Clive Bates, a prominent policy expert with strong views in the field of tobacco control and former director of the Action on Smoking and Health in the UK, was invited by chair of the session Prof. Konstantinos Farsalinos to compare the original expectations of the FCTC with its current reality. Mr. Bates argued that the current focus on nicotine and addiction detracts the attention from the primary goal of reducing smoking-related harm.
During his passionate speech on the evolution of the Framework Convention on Tobacco Control (FCTC), which came into force in 2005, Mr. Clive Bates emphasized many times that the objective of the FCTC was to address the problem of smoking; we should never lose sight of this objective and we should return to it every time we lose our focus. Any idea that we are past smoking is wrong, he stated. Globally, we still have 6.3 million deaths per year, and if we add secondhand smoke, we have another 1.3 million deaths per year. Chewing tobacco, smokeless tobacco, although very widely used, particularly in southern Asia, is related to about 57,000 deaths per year. So smoking is the big problem, Mr. Bates stressed. He pointed out that quitting smoking before 40 avoids nearly all loss of life; quitting by age 50, compared to continuing to smoke, gives a six-year life gain; and cessation for 10 or more years yields a survival comparable to that of never-smokers. So, smoking-related death is a problem that is tractable well into the middle age.
After presenting the various policy strategies to combat smoking, including advertising bans, tax increases, warnings on packages and plain packaging, age restrictions, smoking bans in public places and smoking cessation services, Mr. Bates wondered if all this effort has been effective. The answer is not conclusive, as there is no evidence to indicate global progress in reducing cigarette consumption. A reduction of smokers by 24 million and an increase of quitters by 2 million out of a smoker population of over a billion is not exactly a game changer, he said.
The issue of tobacco control has become more complicated in the last decade, the speaker said, with the expansion of available products: tobacco products, vaping products, oral nicotine products, and longstanding smokeless tobacco products. Although many policymakers, including the WHO and the European Commissioner for Health and Animal Welfare, say that there is no evidence; that no long-term data on their safety, or even that the new tobacco and nicotine products pose health risks comparable to those of traditional cigarettes, there is absolutely no basis for that. We have enough evidence to know that all these new products are very much less risky than smoking—and that is just a fact, Mr. Bates said emphatically.
Mr. Bates added that, unfortunately, in recent years the focus moves away from smoking; he presented five diversions that contribute to this loss of focus: 1) risk comparison between traditional cigarettes and the new products, 2) focus on nicotine and addiction, 3) exclusive attention to youth, 4) fascination with the industry, and 5) prohibition of alternatives. Mr. Bates went on to say that no one involved has been considering the fact that people will always turn to nicotine for its benefits (pleasure stimulation, cognitive enhancement, relaxation, mood modulation, psychiatric benefit, enhanced athletic performance, weight control), nor the consequences of the prohibition of alternative products, such as adverse behaviour change, more smoking, more illicit trade, more workarounds. The smuggling industry is getting easier, there’s more technology to back it, it’s becoming easier to thwart prohibition, the speaker pointed out.
Finally, Mr. Bates referred to the upcoming COP-11 conference and to the “utterly appalling paper on harm reduction,” as he said, which is the Secretariat’s effort to block harm reduction discussion. Mr. Bates reminded the audience that “we have to go back always to the objective and that there is one and one only big idea and that is to transform nicotine use from high risk to low risk behaviour.” “Why is this proving so hard?”, the speaker asked.