More than 100 global experts have called out the World Health Organisation (WHO) for its hostile and baseless stance against Tobacco Harm Reduction (THR), claiming that its prohibitionist approach is contributing to millions of avoidable smoking-related deaths around the world.
In an open letter addressed to the delegates of the Ninth Session of the Conference of the Parties (COP-9) of the Framework Convention on Tobacco Control (FCTC) taking place next month, a group of independent experts in tobacco and nicotine science and policy have urged the body to “modernise” its approach to tobacco policy.
Comprising of seven key points underlining the potential contributions of Tobacco Harm Reduction to public health and six recommendationsfor WHO’sstance on this strategy, the letter laments the organisationfor continuously overlooking the reality of less-harmful nicotine alternativesand slams it for being “dismissive of the potential to transform the tobacco market from high-risk to low-risk products”. The letter further encapsulates how cigarettes and other smoked tobacco products are responsible for the “vast majority” of deaths caused by tobacco use globally, and that smoke-free nicotine products “offer a promising route to reducing the harms arising from smoking”.
Despite evidence from countries such as Japan that have seen record decreases in combustible smoking right after smoke-free products were made available in the market and the fact that countless public health authorities havedeemed vaping to be significantly less harmful than combustible cigarettes, the WHO has held a rather irrational and unscientific view of these alternatives. 
“There is compelling evidence that smoke-free products are much less harmful than cigarettes and that they can displace smoking for individuals and at the population level,” the experts write in the letter. They acknowledged that there was “uncertainty as to the benefits and risks” associated with the products. “However,” they added, “we must also consider the substantial body of evidence we do have and not allow excessive caution or residual uncertainties to deny smokers promising options to switch away from the combustible products that we know with certainty are lethal.”
Smoking causes a massive burden of death and disease worldwide, killing about eight million people annually. With the availability of smoke-free alternatives – products that do not produce smoke, slashing the harm otherwise inflicted by cigarettes through its toxic smoke, and only deliver nicotine at a relatively safer level – there is a possibility to cut the risks for people who cannot or do not want to quit using nicotine. Yet, the usual practice for tobacco-control remains to insist that smokers should just stop, even though we know millions of smokers simply will not do that and millions will continue to take up the habit. THR refers to a public health strategy that aims to mitigate the harm caused by tobacco products like a cigarette by using less harmful alternatives, such as e-cigarettes, vapes, snus, and heated tobacco products (HTPs). It presents a public health opportunity to improve the lives of people who use traditional cigarettes and cannot or will not stop.
The first step to reap the benefits of the THR approach is, however, the acknowledgement of reduced-harm products and their role in helping smokers to quit smoking by switching. Multiple studies around the world have already concluded that vape products are far less harmful compared to cigarettes and even has the efficacy in getting smokers to eventually quit. Public Health England (PHE) posits that e-cigarettes carry 95% less harm than traditional combustible cigarettes. 
The next step is to introduce appropriate and sensible regulations for these alternatives that are differentiated from tobacco products to enable smokers to have access to themand support them in their journey to better health.
Countries that have had the biggest success in reducing smoking rates are doing so by focusing on innovative harm-reduction interventions and actively helping smokers to switch to science-backed alternatives. Smoking rates in these countries including the UK, New Zealand and Japan have fallen twice as fast as the global rates. 
Pakistan is a country where over 16 million adults are active smokers. Repeated tobacco control efforts are made from time to time, only to show little to no improvement. With THR now being globally recognised as an important public health strategy and the mounting evidence showing its positive impact in bringing down the rate of smoking, there is significant potential for Pakistan as well to identify itself among the world leaders in tobacco control. The question is, are we ready to embrace science and innovation to reduce the burden of tobacco-related diseases and premature mortality in the country as quickly and deeply as possible?

— The writer can be reached at rkhan778@gmail.com