy — are expected to raise the issue during the session.
COP11 is unlikely to ignore harm reduction entirely, as the term appears on the official agenda. However, advocates for improving health outcomes argue that the reluctance to adopt the strategy is negatively impacting health outcomes, particularly in developing nations.
While WHO policy is unlikely to affect the availability of harm-reduction tools in the United States, Sweanor notes that the organization has tremendous influence in low-income countries, where smoking rates remain high.
For millions of smokers seeking safer alternatives, the decisions made in Geneva this month could be a life-or-death matter.