Former WHO senior employee Professor Robert Beaglehole calls for reform of WHO to enable the promotion of tobacco control policy and harm reduction
Former World Health Organization (WHO) Professor Emeritus Robert Beaglehole of the University of Auckland in New Zealand has called for the reinvigoration of the body to ensure it takes back leadership on tobacco control and promotes tobacco control policy, which includes harm reduction.
Beaglehole, who worked for WHO for almost five decades, observed that the global health organization has “lost its way in the field of tobacco control”, citing the most recent conference of the parties characterised by a lack of transparency and mired in secrecy.
“The WHO’s chronic disease goals will only be reached if their tobacco reduction goals are strengthened,” he said.
Beaglehole trained in medicine, epidemiology and public health in New Zealand, England and the USA before becoming a public health physician. He was Professor of Community Health at the University of Auckland, New Zealand between 1988 and 1999. He joined the staff of the World Health Organization in 2000 and between 2004 and 2007 directed the Department of Chronic Disease and Health Promotion.
Beaglehole left WHO in February 2007 having reached the UN retirement age and returned to New Zealand. He is now an independent global public health practitioner with a focus on the prevention and control of non-communicable diseases (NCDs).
At the recent the virtual 2021 E-Cigarette Summit, the health expert was a keynote speaker and used the platform to challenge WHO to spearhead the fight against deaths caused by tobacco smoking.
Latest data from the World Health Organization (WHO), tobacco kills more than eight million people each year, with more than seven million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.
WHO also says over 80 percent of the world’s 1.3 billion tobacco users live in low- and middle-income countries.
Beaglehole says this is why WHO must be worried.
“That’s 20, 000 every single day. WHO needs to be at the forefront of tackling this huge death toll,” he said.
After listening to the personal stories of smokers and vapers, Beaglehole is no longer advocating for a tobacco-free world, but instead for a smoke-free world, where the focus is on the harm from carcinogens in smoke. He emphasized that the greatest enemy in tobacco smoking is not nicotine, but the toxic substances in burnt tobacco.
He is expected to chair the Action on Smoking and Health (ASH) 2025 in New Zealand Conference.
He observed that Bloomberg philanthropies have funded a tobacco intervention (Mpower) to the tune of at least one billion dollars. Beaglehole said this funding has been detrimental to WHO because of Bloomberg’s personal prohibitionist agenda.
He added that the WHO Framework Convention on Tobacco Control (FCTC) failed to deliver its promises because it did not tolerate anything short of nicotine abstinence. The failure of WHO to embrace less harmful products and undue focus on youth smoking has been to the detriment of adult smoking reduction.
“The missing ingredient in WHO strategy is harm reduction. Countries that have embraced harm reduction are rapidly reducing smoking rates e.g. Sweden, Japan (30 percent decrease). But under the influence of Bloomberg, WHO has discouraged THR products. Several countries have banned them – leading to them being rewarded by the WHO even though smoking rates went on to increase.
“We can take lessons from the Covid-19 pandemic – we need a coordinated global response with strong, independent evidence, science-based policy and transparent discussion of the risks and monitoring of progress,” he said.
In his presentation, Professor Emeritus Martin Jarvis of University College London emphasised that he did not want to promote vaping to under-18’s.
However, Jarvis admitted that a total ban on nicotine use is not viable.
“The risk is that by bearing down on e-cigarettes we simply advantage incumbent cigarettes. The issue is will, society continue to use nicotine in the future? If yes, it’s better to do so in the form of products that will not kill you. It’s not that e-cig use is a good thing, but it is the least worst option available,” he said.
He further disclosed that the issue of potential benefits from vaping has been bedeviled by the perceived conflict between the needs of children and adult smokers, saying the uptake of vaping by non-smoking children is seen as an unmitigated bad thing.
But Jarvis stated that there is no clear evidence of a gateway effect.
“In fact, the growth of vaping has occurred at the same time as an unparalleled decline in youth smoking. We need to look at the shared risk model instead of a simplistic gateway model. Children who engage in more risky behaviour do it across a spectrum – for example, children who are involved in violence are more likely to smoke, use drugs, have sex, vape, binge drink and so on.
“The argument that one risky behaviour, such as vaping, is leading to another risky behaviour, smoking, has no plausibility. Instead, children who engage in one form of risk behaviour are more likely to be involved in others. So what would happen if youth vaping was eliminated? The ‘implausible utopian future’ of a nicotine-free youth would not occur. The reality is e-cigarettes are replacing cigarettes,” said Jarvis.
At this point, the Emeritus Professor Beaglehole said the success of reducing tobacco harm will depend on the WHO and FCTC leading, not obstructing, harm reduction strategies, with more countries adopting and achieving radical cigarette reduction targets and tobacco companies increasingly transitioning from most harmful to less harmful nicotine delivery products.
He said this will call for an independent enquiry into the WHO’s leadership in this area, progressive countries working together to reform WHO and Conference of the Parties.
“It will also require relentless and urgent focus on urgent goals – reduce adult smoking and deaths, active promotion of reduced harm products, such as vaping and taking advantage of the re-election of Dr Tedros and influencing the organisation’s leadership in this field,” said Beaglehole.
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