Among the numerous controversial bills signed by Trump in his first few days as re-elected President of the United States, is one which would withdraw the States from the World Health Organization (WHO). What impact is this expected to have on tobacco harm reduction (THR)? Experts in the field Clive Bates and Michael Landl discuss.
Picking up where he left off in 2020 before the change of administration, earlier this month Trump reintroduced a bill which would withdraw the United States from the WHO. The U.S. has historically been a key player in global health policies, including tobacco control and harm reduction efforts. However, with its decision to withdraw from WHO, there are significant implications for the future of THR policies worldwide.
In an episode of Vaping Uplugged Podcast, hosted by the World Vapers’ Alliance (WVA) Director, Michael Landl, Clive Bates, Director Counterfactual Consulting Ltd, discussed the best-case and worst-case scenarios of this move, and their respective advantages and disadvantages. The main points of the discussion centered around the influence of the WHO on THR policy, especially in low- and middle-income countries (LMICs), the declining trust in the WHO and the implications of the U.S. withdrawal.
Best-Case vs. Worst-Case Scenarios for THR
The episode highlighted that while the WHO does not have direct authority, it influences policy through “soft power” and recommendations. The organization is known to provide reliable guidance on disease outbreaks (Ebola, Malaria, etc.) but struggles with behavioral health issues like tobacco control. With regards to the latter, it tends to adopt an ideological stance rather than a science-based approach.
Bates explained that a potential benefit of withdrawing from the WHO could be pressure on the organization to reform and improve its scientific integrity, potentially leading to a reassessment of THR policies. This could be likely given that one of the reasons behind the withdrawal, is the fact that Trump despises how the WHO dealt with the Covid pandemic. Such pressure would push the organization to shift towards scientific integrity in THR and focus on reducing smoking rather than banning alternatives. This could lead to more diverse expert involvement in the WHO’s future decision-making.
On the otherhand, the U.S. could fully withdraw without securing reforms. This would likely lead to private entities, such as Bloomberg, stepping in to increase their influence by increasing their funding, and in so doing reinforcing the WHO’s anti-vaping stance. In fact Bloomberg-funded groups have already pushed policies like flavour bans, outright vaping bans, and restrictions on nicotine alternatives. Another possible (and likely) set back, is the fact that the WHO might become more ideological, worsening policies on vaping and harm reduction.
Why is the U.S.’s membership so crucial?
Clive Bates of course hopes for the former, a strategic U.S. negotiation rather than complete disengagement, however like the rest of us, he does not think that this is something the States intends or cares to pursue. “I am sceptical that the US will push for pro-THR reforms or any other worthwhile reforms at this point. Nothing in the wording of the Executive Order suggests a negotiating stance of “no money unless and until the following reforms are underway,” he told Vaping Post.
“I am sceptical that the US will push for pro-THR reforms or any other worthwhile reforms at this point. Nothing in the wording of the Executive Order suggests a negotiating stance of “no money unless and until the following reforms are underway.”Clive Bates, Tobacco Harm Reduction Expert
During the podcast, Bates highlighted that while the U.S. is not a signatory of FCTC, it still exerts significant influence on global tobacco policies, given that it is the main funder of the organization. Hence, withdrawal could weaken science-based policies and empower the European Union, which tends to favour strict regulations like flavour bans and product restrictions. The outcome of this policy shift would undoubtedly have global consequences for tobacco control, and sadly no one sounds optimistic that this will be a postive one.
The U.S. has been a major funder of WHO, contributing a large portion of its budget – another reason why why Trump wants to leave the organization. Withdrawing means losing leverage over WHO’s tobacco policy direction, and countries that follow WHO’s guidance (especially low- and middle-income countries (LMICs)) may double down on anti-vaping regulations, seeing no resistance from the States. The U.S. has previously challenged misleading WHO claims on e-cigarettes, but without its presence, the organization may push even harsher anti-vaping messages, influencing countries to ban or heavily regulate vaping, nicotine pouches, and heated tobacco products (HTPs).In fact, countries that rely on WHO for policy guidance are likely to feel pressured to implement strict anti-THR measures. Many LMICs lack independent public health research and rely on WHO’s recommendations and resources. Hence the WHO’s anti-THR stance could prevent smokers in LMICs from accessing safer alternatives like vaping and nicotine pouches. Moreover, THR could be painted as a Western-driven industry, making governments less likely to support it, and as a result, black markets for vaping products may grow, increasing the risks of unsafe and unregulated products.
What Can Be Done?
Advocacy is crucial – THR experts, researchers, and consumers must push back against WHO’s anti-THR narrative. Moreover countries supporting harm reduction (e.g., U.K., New Zealand) should step up and challenge WHO’s stance, referring to scientific evidence in order to counteract WHO’s misinformation on vaping and nicotine alternatives.
Echoing the sentiment of THR experts worldwide, Clive Bates explained that while he can see where Trump is “coming from,” the path he is choosing is far from being a constructive one. “There’s no doubt that WHO is an astonishingly wasteful bureaucracy in danger of losing public trust and confidence. Having seen its approach to tobacco harm reduction, I no longer trust anything it says on any subject, and I doubt I’m the only one. Was it open-minded and duly sceptical about COVID origin theories? In my view, it was too quick to dismiss the “lab leak” hypothesis. Despite that, I would much rather see it reformed than destroyed.”
“We need a multilateral body to handle pandemics and preparedness, to address the diseases of poverty, to advise on healthcare system reform. We do not need privileged bureaucrats flooding the zone with falsehoods about safer nicotine products and promoting bad policies like prohibitions,” Bates told Vaping Post.