September 9th, 2019

Leaked papers: WHO to intensify its pointless and destructive war against innovation - expect many dead

The enemies of innovation are on manoeuvres

This week there will be a meeting of tobacco regulators under auspices of the FDA-funded WHO Global Tobacco Regulators’ Forum (GTRF) in the Netherlands and part of the preparation for FCTC COP-9, which will be held in 2020, also the Netherlands.  Two leaked papers from WHO’s Eastern Mediterranean Regional Office (EMRO) suggest that WHO is building up to an attempt to treat reduced risk products no differently to cigarettes or with even greater hostility.

  1. EMRO Paper on Electronic Nicotine Delivery Systems
  2. EMRO Paper on Heated Tobacco Products

I do not have time for a line by line critique of these wretched documents,  and to be honest, none is needed. There are common themes that describe the contents sufficiently:

  • These products should be banned where possible (something WHO does not advise for cigarettes)
  • The manufacturers and supply chain should be treated like the tobacco industry and subject to official pariah status under Article 5.3 of the FCTC
  • If they are not banned, ‘strong regulation’ should be applied to these products – at least as stringent as cigarettes.

So, as a former senior civil servant, I can offer some advice to ‘regulators’ attending the GTRF meeting on how to respond to these papers, and what good policymaking actually looks like.

  1. Policy rationale. What problem are these policy positions are supposed to address? While WHO says tobacco kills about 8 million per year – these are overwhelmingly deaths caused by smoking – and it is this gruesome toll that justifies the FCTC and control on tobacco.  There is no evidence of commercially produced vaping or heated tobacco products killing anyone on any material scale. So what is the policy rationale for intervention? It seems to be that some of these products are produced by the tobacco industry.  WHO has never had clarity on its goals: see Who or what is the World Health Organisation at war with (2016)
  2. Justification of proposals. To what extent does the paper justify any measures it proposes.  The answer is: “the papers provide no justification at all for any of the measures proposed“.  The measures follow from an undeclared and unjustified policy purpose to create the most hostile regulatory environment possible.  If I was still a civil servant and I received these, I would return them with a polite note saying that I think the memorandum justifying the proposals had been lost in the post.
  3. The threat of unintended consequences. The killer problem, literally and figuratively, for these measures is the issue of harmful unintended consequences.  Such consequences are obvious and foreseeable once you accept even the possibility that these products are much lower risk than smoking and that they can substitute for smoking in the way people consume nicotine.  There is plenty of evidence to support these contentions and no credible evidence to deny them.
  4. Transparency and consultation. What did they do to seek input and refine the information is the light of stakeholder knowledge are groups, such as consumers, who could be adversely affected? The answer appears to be “nothing at all”.  No-one should be making policy with life-or-death consequences without extensive consultation.
  5. Monitoring, evaluation and governance. What if the advice in these papers is wrong and causes harm? What is the process to monitor effects, check for unintended consequences, change the advice and to be accountable for harms caused?

More on unintended consequences

I would like to draw the GTRF participants attention to the most important of these, the risk that doing what WHO EMRO suggests will cause more harm and that this harm will be attributable to regulators through the imposition of bad policies. In 2016, the Royal College of Physicians (London) set out this problem:

A risk-averse, precautionary approach to e-cigarette regulation can be proposed as a means of minimising the risk of avoidable harm, eg exposure to toxins in e-cigarette vapour, renormalisation, gateway progression to smoking, or other real or potential risks.

However, if this approach also makes e-cigarettes less easily accessible, less palatable or acceptable, more expensive, less consumer friendly or pharmacologically less effective, or inhibits innovation and development of new and improved products, then it causes harm by perpetuating smoking. Getting this balance right is difficult.

