David T. Sweanor, J.D. moderated a very interesting panel discussion focused on the decline of public trust in health authorities, with an emphasis on nicotine and tobacco issues. The panellists, Martin Cullip, Filip Tokic, and Mary Stamp, were called to comment on the reasons and the consequences of this mistrust and to propose solutions.
David Sweanor from the Centre for Health Law, Policy & Ethics, University of Ottawa, Canada, opened the discussion stating that in the current conjuncture, with all the innovative nicotine technologies coming forward, those involved in public health issues have to remember that persuasive power is much stronger than coercive power. The issue of trust becomes even more important given the fact that people resist new technologies. Public health professionals want the public to trust them without being trustworthy, without earning that trust. However, the fear that leaders are lying to us is at an all-time high, Professor Sweanor said. Global trust in government is at 52%, and it is even lower in the Western liberal democracies: 41% in the US, 37% in the UK, 37% in France, and 33% in Spain. Smoke kills, but people are not being given sufficient information to make informed decisions. Faith in institutions is much diminished and that has many consequences, including the rise of populist politicians, because people are giving up on the situation that we used to accept as being a good social contract.
Martin Cullip from the Taxpayers Protection Alliance Consumer Center, USA, pointed out that public health is supposed to protect people and not mislead them, but when it comes to nicotine, officials are choosing coercion over empowerment and ideology over evidence. That’s not how you build trust, Mr. Cullip said, and went on to cite some examples. Oliver Varhelyi, the European Commissioner for Health, tweeted that “new tobacco and nicotine products pose health risks comparable to traditional ones.” When asked for evidence, he provided a report comparing nicotine products to non-smoking rather than to smoking, yet the EU Commission still adopted his statement as official policy. The speaker also cited examples of misleading high officials’ statements, as from Dr. Tedros, WHO Director-General, on vapes causing disease and death, and Dr. Krishnan Sarin’s statement from Yale University, who said that vapes cause popcorn lung. Mr Cullip criticized WHO’s “poor communication policies and its inconsistent messaging” which started during the COVID pandemic that led to being at its lowest in terms of public trust. “If people stop trusting the authorities and go ahead unguided –the speaker said – that could lead to very dangerous situations”.
Mr. Filip Tokic, founder and president of CROHM, a Croatian consumer association dedicated to promoting reduced-risk alternatives to smoking, shared his experience with the Croatian authorities. Mr. Tokic described how, in 2013, there were high expectations for the Tobacco Products Directive (TPD) to end smoking. Despite presenting strong evidence and organizing conferences, Croatian health authorities showed little interest. When CROHM launched successful programs like the Stop Smoking Workshop, achieving a 70% quit rate, health officials were upset, viewing CROHM’s efforts as overstepping their responsibilities.
Mrs. Mary Stamp from the New Nicotine Alliance, UK, emphasized the significant role that harm reduction tools played in the sharp reduction of smoking rates in the UK: from 45% in 1974 to 11.6% in 2023. However, the number of people who are quitting smoking is stagnating and at the same time misconceptions about smoking cessation tools like vaping are increasing. A demonization of the tools that help people quit is observed, a trend that is partly due to the decline of trust in public health authorities and in government, although this does not necessarily mean a distrust in science. Mrs. Stamp commented that perhaps the first mistake that was made was the fact that vaping and tobacco were both included in the same bill that is now heading to the committee stage in the House of Lords, because this seems to send a confusing message. According to the most recent survey of Action on Smoking and Health (ASH), a UK organization, the perception that harm reduction tools cause harm is increasing.
Going back to the example of the COVID pandemic, Prof. Sweanor remarked that death toll in the US was a lot higher than it needed to be, due to the distrust of Americans in any health information coming from the government, whereas death toll was way lower in South Korea and in Japan, where people have a much higher trust in their government. He added that COVID policies further destroyed public trust in health authorities; so, it’s no surprise that we now see these misinformed attitudes towards vaccinations, raw milk, etc. in parallel with a rise in populism, Prof. Sweanor said.
Does mistrust on health issues shape political attitudes?
To Prof. Sweanor’s question whether people’s feelings about the authorities lying on vaping, in conjunction with what they experienced with COVID, are shaping political attitudes more broadly, Mrs. Stamp’s answer was yes. She added that the scandals of the lockdowns in the UK led to a drop of trust in government; people turned to the social media for information, and a lot of that information was deeply unreliable. Mr. Tokic agreed that lies about vaping and nicotine are affecting the overall political views of people and added that there is a gap between personal experience with alternative nicotine products and the messaging from health authorities, who consider them bad; this gap is eroding trust in public health. Mr. Cullip agreed that this gap between personal experience and official messages leads to mistrust, which in turn, led to a lot more populist parties entering the European Parliament in the last elections, because people are just rejecting the EU as an entity completely. The authorities must be very careful about what they do, because the public will abandon them, he noted.
How to solve the problem of mistrust?
The question of how the problem of mistrust -now identified- can be solved, was addressed to the panellists by the moderator, Prof. Sweanor. Mr. Cullip suggested that “a bit of humility would help,” and added that in the upcoming WHO COP meeting, he would want the representatives of countries that are doing quite well with harm reduction to speak up to the delegations of countries such as Mexico, India, or France, which are banning alternative products, and tell them that they are undermining public health and depict the WHO in a negative light. Mr. Tokic reply was that telling the truth is the first step. However, he added, Croatian authorities do not even know what the TPD is, and they are just following what the WHO says; so, the change should start there. Mrs. Stamp said that the solution lies in following the evidence-based research and making sure that the right message is getting across.
Discussion with the audience
In the discussion that followed the questions from the audience, Mrs Stamp pointed out that policy decisions are based on political reality, meaning that when the authorities say something unpopular, they lose votes and popularity. It takes time to build trust and, when it’s lost, it cannot be rebuilt overnight. This is why it is important to tell the truth and follow the evidence. Mr. Cullip agreed that even if the evidence says something that is unpopular, you must stick to the evidence and stay consistent.
Professor Sweanor closed the panel with a more optimistic note, saying that despite all the misinformation, barriers, and even prohibitions, the market keeps changing at a remarkable rate and people are moving ahead, regardless of the wrong messages and policies. When there has been a fundamental breakdown in trust in government and authorities in the past, people just violated the law, and the law eventually changed. We have seen that with a lot of health issues, such as the use of marijuana, contraception, and alcohol prohibition. A lot of people involved in health decision making now seem to be aware of that. Let’s remind ourselves that true public health is actually winning globally, Prof. Sweanor concluded.