The Framework Convention on Tobacco Control is the World Health Organisation’s masterplan to eliminate tobacco use. Its main activity is the two-yearly Conference of Parties, and the next one – COP 7 – will be taking place in India this November. Preparation for the conference is now in full swing, and various documents have now been released. This includes the WHO’s latest report on vaping.
This report is of vital importance to vapers and advocates; it sets the framework for what the WHO will be trying to achieve at COP 7. While theoretically the attendees can disagree with that framework and move things in another direction, COP 6 (held in Moscow in 2014) demonstrated that any deviation from the party line will not be tolerated. The conference’s final recommendations are likely to be very similar to the report.
Some vaping advocates believe that the new report shows a more positive attitude from the WHO, which previously has been heavily biased against vaping. NNA do not share this optimism. Our opinion is that this latest paper simply builds on the dreadful framework of COP 5 and 6. It pays little attention to the latest research, which is mostly rejected without any attempt at justification. Worst of all it recommends a series of policies that will make vaping more expensive, less satisfying and more restricted by law.
Vapers should not sit back and wait to see what happens; it’s vital to build awareness of how bad this report is. That means contacting MPs and the media to make your concerns heard. Here are the Top 10 suggested discussion points:
1. Fixated on Cessation
Paragraph 5 says that there are health gains if smokers switch to a safer form of nicotine – and then eventually stop using the safer source. This doesn’t make a lot of sense. If smokers switch to vaping (which is at least 95% safer, according to the scientific consensus) there’s already a massive health gain, whether they go on to quit vaping or not. As Clive Bates has pointed out, giving up nicotine isn’t the best option for many people. Lots of vapers enjoy using nicotine. Does your life get better when you stop doing things you enjoy? No.
2. Misguided about new vapers
The same paragraph says there will only be a health gain if the rate young people and non-smokers start vaping is no higher than the rate they start smoking – and if it eventually decreases to zero. Again this shows the WHO is more interested in moral purity than in health, because it makes no sense at all. Vaping is so much safer than smoking that if all smokers switched to vaping, and all non-smokers started vaping too, there would still be an overall health gain.
3. Alarmist on Ingredients
Several paragraphs of the report talk about potentially harmful chemicals found in e-cigarette vapour. They do admit that the levels are much lower than in tobacco smoke; they don’t admit that they’re the same or lower than what’s found in licensed nicotine inhalers. Heavy metals and volatile organic compounds sound scary, but these are natural substances that are found everywhere in the world we live in. We’re all exposed to tiny quantities of them every day. Is e-cigarette vapour more toxic than pure air that’s been through a laboratory-standard HEPA filter? Probably. Is it more toxic than the air you inhale on a city street, or even a beach? No.
4. Unfounded Fearmongering
Paragraph 11 states that “long-term use is expected to increase the risk of chronic obstructive pulmonary disease, lung cancer, and possibly cardiovascular disease”. This is simply a lie. There is no evidence that long-term use of e-cigarettes will cause any of these things, and no credible research even suggests that it could. The chemicals which cause these conditions either don’t exist in e-cigarette vapour or are found at very low levels. To claim that vaping is “expected” to cause life-threatening illnesses is dishonest, wildly irresponsible and bordering on malevolent.
5. Dismissal of PHE Report
The report’s authors have been remarkably selective in the evidence they accept – you might almost think they’ve been cherry picking the reports that suit them. The most egregious example of this is in Paragraph 11, which says “no specific figure about how much “safer” the use of these products is compared to smoking can be given any scientific credibility at this time.” This looks like a clear attack on Public Health England, whose 2015 review – the largest and most detailed study ever carried out on vaping and health – supported earlier estimates of at least 95% safer. The PHE report has since been supported by many others, including the Royal College of Physicians. To say it has no scientific credibility is simply absurd.