Royal College of Physicians (London) Nicotine without smoke: tobacco harm reduction 28 April 2016 [link] Section 12.10 page 187

So is there any sign of any effort to ‘get this balance right’? No there is nothing here, not even an acknowledgement that there is a balance to get right.   Let me give four examples of possible unintended consequences:

  • Banning ENDS advertising is like banning anti-smoking advertising – it is a regulatory protection of the harmful incumbent product (cigarettes) from competition from an much better entrant (vaping and heated tobacco product).  Why protect the cigarette trade?
  • Banning vaping in public places may drive some users back to smoking or make switching from vaping to smoking less attractive
  • High taxes on vapour or heated tobacco products reduces the financial incentive to switch away from smoking and destroys an important rationale for low-income or otherwise disadvantaged smokers to both improve their health and save money.
  • Harsh warnings or plain packaging can imply much greater risk than there actually is and therefore distort personal risk decision-making of nicotine consumers in a way that favours smoking and causes more disease and premature death.

Suggested additional reading and paper for circulation for the GTRF: I have discussed a wider range of possible unintended consequences in this longer document: Plausible unintended consequences of excessive regulation of low-risk nicotine products.

I hope this paper on unintended consequences can be circulated as a paper at the Global Tobacco Regulators’ Forum.

We have become used to WHO being absolutely clueless at the basic policy-making disciplines, but these papers take that to a new, lower level.  WHO tried something like this before (see: WHO plans e-cigarette offensive from 2014) and, thankfully, were driven back. But this time they are doing more to promote their idea well in advance of the COP and also lined up the argument with the Bloomberg-funded WHO report on the global tobacco epidemic 2019 (see pages 47, 52-57 in the PDF), which was a collection of evidence-free assertions about tobacco-harm-reduction.

Public health and efforts to reduce the burden of non-communicable disease are very poorly served by Bloomberg-funded WHO.

 

14 comments to Leaked papers: WHO to intensify its pointless and destructive war against innovation – expect many dead

  • I might be confused but I KNEW WHO were corrupt the minute I saw them congratulating India for banning vape.
    I mean COME ON?! I said NZ should leave the WHO TREATY I thought they were dragging us down
    Shaking the hands of Narendra Modi patting him on the back because he banned the most successful cessation device that the medical world has ever seen , but says NOTHING about India’s youth smokeless tobacco epidemic?
    It’s so obvious I WORKED IT OUT the treaty is a joke the treaty is supposed to PROTECT us from big TOBACCO
    But why would big tobacco start a war on a product they have invested in? If they are so powerful why can’t they get the same people to lie…… Ok I just got it IQOS isn’t A VAPE PRODUCT! and maybe altria just invested in JUUL so they could DESTROY them India made close to 150 billion last year in smoke tax so investing 12.5 billion to SINK your enemy is probably money well spent

    Who will speak out?
    Is NZ really part of this

  • Why is this not a bigger story? Why is no one interested?
    Will this ever end? And what do you think it will take?
    Or is this a cover-up so global so vast that big tobacco will never loose?
    You probably don’t reply but this keeps me up at night it’s so profound I just can’t get my head around it.
    When I read articles about America banning flavours I hate to say it but I felt a little smug I live in New Zealand and I truly thought “that wouldn’t happen over here” I believed that 100%
    And I believed it because I thought the NZ government cared about me, I believed that NZ was committed to being SmokeFree 2025 and we’re happily giving up the 2 billion in smoke tax because they would rather save lives than make money.
    I understand why INDIA has banned vape the government ignores a million deaths a year and the highest be oral cancer rate in the world because they own a big chunk of the largest TOBACCO company.
    I understand why Trump is banning
    But is New Zealand truly that evil? I have said it over and over previously on Reddit or in my online vape forums

    If your govement bans vape but supports tobacco your govement does not care about you

    Is that really my answer?
    Is New Zealand small enough that those lies won’t work with us? Can a small country be lied to as easily?
    Lol sorry this isn’t a questions page it’s supposed to be comments
    I’m angry and I’m confused they can’t just keep killing millions of people with tobacco can they? Doesn’t the truth HAVE to come out
    Ok no more questions
    Thanks this was AMAZING to read even tho now I can’t sleep

