This November, Panama will play host to the tenth WHO Framework Convention on Tobacco Control (FCTC) Conference of the Parties (COP), where decisions on tobacco control will be taken that may have far-reaching implications for the world's more than a billion smokers. The WHO FCTC has faced criticism for achieving only marginal reductions in the number of smokers and for failing to implement guidelines and recommendations on tobacco harm reduction (THR), which can provide better alternatives to smokers who are unable or unwilling to quit. This year marks the 20th anniversary of the FCTC's adoption and advocates of THR are keen to see whether this COP will take meaningful action on THR. In 2003, the FCTC defined tobacco control as "a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke". The recommendation to adopt THR strategies goes back even further. In 1997, leading experts convened by the United Nations concluded that "to attain a substantial reduction in tobacco-caused death and disease in existing smokers and in future generations, it is important to adopt a triadic approach of coordinated (i) tobacco-use prevention, (ii) smoking cessation, and (iii) reduction of exposure to tobacco toxins in people who are unable or unwilling to completely abstain from tobacco." It is well established that the harmful toxins responsible for smoking-related diseases are contained in cigarette smoke. The Food and Drug Administration states "Nicotine is what keeps people using tobacco products. However, it's the thousands of chemicals contained in tobacco and tobacco smoke that make tobacco use so deadly." Smoke is a by-product of burning and alternatives to cigarettes that do not burn tobacco therefore do not produce smoke and can result in a considerable reduction in toxins compared to smoking cigarettes. The growing body of scientific evidence confirms this leading many to champion the benefits of enabling smokers who do not quit to switch to one of these alternatives in order to reduce harm compared to smoking. Also, an increasing number of countries have recognized the public health opportunity that THR presents and have adopted or are in the process of adopting regulatory and tax policies that differentiate between cigarettes and non-combustible nicotine products to incentivize smokers who do not quit to choose better alternatives. These include the UK, USA, Italy, Portugal, Philippines, among others. By contrast, the WHO has advised countries to take a different approach, going as far as recommending or rewarding countries that ban these alternatives entirely. It goes without saying the first prize is for smokers to quit, but what good could come of withholding better alternatives from hundreds of millions of smokers who don't quit? The Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), nine member organizations wrote the FCTC delegation heads from around the world, urging them to review the evidence that in support of THR ahead of COP10. "Delegates to COP10 should be representing the rights and aspirations of the citizens whose taxes are paying for their attendance, who expect them to speak on their behalf, acknowledge the science underpinning the harm reduction benefits of ENDS and maintain democratic principles," they wrote. This COP needs to recognize the significant positive impact that THR can have on public health and take urgent action to activate this pillar of tobacco control. 20 years of THR inertia is 20 years too long.
