When Dogma Overrides Science: Reflections on the WHO’s Stance on Tobacco Harm Reduction

By Jeffrey Willett, PhD

I believe the WHO position on tobacco harm reduction clearly demonstrates how deeply mainstream tobacco control has become rooted in dogma. The stance is so rigid that it undermines even the idea of harm reduction for people who want to quit smoking.

The WHO discounts tobacco harm reduction by stating “Genuine harm reduction programmes see health actors and agencies pursuing health objectives by implementing evidence-based strategies and interventions that are tightly controlled and monitored.” This reflects a self-fulfilling prophecy within mainstream tobacco control: the reason health actors and agencies are not identifying and implementing evidence-based strategies for tobacco harm reduction is because they are ignoring the science and have chosen not to. The absence of their action is treated as evidence that no action is possible.

In the United States, the Tobacco Control Act - which granted FDA regulatory authority over tobacco products - was carefully crafted with full awareness of what WHO accurately describes as the tobacco industry’s “long history of dishonestly downplaying the harms caused by their products.”

That history is precisely why so many public health groups supported the Act: they wanted FDA to conduct rigorous scientific reviews of new products to determine their potential public health benefit and relative risk. These same groups later argued that e-cigarettes and synthetic nicotine should be regulated under that same scientific framework.

Today, only a small number of e-cigarette and nicotine pouch products have received FDA marketing authorization after years-long, highly technical scientific evaluations. But which tobacco control organizations are now working to ensure that the public understands what these authorizations mean? Which groups are actively developing evidence-based approaches for tobacco harm reduction anchored in FDA’s regulatory decisions?

The answer, unfortunately, is essentially none.

The WHO states: “Many of the 1.2 billion tobacco users worldwide want to quit and they deserve support that is safe and effective. WHO promotes access to proven cessation tools such as counseling, approved nicotine-replacement therapies, and quit-lines.” These tools are important and essential, but it is abundantly clear that they are not sufficient for the hundreds of millions of people who want to quit smoking.

Tobacco harm reduction is a sensible, public health concept – and one that public health must embrace with urgency.