  • […] organization continued to intensify its pointless and destructive war against innovation – two leaked papers showed that the WHO is building up to an attempt to treat reduced risk products no…. These decisions have nothing to do with public health, as evident from the WHO recent appraisal of […]

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  • […] september publiserte Clive Bates en artikkel på sin side med overskriften “Papirer lekket – WHO intensiverer sin meningsløse og […]

  • J. Ivanna Awrey

    This is a deep tragedy for all smokers & vapers. Once again, those with the power, use it to create a puritan state of dictatorship over other people’s lives. As a 5 year vaper, who tried numerous ways to stop smoking with NRT’s, hypnosis and cold turkey, vaping was the only thing that worked for me. I’m literally very afraid of being pushed towards cigarettes again. I found my freedom. This is a deep shame for newbie vapers, who are not involved with social media groups, to keep up to date with the current USA fear-mongering, and how this policy of ban vaping (the act of vaping) affects them and not let it be known that it was illegal THC counterfeit vaping e-liquids that have cause the lung illnesses in youth in the USA. I do feel bad for the families. But, it shows how puritan ideals with bans on cannabis in the USA, goes against them. Bans lead to a demand for black markets. Prohibition arenas send the vaper to black markets to maintain their harm reduction lifestyle choice. The WHO seems so focused on keeping members with strong combustible tobacco industry ties, alive and afloat. Once again, when is enough time for the same old. “We don’t know enough?” When is enough time, 20, 30, 40, 50 years, and in that time of puritan bans, how many smokers will continue to smoke and die? I’m seriously worried now. I honestly don’t know if vaping will be allowed in 2 years’ time in Canada. Due to the geographical distance from the USA, if it happens there, it “must” be happening in Canada too. It’s frightening how fearful the Canadian vaper consumer is. The USA vaper is terrified as well. We live is a sad society where profits, via taxes, puritan ideals, are ruling every aspect of our lives. When, does an adult product be available to adults who require them, to remain smoke-free. I wonder if the antz zealots in their attempt to create a puritan world, realize that means adult freedoms they enjoy now, may be treated in the future. What kind of society is being created for the future adults of the world?

  • It’s as if the WHO was trying to combat deaths from “gun violence” around the world by banning “Duck Hunting”.

    Antismokers dressed up as Antivapers continuing to spout the same sort of lies… just outfitted with new bells ‘n whistles.

    Blaming vaping etc for deaths is like blaming your Grandpa’s collection of Meerschaum pipes for the deaths of meth addicts.

    “Pipes cause this”:

    – MJM, smoker, occasional vaper…

  • Mr Bates,

    Did you ever regret having helped creating the Framework Convention on Tobacco Control for an organisation that already at that time was partnering with biggest players in the pharmaceutical industry?

    WHO Press Release 30. January 1999

    A monster was created. Who will take the monster down?

  • David Sweanor

    Juma nailed this, and it is tragic that regulators have taken so little notice of his work. From page 308 of his book:

    Debates over new technology are part of a long history of social discourse over new products. Claims about the promise of new technology are at times greeted with skepticism, vilification, or outright opposition – often dominated by slander, innuendo, scare tactics, conspiracy theories and misinformation. The assumption that new technologies carry unknown risks guides much of the debate. This is often amplified to levels that overshadow the dangers of known risks . . . . Another characteristic of the debate is the assumption that adopting new technologies comes with new risks, while doing nothing is risk free. As a result, most communication efforts do not include the risks of inaction.

    • John

      Privileged groups have always stopped at nothing to maintain their privileged status. And the more unjustified and arbitrary their privileged status is the more violent and the more shunning their response will be.

