The WHO position on e-cigarettes

In advance of its secret meeting in India in November, the WHO has published its thoughts on e-cigarettes. I was surprised to see my name in the references but even more surprised to see people on social media describing the WHO's position as 'supportive' of vaping yesterday. That's not how I read it.

Their main statement is below. Note that they have decided that calling e-cigarettes 'electronic nicotine delivery systems' is not clumsy enough so they have added 'electronic non-nicotine delivery systems'.

If the great majority of tobacco smokers who are unable or unwilling to quit would switch without delay to using an alternative source of nicotine with lower health risks, and eventually stop using it, this would represent a significant contemporary public health achievement.

This would only be the case if the recruitment of minors and non-smokers into the nicotine-dependent population is no higher than it is for smoking, and eventually decreases to zero. Whether ENDS/ENNDS can do this job is still a subject of debate between those who want their use to be swiftly encouraged and endorsed on the basis of available evidence, and others who urge caution given the existing scientific uncertainties as well as the performance variability of products and the diversity of user behaviour.

That's about a supportive as it gets and most of it isn't actually true. In reality, it would be a 'significant contemporary public health achievement' if a lot of smokers switched to e-cigarettes even if they didn't 'eventually stop using' them and even if the number of non-smokers who took up vaping did not 'decrease to zero'. Nor would the 'the recruitment of minors and non-smokers into the nicotine-dependent population' have to be below the current smoking rate, which is an entirely arbitrary benchmark. See Carl Phillips's recent paper on tobacco harm reduction if a more detailed explanation is needed.

So the FIFA of health don't really get it from the outset and it's not the business of an elected UN agency if people smoke or vape anyway. Nevertheless, they have a raft of policies they want implemented. Here's what the 'supportive' WHO wants governments to do:

Parties that have not banned the importation, sale, and distribution of ENDS/ENNDS may consider the following options:

a. Banning the sale and distribution of ENDS/ENNDS to minors;

b. Banning the possession of ENDS/ENNDS by minors;

c. Banning or restricting advertising, promotion and sponsorship of ENDS/ENNDS (see FCTC/COP/6/10 Rev.1);

d. Taxing ENDS/ENNDS at a level that makes the devices and e-liquids unaffordable to minors in order to deter its use in this age group. In parallel, combustible tobacco products should be taxed at a higher level than ENDS/ENNDS to deter initiation and reduce regression to smoking;

e. Banning or restricting the use of flavours that appeal to minors;

f. Regulating places, density and channels of sales; and

g. Taking measures to combat illicit trade in ENDS/ENNDS

Banning the sale to minors is fairly uncontroversial but banning possession by minors is a bit extreme. We don't ban possession of tobacco or alcohol by minors.

Banning advertising is ridiculous, unjustified and an infringement on free speech. Wasn't the ban on tobacco advertising supposed to be a one-off response to a 'unique' health threat?

Taxing e-cigarettes in order to stop young people buying them is disgusting and absurd. It is the same thing as taxing them to stop people on low incomes buying them. Elsewhere in the document says: 'ENDS/ENNDS and cigarettes are substitutes, with higher cigarette prices being associated with increased ENDS/ENNDS sales.' They don't join the dots and conclude that this also means that higher e-cigarette prices are associated with increased cigarette sales. These people really are dangerous idiots.

There is no such thing as flavours that exclusively appeal to adults or minors. Everyone likes sweet flavours (which is presumably what they are getting at).

I don't know what (f) means and (g) is a tacit acknowledgement that their dreadful policies are going to create yet another black market.

Note also that the WHO doesn't tell countries which have 'banned the importation, sale, and distribution of ENDS/ENNDS' to legalise them. Nor do they acknowledge that snus is a 'an alternative source of nicotine with lower health risks' and should be legalised in the EU.

They also say this:

Prohibiting by law the use of ENDS/ENNDS in indoor spaces or at least where smoking is not permitted

Why? There is zero evidence that passive vapour causes the slightest harm and it wouldn't be the WHO's business to tell government's how to address it even if it did.

I see nothing in this document to suggest that the WHO has moved away from its essentially prohibitionist vision of a zero-nicotine future.

Share

Tweet