AL Gore 01 December 2024
Dr Tedros Adhanom Ghebreyesus, the WHO Director-General's recent praise for Vietnam’s ban on vaping and heated tobacco products misses an important point: vaping is a proven harm-reduction tool that could help millions of smokers quit or reduce their tobacco use. In Vietnam, where 40% of men smoke, the need for alternatives to traditional cigarettes is critical. While the WHO focuses on preventing youth from getting addicted to nicotine, it overlooks the overwhelming evidence that vaping is much less harmful than smoking traditional cigarettes. Studies show e-cigarettes contain fewer toxins and do not produce the tar and carcinogens that cause smoking-related diseases.
The WHO and Vaping: A Harm Reduction Missed Opportunity
When it comes to global public health, one of the most glaring missed opportunities in recent years is the World Health Organisation’s (WHO) stance on vaping. The WHO has consistently taken a sceptical, and at times, adversarial position on e-cigarettes, despite mounting evidence that they represent a much safer alternative to smoking. As smoking-related diseases continue to claim millions of lives worldwide, vaping has emerged as a potential harm-reduction tool for smokers looking to quit or reduce their tobacco consumption. Yet, the WHO’s approach remains rooted in caution, focusing on the potential risks of e-cigarettes without fully embracing their role in reducing tobacco-related harm.
Vaping as a Safer Alternative: Ignoring the Evidence
One of the core principles of harm reduction is to offer practical solutions that minimise harm in situations where perfect outcomes (like complete cessation) are not feasible. Smoking, the leading cause of preventable deaths worldwide, is a crisis that demands immediate attention. While quitting smoking entirely is the ideal, many smokers struggle to quit. For these individuals, vaping offers a significantly less harmful alternative. Unlike traditional cigarettes, which contain numerous carcinogens and produce harmful tar, e-cigarettes do not emit the same toxic substances.
The evidence supporting vaping as a safer alternative is robust. Research shows that e-cigarettes are considerably less toxic than traditional cigarettes, and they have been linked to lower levels of harmful toxins in the body. The UK’s National Health Service (NHS) and Public Health England have endorsed vaping as a smoking cessation tool, with studies indicating that vaping is much less harmful than smoking — with the overall risks being significantly reduced, especially when compared to the damage caused by combustible tobacco. However, despite this growing body of evidence, the WHO has remained deeply sceptical, often treating vaping as just another potential public health risk rather than a solution.
he WHO’s focus on the potential dangers of vaping, fails to take into account the greater harm posed by continued smoking. By downplaying the benefits of vaping, the WHO inadvertently condemns smokers to continue using combustible cigarettes — a product that is responsible for millions of deaths annually.
Dr Tedros and the WHO’s Overly Cautious Stance
Dr Tedros Adhanom Ghebreyesus, the WHO Director-General, has long emphasised the importance of protecting young people from nicotine addiction, especially in the case of e-cigarettes. This concern is valid, but it has led the WHO to adopt a prohibitionist approach toward vaping, often disregarding the rights of adult smokers to make informed decisions about their health. While the risks of youth uptake should not be ignored, the blanket approach of restricting or banning vaping products disproportionately affects adult smokers who could benefit from making the switch to a less harmful alternative.
The WHO’s stance restricts vaping products or imposes stringent regulations on their use, despite the growing evidence supporting their role in harm reduction. Dr Tedros’s congratulatory messages to countries with prohibitive measures against vaping underscore the WHO’s commitment to preventing the "renormalisation" of smoking and limiting nicotine consumption, especially among youth. However, this approach misses a crucial point: the overwhelming majority of e-cigarette users are current or former smokers seeking to reduce or quit tobacco use. For these individuals, vaping presents a much safer option, and by focusing too heavily on the potential risks of vaping without acknowledging its benefits, the WHO risks pushing smokers back to the much more dangerous alternative — smoking.
Lessons from Sweden, New Zealand, and Japan
Sweden is an exemplary model of success in tobacco harm reduction. Through a combination of policies, including the promotion of snus (a smokeless tobacco product), Sweden has achieved one of the lowest smoking rates in the world, with smoking-related diseases in sharp decline. In fact, Sweden is now considered smoke-free due to the widespread shift away from combustible tobacco, and many experts believe that Sweden will be one of the first countries in the world to completely eradicate smoking. The success of Sweden's approach — which encourages switching to less harmful alternatives like snus and vaping — demonstrates the effectiveness of harm reduction strategies in reducing smoking prevalence and improving public health.
Similarly, New Zealand has embraced vaping as a key element in its “SmokeFree 2025” initiative, aiming to reduce smoking rates to below 5% by that year. The government has not only legalised vaping products but has also created a regulatory framework to ensure their safe use. The result has been a significant decline in smoking rates, with more smokers switching to vaping as a less harmful alternative.
Japan has also seen success with heated tobacco products, with adult smokers turning to these alternatives in large numbers. These countries’ success stories highlight the benefits of adopting a more pragmatic, harm-reduction approach that prioritises the health of smokers over the fear of potential risks associated with new products.
By contrast, the WHO’s approach of imposing blanket restrictions on vaping is at odds with the growing body of evidence from these countries that show the benefits of providing adult smokers with safer alternatives.
A Call for Change: Shifting the WHO’s Stance on Vaping
It is time for the WHO to rethink its approach to vaping and adopt a more balanced, evidence-driven policy. Rather than treating e-cigarettes as an existential threat, the WHO should regulate them in a way that maximises their potential as a harm-reduction tool, while minimising the risks of youth uptake and non-smokers starting to use nicotine products.
The evidence in favour of vaping is clear: it is far less harmful than smoking and provides adult smokers with a chance to reduce their tobacco-related health risks. Instead of imposing heavy-handed restrictions, the WHO should encourage responsible regulation that allows adult smokers to make informed decisions about their health. By doing so, the WHO could play a key role in reducing smoking-related diseases and saving millions of lives globally.
The WHO must change its approach if it truly wants to fulfil its mission of promoting health and well-being for all. By acknowledging the role of vaping in tobacco harm reduction, the WHO can help smokers transition to safer alternatives, protect public health, and take a meaningful step forward in the global fight against smoking-related mortality.
Instead of banning vaping, the WHO should support responsible regulation, making safer alternatives available to adult smokers while protecting youth. The real threat to public health is not vaping, but continued smoking. If the WHO truly wants to reduce smoking-related diseases, it must change its approach and support policies that help smokers transition to less harmful options.