6. Stoking Cessation Fears
Paragraph 17 gives an airing to two studies that suggest e-cigarette use can make it more difficult for smokers to quit. These studies have already been widely discussed and thoroughly debunked. They both contain serious methodological flaws – so serious that it’s hard to believe they weren’t designed to give a specific result. In both cases the studies excluded smokers who had successfully quit using e-cigarettes, which predictably inflated the proportion who hadn’t. This isn’t questionable science; it’s incompetent science and may well be fraudulent. Actual, well-documented trends in smoking rates show that e-cigarettes are not preventing smokers from quitting and are almost certainly helping them.
7. Gateway Garbage
The “gateway” effect is also trotted out again, in Paragraphs 18-20. A few countries and regions – principally Florida and Poland – are cherry picked to claim that -e-cigarette use among young people is increasing rapidly. In the absence of evidence that this is leading to an increase in smoking (teen smoking in the USA is at record low levels and falling fast) the report says there is “considerable debate” on this issue. There is, but only one side of it has any evidence. The whole field of research into teenage vaping is contaminated, probably fatally, by the refusal of US researchers to distinguish between regular use and ever use. Another problem is the repeated claims of rapidly increasing prevalence. This is correct, but misleading. E-cigarettes are a relatively new product, and use is growing from a very low baseline. Teenage use of e-cigarettes can double, treble or increase by a factor of ten – that still means it’s gone from a very small number to a slightly less small number. The WHO prefers to use wording that suggests a major epidemic.
What would it mean if the number of teen vapers is growing rapidly? From the point of view of nicotine use, not much. Recent research from the University of Michigan shows that the vast majority – more than 80% - of teen vapers are using nicotine-free liquids. This makes the already improbable gateway hypothesis even less likely.
8. Opposed to Flavours
Paragraph 23 acknowledges that flavours can be important for adult smokers who want to break links with tobacco, but attention keeps going back to how flavours allegedly appeal to children. There is absolutely no evidence to suggest that flavours are particularly attractive to young non-smokers. The report highlights that one company decided to stop making flavoured products (actually non-tobacco flavours) in 2009 but then reversed that decision. They reversed it because, entirely predictably, they were losing adult customers.
A ban on flavours that “appeal to minors” is one of the policy suggestions given in the report.
9. Obsession with Big Tobacco
Overblown worries about the role of tobacco companies are given another airing in Paragraphs 25-27. Possible concerns are that tobacco companies could:
- Encourage dual use
- Discourage innovation that would make e-cigarettes a more attractive alternative to tobacco
- Promote vapour products to children
- Promote smoking via e-cigarette adverts
- Use e-cigarettes as an opening to talk to policymakers
Some of these concerns lack evidence or are purely speculative. Others are hugely hypocritical. For example, the WHO complains that tobacco companies might restrict innovation to produce better products – then proposes a huge list of policies aimed at restricting innovation.
The fact is that tobacco companies have a small and declining share of the vapour product market. Their best home for achieving a dominant position is regulation that wipes out smaller, more agile competitors – exactly the sort of regulation that the WHO recommends.
10. Dangerous Policy Proposals
Any illusions that the WHO's position on vaping had become more supportive should have been destroyed by the body of the report, but the list of policy recommendations at the end must remove all doubt. Suggestions include:
- Banning the possession of vapour products by minors (not sale to - possession by)
- Banning all advertising of e-cigarettes
- Banning or restricting flavours
- Imposing punitive taxes on vapour products
- Prohibiting vaping anywhere smoking is banned
- Imposing health warnings (despite the lack of identified health risks)
- Shutting the e-cigarette industry out of discussions
The delegates at FCTC can make any recommendations they like, but it’s up to national governments to turn them into laws. A court in the Netherlands has just ruled that FCTC guidelines are not legally enforceable, and whatever COP 7 says about e-cigarettes will not become British law unless British politicians make that happen. Unfortunately politicians will be heavily lobbied by ASH and others to support FCTC; it’s up to vapers to counter that with more accurate messages.
Written by Fergus Mason