      It’s clear that a orchestrated international campaign to maintain a simple status quo : smoking ie tobacco industry vs no smoking ie PH , with no room for any nuance, is going on…

  • […] L’Organizzazione mondiale di sanità si prepara all’offensiva contro i prodotti che riducono il rischio da fumo? Sembrerebbe di sì, leggendo due documenti interni appena pubblicati da Clive Bates sul sito The Counterfactual. L’autore è un esperto di salute pubblica con una lunga storia da dirigente del settore pubblico che lo ha portato, fra l’altro, a occuparsi nel 2005 di sanità e di fumo nel gabinetto dell’allora primo ministro britannico Tony Blair e a lavorare all’elaborazione della Convenzione quadro sul controllo del tabacco della stessa Oms. Bates è venuto in possesso di due documenti dell’Ufficio regionale del mediterraneo orientale (Emro) dell’Organizzazione, preparati per un incontro del Global tobacco regulators’ forum che si terrà questa settimana e getterà le basi del prossimo Cop9, in programma per il 2020. I documenti riguardano gli Ends e gli Ennds (rispettivamente Electronic nicotine delivery systems e Electronic non-nicotine delivery sistems), cioè le sigarette elettroniche, e i riscaldatori di tabacco e vogliono dare indicazioni agli Stati dell’area su come regolamentare i prodotti. Il documento comincia in bellezza, suggerendo di trattare le sigarette elettroniche come i prodotti del tabacco, “sebbene l’Oms non le classifichi come tali”. I motivi elencati per scegliere questa strada sono molteplici: dal fatto che “generalmente contengono nicotina, che è una sostanza derivata principalmente dal tabacco”, al fatto che il loro uso mimi quello del tabacco “sia per la dipendenza fisiologica e comportamentale che come metodo di consumo”. In spregio a una vasta letteratura scientifica, si sostiene che non vi siano prove che riducano il rischio da fumo, né che possano essere usate per smettere di fumare. Si sostiene che attirino i minori e li spingano a fumare e che siano “prodotte, distribuite e vendute da aziende dell’industria del tabacco o da altre industrie ad essa collegate”. Al punto g dell’articolo 1, si fa riferimento ad una nota della Banca mondiale che raccomanda di classificare gli strumenti elettronici come prodotti del tabacco ai fini fiscali. “I device – si legge – dovrebbero essere classificati come sostituti dei tabacchi lavorati e i liquidi (a prescindere dal contenuto di nicotina) come estratti ed essenze di tabacco”. Anche, supponiamo, se sono liquidi alla fragola senza nicotina. I Paesi portati ad esempio come best practice sono la Georgia, il Sudafrica e la Turchia. Da queste premesse, il documento si dilunga su vari aspetti specifici che vanno dal tobacco control al prezzo, dal prelievo fiscale al packaging, dalla protezione dall’esposizione al vapore alla pubblicità a molto altro. Ogni paragrafo è introdotto dalla seguente locuzione: “Gli Stati membri possono considerare opzioni normative come 1. Vietare l’importazione, la vendita e la distribuzione di sigarette elettroniche”. Poi, per chi proprio non vuole vietarle, seguono una serie di possibilità alternative estremamente restrittive e vincolanti. Ed è singolare che l’Oms suggerisca come prima opzione di vietare l’e-cigarette, quando invece non propone la stessa per il tabacco. Secondo Bates, il documento dell’Emro non ha una logica, non mira a diminuire le morti da fumo e potrebbe avere pesanti conseguenze sulla salute pubblica. “Conseguenze – scrive – ovvie e prevedibili se si accetta anche solo la possibilità che questi prodotti riducano il rischio del fumo e che possano sostituirlo per chi consuma nicotina. Vi sono sufficienti evidenze scientifiche a sostegno di queste affermazioni e nessuna prova credibile per negarle”. Per la cronaca, il documento suggerisce le stesse misure draconiane per i riscaldatori di tabacco. Per leggere i documenti dell’Ufficio regionale del mediterraneo orientale (Emro) dell’Oms e le riflessioni di Clive Bates, cliccate su questo link. […]

  • Joseph Magero

    This is serious! I’m baffled, but not really surprised

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