As the 11th Conference of the Parties (COP11) to the WHO Framework Convention on Tobacco Control (FCTC) approaches, calls for reform are growing louder. Independent scientists, journalists, civil society groups, and the tobacco industry are all demanding a seat at the table.
The conference, set for November in Geneva, is expected to reinforce restrictions in line with Article 2.1 of the WHO FCTC. The article allows countries to adopt stricter tobacco control measures than those outlined in the treaty, provided they are consistent with international law and the FCTC’s objectives. Many observers, however, fear this could further marginalise key stakeholders and silence scientific debate around Harm Reduction.
With this in mind, several health experts are urging greater transparency and inclusivity at COP11. Dr Dereck Yach, a global public health expert, argues that as long as the FCTC excludes certain voices, particularly those working in Tobacco Harm Reduction, meaningful progress will remain elusive.
“We recognised that if you learn from other treaties within the United Nations (UN) system, progress happens when the public, private, and non-profit sectors are all involved and willing to debate in open fora, rather than being restricted,” said Dr Yach.
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Dr Yach, who spent a decade at the World Health Organisation (WHO) as Executive Director for Non-Communicable Diseases and Mental Health, was instrumental in establishing the FCTC, the WHO’s first-ever treaty on tobacco control. Reflecting on the early stages of the treaty, he said, “We recognised as we were developing the treaty that we needed to hear from tobacco industry scientists to understand what they were doing in laboratories, particularly in Harm Reduction.”
As one of the architects of the FCTC, Dr Yach believes the convention has failed to deliver on many of its initial promises, especially those that could have strengthened Harm Reduction capacity in low-resource countries.
“We envisioned that the success of the treaty would depend on significant financing for low- and middle-income countries to develop their own research capacity, so they wouldn’t be reliant on data imported from the US or Europe to guide their policies. Unfortunately, that funding never materialised,” he noted.
Another shortcoming, according to Dr Yach, was the failure to support farmers affected by declining tobacco demand. More concerning, however, is what he describes as the total neglect of Harm Reduction, innovation, and science. While technological advances in nicotine delivery have rapidly evolved within industry circles, the WHO and the FCTC have largely ignored them, continuing to operate within a restrictive, outdated framework.
Is the FCTC Flawed in its Entirety?
Despite these shortcomings, Dr Yach maintains that the FCTC still contains valuable provisions. “For example, the principle of increasing excise taxes above inflation and the idea of banning certain tobacco products are sound. Many of these elements remain valid and necessary,” he said. “What needs strengthening is the role of Harm Reduction and the adoption of a more proportionate regulatory approach, one that aligns the level of regulation with the degree of risk.”
He emphasised that the tax structure for tobacco and alternative nicotine products should reflect the difference in harm. “While you might tax traditional cigarettes at a unit of 100, e-cigarettes and other Harm Reduction products should be taxed at a much lower rate, perhaps one percent of that. The messaging should also be risk-proportionate: communication about harms must focus primarily on combustible tobacco, while we remain cautious and evidence-based in what we say about vaping, which is now one of the most common tools people use to quit smoking altogether. That should be part of the broader advocacy.”
Dr Yach added that reforming the FCTC does not mean discarding its foundations but rather expanding its focus to embrace science and innovation. “We need to keep what is working but add, with greater emphasis, the enormous power of Harm Reduction to help adult smokers transition away from combustible tobacco. If we did that, we could save as many as 100 million lives over the next few decades.”
In an article published in The Lancet in 2022, Professor Robert Beaglehole wrote that the FCTC is no longer fit for purpose, particularly for low-income countries.
What Has Changed Over the Past 20 Years?
As the WHO FCTC marks its 20th anniversary this year, a fundamental and seemingly irreconcilable conflict remains between tobacco industry interests and public health policy. Despite years of stringent measures under the FCTC targeting both tobacco and nicotine products, global smoking rates among users of combustible products have barely shifted.
“If you think back to the late 1990s, the industry didn’t have much on the table in terms of Harm Reduction,” said Dr Yach. “One hundred percent of their sales were combustible or toxic oral tobacco products. Today, we have 140 to 150 million consumers around the world who are using a range of products, be it heated tobacco, vapes, or nicotine pouches. We have many companies now earning up to 50 percent of their revenue from reduced-risk products, with billions of dollars invested in research.”
He added that the world has changed dramatically and that maintaining the current level of hostility between tobacco control institutions and Harm Reduction advocates does more harm than good to global Tobacco Harm Reduction efforts.
What Has Worked and What Hasn’t?
To date, more than six billion people across the globe are protected by at least one tobacco control measure under the WHO’s MPOWER strategy, according to the organisation’s Global Tobacco Epidemic 2025 report launched in June at the World Conference on Tobacco Control in Dublin. Moreover, the number of countries regulating or banning Electronic Nicotine Delivery Systems (ENDS) has increased from 122 in 2022 to 133 in 2024.
The WHO continues to push for smoking cessation, supported by FCTC regulations in member states. Through taxation and strict regulation, the FCTC’s foothold has deepened in many parts of the world. However, data shows that approximately 70 percent of smokers want to quit, yet doing so remains extremely difficult because nicotine is addictive. Data from the US Centres for Disease Control and Prevention (CDC) indicate that as few as one in ten adult smokers successfully quit each year.
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Moreover, taxation and regulation, instead of reducing smoking rates, appear to be driving smokers to obtain their products through illicit channels. “We always felt that the most powerful interventions to reduce consumption or to address the needs of smokers were not mutually exclusive,” said Dr Yach. “Increasing excise tax above inflation has not made much progress in many countries. Despite this, some now want to push for a 50 percent tax increase, which would only drive illicit trade through the roof.”
He added that smoking cessation, which should have been a cornerstone of medical and public health interventions, has also failed. “You would expect that primary healthcare clinics in low- and middle-income countries would at least offer nicotine replacement therapies and other cessation products, but that too has been an extraordinary failure.”
The Road to Geneva
As COP11 convenes in Geneva, the call for a more transparent, inclusive, and science-driven FCTC is growing stronger. Whether the convention’s leadership will heed these calls remains to be seen, but one thing is clear: the future of global tobacco control depends on dialogue, evidence, and the courage to evolve.
