Electronic Cigarette Industry Trade Association

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WHO Framework Convention on Tobacco Control (FCTC)

01, Nov, 2010

Alongside the abstract we have submitted, the Canadian researcher Catherine Nissen (part of Carl Phillips’ team with Paul Bergen et al) is preparing a presentation about the FCTC. At ECITA, we are also working on this, since there does appear to be a quite astonishing attitude from this group. The Conference of the Parties to the WHO Framework Convention on Tobacco Control (conveniently abbreviated to COP4) will be holding their fourth session at a conference in Uruguay in November. ECITA will not be attending but we have been talking with representatives from Europe who will.

In a media advisory note about this conference, COP4 have said:

“For the first time the Conference will debate:

• price and tax policies;

control and prevention of smokeless tobacco products and “electronic cigarettes”;

• liability with regard to the health effects of tobacco consumption.” (emphasis added)

Why, oh, why must electronic cigarettes be contained within inverted commas as if to speak the words is a sin, in and of itself?! And why on earth would an arm of the World Health Organisation – an internationally-recognised body designed to act in the best interests of human health – seek to “control and prevent” access to modified and/or reduced risk tobacco alternatives? Renowned public health experts the world over are expressing their support for smokeless tobacco products and electronic cigarettes because, unhampered by vested interests, they are able to examine the scientific evidence and facts underlying these issues, and overwhelmingly find that this HAS to be safer than smoking. And yet the WHO, via COP4, seeks to “control and prevent” smokers’ having access to these potentially life-saving products.

Perhaps one of the reasons is explained in the text of a recent publication entitled WHO Technical Manual on Tax Administration. This is a long-winded and desperately boring document, but on pages 88-90, we begin to gain some insight into the mental processes going on behind the façade of public health protection:

“In recent years, the variety of available products has expanded considerably, particularly in high-income countries, as the tobacco industry has introduced products that are marketed as “reduced risk” products. Some new cigarettes, for example, claim to reduce the carcinogens contained in their smoke while others deliver considerably less tar, nicotine and/or carbon monoxide.

Many new non-combustible products are being similarly marketed, from Swedish Match’s “snus” (a moist snuff product that uses tobacco cured in a way that is supposed to significantly reduce cancer causing agents) to the lozenges, dissolvable strips, tobacco chewing gum, and others. At the same time, the number of available non-tobacco products that deliver nicotine has risen, ranging from those intended for smoking cessation (nicotine gum, patches, inhalers, etc.) to the ‘e-cigarette’ (a battery powered device that delivers nicotine through a mixture of air and water vapor).

Governments have struggled with how to regulate these products and, given experiences with filtered and low-tar and nicotine cigarettes, have been reluctant to allow these products to be marketed as less harmful. Research has clearly demonstrated that smokers’ perceptions that low-tar and nicotine cigarettes, for example, were safer than regular cigarettes led many who might have otherwise quit smoking to continue. Only decades after their introduction did it become clear that the machine measurements of tar and nicotine did not reflect human exposure and that these cigarettes were not safer than regular cigarettes.

The variety of tobacco products available have led some to suggest that tobacco excises be set differentially, so as to more heavily tax those that have greater health risks, while taxing those perceived to be safer at lower levels (or not at all). Harris (1980), for example, suggested that a differential tax based on tar and nicotine content could promote public health by encouraging smokers to move from high tar/nicotine brands to low tar/nicotine brands, assuming that the latter were less harmful.

However, given what we now know about the relative risks of these cigarettes, it’s clear that such a policy would have done more harm than good as it would have likely kept even more smokers in the market consuming what they perceived to be safer products.

To date, differential taxation of various tobacco products (e.g. for filtered vs. unfiltered cigarettes or for smoked vs. smokeless products) does not seem motivated by interests in promoting harm reduction. Where differential taxes exist, they appear more motivated by efforts to protect domestic producers (e.g. those producing unfiltered cigarettes) from multinational firms (e.g. those producing filtered cigarettes) or by efforts to increase revenues (e.g. by taxing the manufactured cigarettes consumed by higher income, less price sensitive consumers more than the hand-rolled bidis smoked by more price sensitive, lower income smokers).

Recognizing past misrepresentations and current uncertainties, at this point in time, designing a tobacco tax system that favours products perceived to be safer while disfavouring those perceived to be more harmful should await clear evidence of a harm reduction benefit for both the individuals using the products and the public health of the general population.”

There are a number of assumptions in this text which demand closer consideration. For example, “[r]esearch has clearly demonstrated that smokers’ perceptions that low-tar and nicotine cigarettes … were safer than regular cigarettes led many who might have otherwise quit smoking to continue.” Firstly, I find it very odd that a document of this kind, littered with numerous references throughout, and with seven pages of references at the end, does not specifically cite the research to which this refers! Secondly, how can they possibly know that these people ‘might have otherwise quit smoking’?

This is the sort of thing which bugs me enough to send me searching. Within the seven pages of references at the end, I found only two which looked as if they might be likely candidates, the first from 2004, based on evidence from Vietnam (abstract available), and the second from 1994 (Broken link. Removed). This second passes some outdated and frankly incredible comment on nicotine:

“Cigarette smoking stands out as somewhat different: nicotine is not a drug whose acute effects lead directly to disturbed behaviour, crime, or violence, but it imposes the greatest costs of all in terms of premature death.”

Nowadays, we know better than this: it is not the nicotine which is the cause of premature death (in the vast majority of cases), but rather the means of delivery of nicotine, hence the prosperous – and government-funded – pharmaceutical nicotine trade. It is the combustion-based smoking of nicotine which causes premature death, and not the taking of nicotine. But I digress….

One of the most shocking references I found at the end of this document on how to maximise tax revenues from tobacco was:

Joossens L et al. (2009). How eliminating the global illicit cigarette trade would increase tax revenue and save lives, Paris: The Union against tuberculosis and lung disease.

Professor Michael Siegel in the US addressed this issue in his blog on 6th May 2010, saying:

“Making important government programs dependent upon continuing cigarette sales is not only bad fiscal policy, it runs counter to public health goals and incentives. It is not appropriate for the government to rely upon high rates of cigarette consumption to fund essential programs. It creates a need for continued smoking, removes any incentive for the state to reduce cigarette consumption, and unfairly balances the budget on the backs of smokers.”

The WHO also mentioned (in the media advisory note) that “proposed outline recommendations for economically sustainable alternatives to tobacco growing will also be on the agenda.”

So taking it all very seriously, and determined to REALLY take action on tobacco, once and for all. Or are they?

In a ‘background note’ to this COP4 conference, WHO published the following:

“On the issue of the potential impact on tobacco growers as a result of restrictions or a prohibition on additives, the impact is expected to be negligible. A World Bank’s study (Curbing the Epidemic, 1999) on the impact of tobacco control on world economies found that activities to reduce tobacco consumption would not result in job losses for the next few decades, if at all. The WHO’s figures indicate that the number of smokers will unfortunately continue to increase slightly over the next 30-40 years (The Tobacco Atlas, 2002) as will the demand for tobacco from growers.”

Well, this ‘unfortunate’ ongoing increase in the number of smokers can only be supported, nay encouraged, by WHO programs to control and prevent access to smokeless tobacco products and electronic cigarettes!