The taxpayer-funded World Health Organization (WHO) recently released new guidelines on smoking cessation that conspicuously exclude the use of e-cigarettes and heated tobacco products. Despite the evidence supporting their effectiveness in helping smokers quit, the WHO’s stance appears more rooted in bureaucratic comfort than in genuine concern for public health. This omission reflects a troubling disconnect between the WHO’s recommendations and the growing body of evidence that demonstrates the efficacy of these harm reduction tools.
In 2021, Varenicline (a smoking cessation drug) was withdrawn from the market due to unacceptably high levels of a nitrosamine impurity called N-nitroso-varenicline, a probable carcinogen. Despite this, the WHO’s new guidance recommends it as a first line product for cessation practitioners. This decision is baffling given the significant health risks associated with Varenicline (plus its lack of availability worldwide) and the proven effectiveness of alternative products such as vapes, nicotine pouches, and snus.
The WHO has acknowledged the potential of safer nicotine products in one of its own reports in 2016, saying that “if the great majority of tobacco smokers who are unable or unwilling to quit would switch without delay to using an alternative source of nicotine with lower health risks … this would represent a significant contemporary public health achievement.”
Yet, the WHO seems determined not to seize the opportunity that reduced risk products present for smoking cessation. The exclusion of e-cigarettes from their latest guidelines contradicts this earlier admission and disregards the increasing evidence supporting their efficacy over and above traditional pharmaceutical therapy.
The WHO’s new guidelines heavily reference 15 evidence reviews by the highly respected Cochrane Library on all manner of cessation methods, yet conspicuously ignore the Cochrane review on the use of e-cigarettes as a quitting aid. This omission is significant because the Cochrane review concluded that vaping is twice as effective as nicotine replacement therapy for helping smokers quit. By ignoring this critical evidence, the WHO undermines its own credibility and raises questions about its commitment to reducing smoking rates.
Moreover, the WHO’s guidelines conflate smokeless and heated tobacco products with combustible cigarettes, as if all tobacco products present the same level of risk. This conflation is misleading and fails to recognize that non-combustible products are orders of magnitude less harmful than traditional cigarettes.
The WHO’s reluctance to endorse e-cigarettes and other harm reduction tools seems to stem from a combination of bureaucratic inertia and ideological opposition. Many within the WHO and the broader public health community remain uncomfortable with the idea of endorsing products that contain nicotine, despite the clear evidence that these products can help smokers quit and significantly reduce health risks. Even the U.S. Food and Drug Administration understands the importance of cessation products containing nicotine with its approval of nicotine gum and patches.
Moreover, the WHO routinely emphasizes the dangers of nicotine while downplaying the benefits of harm reduction. For example, the WHO often highlights the potential risks of e-cigarettes, such as their appeal to youth, without giving equal weight to the substantial benefits they offer to adult smokers seeking to quit. This one-sided narrative perpetuates misconceptions about vaping and other harm reduction products, ultimately hindering their adoption and limiting their potential to improve public health.
Furthermore, the WHO’s reliance on traditional cessation methods, such as nicotine replacement therapy and pharmaceuticals, shows a Luddite hesitancy to embrace newer and less conventional strategies, however successful.
It makes one wonder if the WHO is even interested in reducing smoking rates at all. The WHO is shunning a balanced and pragmatic stance on harm reduction and prioritizing stubborn ideology over what works for public health. The authority refuses to acknowledge the substantial body of evidence supporting the use of e-cigarettes, nicotine pouches, snus, and other reduced-risk products as effective smoking cessation tools and is unwilling to engage with the latest scientific research to come up with guidelines based on emerging evidence.
It is easy to conclude that the WHO’s current approach to smoking cessation is not genuinely serious about reducing global smoking rates. Instead, it proves that the WHO prefers bureaucratic comfort over what works. The organization must overcome its ideological biases and embrace harm reduction as a vital component of its tobacco control strategy. The WHO could truly contribute to a significant contemporary public health achievement by accelerating smoking cessation globally, but it will not do so by ignoring innovative nicotine alternatives because of naked bureaucratic intransigence.
