Amid a growing chorus calling for the WHO to drop its opposition to tobacco harm reduction, many are pinning their hopes on a post-Brexit UK to challenge the status quo at the upcoming FCTC COP9 meetings.

Following a pandemic-induced delay, the WHO’s ninth Conference of the Parties (COP9) on their Framework Convention on Tobacco Control (FCTC) is set to take place the week of November 8th.

And tobacco harm reduction advocates are hoping the UK will use the gathering to put pressure on the global health body to drop its opposition to vaping and other less harmful nicotine products like snus and nicotine pouches.

“COP9 could be a critical turning point,” UK Vaping Industry Association (UKVIA) head John Dunne said in a statement.

“At the Conference, the United Kingdom has a duty to lead the charge against the WHO and be proud of its record so far. The UK delegation should use its influence to encourage other delegations to back the science and follow its example.”

UK a ‘world leader’ on tobacco harm reduction

There had been hopes that the meeting would include discussions about tobacco harm reduction. But the topic was left off a draft agenda circulated ahead of the meeting, signalling the WHO was uninterested in addressing tobacco harm reduction.

The news was a setback for public health experts and advocates who had hoped the biennial meeting would be a forum where the UK, free from the constraints of EU membership, could highlight its success with tobacco harm reduction.

“The UK is a world-leader when it comes to harm reduction, and during COP9 it is important that we continue to lead the way as we work to reach our ambitious smoke-free 2030 target,” Conservative MP Mark Pawsey, chair of the APPG for Vaping, said in a statement to the Express newspaper in October.

“Our delegation must not let the WHO use its power, influence, and authority to pull the wool over their eyes.”

Clues about the UK position at FCTC COP9

So far, few clues have emerged about whether the UK delegation to the FCTC COP9 will heed the calls of Pawsey and others who want to see a “global Britain” flex its muscles on tobacco policy post-Brexit.

When Pawsey in June asked then health secretary Jo Churchill about the UK’s COP9 plans, her response raised hopes about the government’s ambitions for the November meetings.

“Officials will use the opportunity to speak about the United Kingdom’s progress on the implementation of tobacco control policies. This will include, where relevant, the role of nicotine replacement therapy and e-cigarettes in supporting smokers to quit,” she said.

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However, when fellow Conservative MP David Jones, who has previously called for the UK to legalise snus, submitted a parliamentary question in October seeking clarity on the UK’s position at COP9, the response was muted at best.

Maggie Throup, a Conservative MP who serves as the Under Secretary of State for the health department noted simply that the government’s position on e-cigarettes, heated tobacco, and snus “will be in accordance with the current 2017 Tobacco Control Plan for England”.

Will Britain seize the FCTC COP9 opportunity?

While the health department continues to support the “use of e-cigarettes as a safer alternative to smoking”, snus “remains banned” under the UK’s 2016 Tobacco and Related Products Regulations, Throup continued, refraining from giving any indication that the UK would advocate strongly for tobacco harm reduction at COP9.

Throup later reiterated the government is “fully committed to the World Health Organization Framework Convention on Tobacco Control” in response to a question from Conservative MP Andrew Lewer.

She added that the UK “will not advocate for a contemporary approach nor a working group on tobacco harm reduction products” yet plans to “set out our approach to e-cigarettes which is pragmatic and evidence-based”.

Perhaps the most detailed information came in response to a question posed to Throup by Labour MP Ellie Reeves about the gender balance of the UK delegation which revealed the government plans on sending two men and four women to the COP9 meetings. 

WHO could ‘avoid millions of smoking-related deaths’

Pressure on the WHO ratcheted up further following the publication in October of a letter signed by 100 tobacco policy and public health experts calling on the body to “change its hostile stance on tobacco harm reduction”.

“[The] WHO is rejecting a public health strategy that could avoid millions of smoking-related deaths,” the letter states.

“Smoke-free nicotine products offer a promising route to reducing the harms arising from smoking. There is compelling evidence that smoke-free products are much less harmful than cigarettes and that they can displace smoking for individuals and at the population level.”

The UK further strengthened its harm reduction leadership potential just days ahead of COP9 when it announced that the NHS in England would start prescribing e-cigarettes to help people stop smoking.

Conservative MP Adam Afrieyie added his voice to the growing chorus of politicians who want the UK to blaze its own trail on vaping and harm reduction rather than bow to the “unaccountable, unscientific WHO”.

“We left the EU to be free to make decisions for ourselves. Joining in with the smoke-filled back rooms of the anti-scientific WHO would be a betrayal of this freedom,” he wrote in an article published on free-market opinion site CapX.

However, it remains unclear whether or not the UK delegation to COP9 will seize the opportunity to change the conversation about tobacco harm reduction within the WHO.

Mark Oates, head of the UK-based Snus and Nicotine Pouch Users Association, said the governments appeared “disinterested in showing real leadership on harm reduction at COP9”.

“Unfortunately, the UK seems less keen to champion harm reduction as a concept, instead focusing only on one product, e-cigarettes,” he told Snusforumet.

“They don’t seem to understand the harm reduction philosophy which has led to the UK’s success. This has resulted in a position where they seem unwilling to discuss other harm reduction products, such as nicotine pouches, snus, and heated tobacco.”

Sweden ‘sadly’ silent about snus success

Patrik Strömer, head of the Association of Swedish Manufacturers, would also like to see the UK take a stronger stance in support of tobacco harm reduction at COP9.

He lamented that his home country of Sweden, a country with a strong track record on harm reduction success thanks to snus, has failed to show leadership on the issue within the EU or WHO.

“Sadly, Sweden has been and will likely continue to be silent about its own success with snus,” he told Snusforumet.

“The evidence is clear. Sweden is proof of concept that providing safer alternatives helps reduce smoking rates and tobacco-related mortality – but our government doesn’t want to trumpet this success internationally.”

Strömer theorized that a more vocal, pro-harm reduction UK could eventually embolden Swedish politicians to speak about the Swedish Experience with tobacco at the WHO.

But any substantive changes likely won’t happen until COP10 in 2023, he added.

“It’s disappointing, and frankly, infuriating, that millions of smokers will face early deaths because this unelected, unaccountable global body continues to ignore all the scientific and real-world evidence about the public health benefits of tobacco harm reduction,” said Strömer.