The UN’s Recent Special Rapporteur Ignores Harm Reduction in Relation to Tobacco Use

Despite the fact that harm reduction is one of the UN's own principles, while applied to other areas of concern such as drug abuse, it is being ignored in relation to smoking and tobacco use.

A recent report by the UN Special Rapporteur on the right to health, has drawn criticism from tobacco harm reduction (THR) experts for its negative stance on vaping and other reduced-risk nicotine products which are known to lead to decreased smoking rates. The Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA) which represents THR advocates across the Asia-Pacific region, believes the report is misguided and could endanger millions of smokers seeking safer alternatives.

In a media release, CAPHRA said the report is a harmful step backward in the global fight against smoking-related deaths and expressed concern that the report ignores the growing scientific evidence supporting vaping as a less harmful alternative to smoking. While CAPHRA’s Executive Coordinator Nancy Loucas, argued that by demonizing these products, the UN is condemning smokers to continued exposure to harmful toxins in cigarette smoke.

The main flaws in the report were summarized as follows:

1.Disregard for Harm Reduction: The report fails to recognize tobacco harm reduction strategies’ important role in public health.

2.Overlooking End Users: It neglects the rights and health of smokers, particularly in low- and middle-income countries (LMICs), while ignoring replicable scientific evidence.

3.Misrepresentation of Evidence: The report selectively presents data, ignoring comprehensive studies proving vaping’s effectiveness in smoking cessation.

4.Human Rights Concerns: By advocating for restrictions on safer nicotine products, the report limits adults’ right to choose less harmful alternatives.

In line with recomendations by other THR groups CAPHRA calls for pragmatic, science-based regulations that support public health and protect smokers’ rights to access safer alternatives. These experts urge the UN and WHO to engage with harm reduction advocates and reconsider the report’s recommendations, which could have a detrimental impact on global health goals.

Data from countries endorsing THR speak for themselves
In fact, in its submission to the consultation on the report in 2023, the World Vapers Alliance (WVA) had highighted that article 1(d) of the FCTC emphasizes the need to integrate harm reduction strategies into broader tobacco control efforts, addressing both supply and demand. The WVA added that in fact evidence from countries like Sweden, the UK, New Zealand, and Japan shows that the adoption of less harmful smoking alternatives has significantly contributed to reduced smoking rates in these regions.

Despite global efforts, smoking remains a significant public health challenge, with over a billion people worldwide still smoking, especially in less affluent nations. This leads to around 8 million deaths annually. To address this crisis effectively, it is essential for organizations like the UN and WHO to incorporate harm reduction strategies into their future initiatives, aiming to reduce smoking rates and its associated health consequences.

In the United Kingdom, harm reduction strategies have expanded to include vaping as a key tool for reducing smoking rates. Over the past decade, smoking rates in the UK have dropped by more than 29%, a decline that coincides with the rise of vaping. This decrease is twice as fast as the EU average. In 2023, the UK government launched the “Swap to Stop” program, which encourages smokers to switch from cigarettes to vaping. This initiative further highlights the UK government’s endorsement of vaping as a less harmful alternative to smoking, aiming to enhance public health and reduce smoking prevalence.

In Japan, the introduction of heat-not-burn products led to a 43% drop in cigarette sales between 2016 and 2021. Many smokers in Japan have transitioned from cigarettes to these less harmful alternatives, significantly reducing smoking rates. This shift highlights the success of harm reduction strategies, which offer safer alternatives and supportive policies to minimize smoking-related health risks. Along with similar efforts in countries like Sweden and the UK, Japan’s experience demonstrates how providing less harmful options can effectively decrease smoking prevalence and its associated health consequences.

Regulations can make it or break it for any given country
The WVA underscored how legal frameworks play a crucial role in shaping harm reduction policies for smoking, particularly in ensuring adults’ right to health by providing access to safer alternatives. This principle is connected to the right to information, enabling people to make informed health decisions. However, regulatory barriers, such as bans and restrictions, often hinder these efforts.

For instance, vaping product bans or flavour restrictions have led to unintended consequences, like increased smoking rates. In San Francisco, a flavour ban caused teenage smoking rates to rise, while in Estonia, vapers turned to unsafe, black-market products. Similarly, Massachusetts saw increased cigarette sales after a comprehensive flavor ban. These examples highlight the complex impact of restrictive legal measures on harm reduction efforts.

Countries with higher adoption of alternative nicotine products, such as vaping, heated tobacco, nicotine pouches, and snus, tend to reduce smoking rates faster than those with more restrictive policies, like Australia. Evidence suggests that making these products more affordable and accessible can decrease tobacco consumption. However, there is a stark contrast in how countries embrace tobacco harm reduction strategies. Sweden and the UK have seen significant smoking rate declines by supporting these alternatives, while low- and middle-income countries face more restrictive policies. This disparity not only hampers harm reduction but also exacerbates global health inequities by limiting access to safer smoking alternatives.

THR science and real-world data point in the same direction
Providing accurate information on safer alternatives like vaping is crucial for effective harm reduction. Sweden’s strategy, combining regulations, education, and accessible safer alternatives, positions it to become the first “smoke-free” country. In fact, the 2022 Cochrane Review highlights that vaping is more effective than traditional nicotine replacement therapies (like patches and gums) in helping people quit smoking. While a clinical trial by Queen Mary University found vaping to be twice as effective for quitting, and studies from the University of Geneva and Virginia Commonwealth University show that former smokers who switch to vaping are less dependent than long-term gum users. Such findings reinforce the importance of access to safer smoking alternatives as part of public health efforts.

France, along with the UK, Canada, and New Zealand, recommends vaping as a method to help smokers quit. In these countries and globally, individuals have the right to pursue the highest attainable standard of health, which includes making informed choices about harm reduction strategies. Providing access to safer nicotine alternatives like vaping, heated tobacco, nicotine pouches, and snus supports this right. These alternatives offer individuals a less harmful and more effective way to quit or reduce smoking, aligning with the broader goal of improving public health through harm reduction strategies.

The WVA concluded by reiterating that public health policies that provide safer alternatives to smoking can help individuals reduce or quit smoking, leading to better health outcomes. The right to health includes not only access to healthcare but also the availability of accurate information about the risks and benefits of different products. Ensuring that individuals have access to these alternatives, along with reliable information, is essential for respecting and fulfilling the right to health, empowering people to make informed choices for their well-being.