A leaked memo from the World Health Organisation (WHO) recently suggested that ecigarettes should be classified as Tobacco Products and would therefore be subject to the Framework Convention on Tobacco Control (FCTC). The suggestion, if adopted, would require Governments that have signed up to the FCTC to take active steps to reduce the use of ecigs, to ban advertising completely and to place restrictions on the ecig industry's access to legislators. In short, it would treat ecigs as part of the problem, rather than part of the solution to Smoking Harm.
We wrote to the Director General of the WHO, Dr Maragret Chan, to ask her to consider the potentially enormous public health benefits of actively encouraging smokers to switch to ecigarettes. Click "Read more" to see the full text.
Dr Margaret Chan
World Health Organisation
9th July 2014
Dear Dr Chan,
Regulation of electronic nicotine delivery systems (including and in particular e-cigarettes) under the FCTC COP-6
The New Nicotine Alliance UK (NNA(UK)) is an organisation which aims to engage with the general public, employers, public organisations, charities/NGOs, legislators and those working in science and public health, to foster a greater understanding of safer nicotine products and technologies, via campaigns, policy statements and educational initiatives. Ultimately, we aim to support the on-going development of regulatory frameworks for these products and technologies that are appropriate, evidence-based and supportive of public health. The NNA(UK) is entirely governed by its Board of Trustees, who are drawn from the scientific community and from the ranks of “new nicotine” consumers. The NNA(UK) is funded by donations from private individuals and organisations. We do not accept donations from the tobacco industry, the electronic cigarette industry or manufacturers/distributors of other nicotine products. Our independence from commercial conflicts of interest is of paramount importance.
We write to you now in light of the forthcoming 6th Conference of the parties to the FCTC, and having seen the minutes of the second meeting of the Bureau of the COP, held in Geneva on the 13th & 14th of November 2013. We are particularly concerned about the attitude which the Bureau appears to have adopted towards ENDS and e-cigarettes in particular in that document.
The rise in popularity of e-cigarettes is a consumer driven phenomenon previously unparalleled in the field of tobacco control. In their millions across the world smokers are turning to e-cigarettes in order to free themselves of the scourge of tobacco related disease and they do so because these products are appealing, effective, offer choice and empower them to reduce the harm that smoking will no doubt inflict on them. And they do so willingly and even passionately, and from their own pockets, with no cost to the public purse.
The proposed intention revealed in the Bureau minutes to treat ENDS, and in particular e-cigarettes, as a tobacco product, even though they do not contain tobacco and there are, thus far, no known harmful effects from their normal use, will have the effect of restricting the less harmful product to the advantage of the incumbent, far more dangerous product – tobacco cigarettes. It will make e-cigarettes a part of the problem to be solved and thereby expose them to higher taxes, bans on use and all of the various other control measures designed to reduce smoking prevalence. E-cigarettes and other harm reduced products are a part of the solution to tobacco related disease, not the problem.
We would like to draw your attention to The Ottawa Charter which describes health promotion as the process of enabling people to increase control over, and to improve, their health. The Charter goes on to state that “People cannot achieve their fullest potential unless they are able to take control of those things which determine their health”. When describing what health promotion action means the charter states “Health promotion goes beyond health care. It puts health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health.” Among the pledges of the charter is “to acknowledge people as the main health resource; to support and enable them to keep themselves, their families and friends healthy through financial and other means, and to accept the community as the essential voice in matters of its health, living conditions and well-being.”
The principles of the Charter were reiterated in the Jakarta Declaration on Leading Health Promotion into the 21st Century. The Declaration further described health promotion as “a process of enabling people to increase control over and to improve their health”. It stated further that there is now clear evidence that: “participation is essential to sustain efforts. People have to be at the centre of health promotion action and decision-making processes for them to be effective”. The declaration identifies the importance of decision makers being committed to policies and practices that avoid harming the health of individuals and advises that “Health promotion is carried out by and with people, not on or to people”.
The principles set out in both the Ottawa Charter and the Jakarta Declaration are admirable. However, those principles are exactly those under which the users of reduced harm products are attempting to operate, and with considerable resistance from some in the public health community. The consumers of harm reduction products are well informed and, like ourselves, are concerned at the levels to which some in the public health community will stoop in order to manipulate the science surrounding these products, apparently without fear of the consequences of the decisions which may result. There is the very real fear that millions could relapse to smoking, and further millions will never switch to harm reduced products if disproportionate restrictions are placed on the safer alternative.
It appears to be impossible for consumers to participate in COP-6 with the same standing as the NGOs who participate in the Framework Convention Alliance, nor has there been any consultation or engagement that includes the users as beneficiaries of ENDS - yet from leaked documents it appears WHO officials have already decided that ENDS should be marginalised. WHO representatives we have so far encountered have been poorly informed about tobacco harm reduction and products we consider to be life-saving, but do not appear to be open minded or willing to listen. In that light, we would like to ask you how WHO will ensure that the principles of the Ottawa Charter are respected and users of ENDS engaged and empowered under the Charter?
We urge the WHO and the parties to the FCTC to take great care that they do nothing which would reduce the potential that tobacco harm reduction offers, and indeed to actively promote the concept and formulate proportionate, evidence based regulation which would encourage and support consumers in their efforts to reduce the dreadful toll from tobacco related disease. We consider ENDS and non-combustible tobacco products to be a key strategy in addressing non-communicable diseases and we feel strongly that if WHO takes a hostile approach to these products it will be making an historic error of global significance putting perhaps several hundred million lives at unnecessary and avoidable risk. We would like to request a meeting with you to make these points to you directly.
New Nicotine Alliance (UK)