For anyone who has watched family members suffer and die from smoking-related disease, tobacco control is not an abstract policy debate, it is deeply personal. Lung cancer, cardiovascular disease, and chronic respiratory illness are not caused by nicotine itself, but by the toxic products of combustion. That distinction matters, because misunderstanding it costs lives.
Yet global tobacco control policy, led by the World Health Organization (WHO), continues to blur this crucial line. Instead of accelerating the transition away from smoking, it increasingly promotes prohibitionist policies that restrict or stigmatise safer nicotine alternatives. The result is slower declines in smoking, expanding illicit markets, and missed opportunities to prevent disease.
This growing disconnect has prompted the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA) to call on governments across the region to urgently reassess their commitment to the WHO Framework Convention on Tobacco Control (FCTC). That call has taken on new urgency following the United States’ withdrawal from the WHO on 22 January 2026, citing mismanagement, and New Zealand Foreign Minister Winston Peters’ demand for scrutiny of funding directed toward what he described as “unelected globalist bureaucrats.”
Harm reduction recommended in theory but ignored in practice
At the heart of CAPHRA’s concern is a fundamental contradiction. The FCTC itself explicitly includes harm reduction in Article 1(d). Yet in practice, WHO policy guidance consistently opposes or undermines the very tools that have proven most effective at reducing smoking—vaping, heated tobacco products, and nicotine pouches.
“The treaty recognises harm reduction, but current practice has not consistently supported the tools that can accelerate the decline of smoking,” said Nancy Loucas, CAPHRA’s Executive Coordinator. “Governments should be asking whether the system is aligned with its own mandate and with real-world evidence.”
That evidence is not speculative. Combustible tobacco remains the leading cause of preventable death worldwide. Non-combustible nicotine products eliminate combustion entirely, dramatically reducing exposure to carcinogens and toxicants. Public health authorities in countries such as the UK and New Zealand have repeatedly acknowledged that vaping is substantially less harmful than smoking and an effective cessation aid. Yet WHO guidance increasingly treats switching away from cigarettes as a “risk of substitution”—a phrase that reveals how ideology has overtaken evidence.
Inside the FCTC’s COP11
Concerns about the direction of global tobacco control were sharpened following remarks by Jindřich Vobořil, a veteran public health and drug policy specialist with decades of experience in evidence-based regulation. Reflecting on his participation at the WHO’s COP11 meeting in Geneva, Vobořil described the process as deeply troubling and increasingly detached from scientific and public health objectives.
Vobořil said COP11 discussions included extreme proposals, such as criminalising legal nicotine companies—ironically backed by countries like China that profit from state tobacco monopolies while exporting vapes, exposing a credibility gap. Harm reduction advocates and consumers were excluded, while well-funded NGOs dominated debate, sidelining evidence-based perspectives. And of course, instead of examining real-world successes in Sweden, Japan, the UK and New Zealand, delegates focused on disputed theoretical risks, undermining both public health and institutional legitimacy.
When prohibition replaces regulation
Across the Asia-Pacific region, the consequences of this approach are very visible. Countries which restrict or ban safer nicotine products, such as Australia, often see smoking rates decline more slowly while illicit markets flourish. This pattern mirrors global experience. High taxes and blanket bans do not eliminate demand; they displace it. Illicit tobacco and unregulated vaping products thrive precisely where legal, regulated alternatives are unavailable. This not only undermines public health goals but strengthens criminal supply chains and removes consumer protections altogether.
Contrast this with countries that have embraced risk-proportionate regulation. New Zealand’s adult smoking rate has fallen to 6.8%, one of the lowest in the world. This decline did not happen through prohibition alone, but through firm regulation paired with widespread access to safer alternatives.
Public health experts such as former Action on Smoking and Health UK director Clive Bates have repeatedly criticised the FCTC process for failing to incorporate evidence from jurisdictions achieving rapid smoking declines through harm reduction, such as Sweden.
The United Kingdom offers similar lessons. Government-backed “Swap to Stop” initiatives encourage adult smokers to switch to vaping, supported by behavioural counselling. Local authority data show quit rates exceeding 50% in some regions. These outcomes are not theoretical, they translate directly into fewer hospital admissions, fewer cancer diagnoses, and fewer funerals.
The WHO’s dangerous cancer messaging
Meanwhile, nowhere is the WHO’s resistance to harm reduction more damaging than in its cancer messaging. The fifth edition of the European Code Against Cancer, released in late 2025, removed critical nuance present in earlier editions. Whereas the 2014 edition clearly explained that nicotine is not the cause of cancer and acknowledged vaping’s lower risk compared to smoking, the latest version collapses smoking and vaping into a single warning category.
This change is not cosmetic. It fundamentally alters public understanding. When people are told simply “Do not smoke. Do not use any form of tobacco or vaping products,” without explanation, many incorrectly conclude that vaping is as dangerous as smoking. This misperception is already widespread among clinicians and the public, and it discourages smokers from switching to safer alternatives.
The same document goes further, explicitly calling for heavy taxation and restrictions on all nicotine products, including e-cigarettes and pouches, despite acknowledging that long-term cancer links have not been established. The role of these products in smoking cessation is conspicuously absent.
No, harm reduction is not an industry spin
Modern vaping products were not invented by tobacco companies. They were developed by Hon Lik, a pharmacist trying to quit smoking after his father developed lung cancer. Tobacco companies entered the market years later, responding to consumer demand already created by grassroots efforts. Equating tobacco harm reduction with “Big Tobacco” is as illogical as equating opioid harm reduction with pharmaceutical companies that manufacture Methadone.
Governments should be demanding transparency
Tobacco harm reduction experts argue that governments funding the WHO system should demand accountability. And equally important: continued support for the FCTC should be conditional on transparency, meaningful engagement with independent scientists and consumers, and performance indicators based on outcomes, such as smoking prevalence, switching rates, and disease trends, not the number of bans imposed.
To remain relevant, the WHO and its FCTC must evolve. A structured, risk-proportionate framework for all nicotine products would allow countries to share evidence, learn from regulatory successes, and evaluate policy honestly. The choice faced is no longer a theoritcal one: governments can continue funding and following a system that resists evidence and perpetuates smoking, or they can demand a modern approach grounded in science, compassion, and measurable public health success.
The goal should never be ideological purity. It should be fewer cancers, fewer premature deaths, and fewer families left behind wondering why lifesaving alternatives were kept out of reach
Progress Shamed, WHO Exposed: How Harm Reduction Challenged COP’s Backwards Agenda in Geneva
