Former World Health Organisation (WHO) Director of Research Policy and Cooperation, Professor Tiki Pan, says Low-and Lower-Middle-Income Countries are adopting the WHO position on tobacco harm reduction hook, line and sinker despite stagnant smoking rates and the high morbidity and mortality linked to tobacco in LLMICs.
Professor Pan was involved with the agency during the discussions that led to the formation of the WHO Framework Convention on Tobacco Control (WHO FCTC). However, he now has concerns about how the FCTC has been administered and how it has failed to address the global tobacco problem.
Speaking during the Good COP 2.0 Panel hosted by the Taxpayers Protection Alliance and running concurrently with the 11th Conference of the Parties in Geneva, Switzerland, Professor Pan said LLMICs need to be empowered to develop their own regulations to guide their Tobacco Harm Reduction interventions.
“The reality is that the WHO position is seen as a guiding principle by many low- and lower- middle-income countries simply because many of these countries do not have the capability to evaluate the relevance of evidence to inform their policy. The default is that if the WHO says something about harm reduction, we will honour what they say,” said Professor Pan.
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He said this approach has contributed to stagnating smoking rates in Indonesia, which currently has the highest smoking prevalence in the world at 70 percent.
“That is basically what happened with Indonesia and many other LLMICs. That is partly due to the absence of locally relevant evidence. As a result, there has been reluctance to implement risk proportionate policies for harm reduction products.”
He also spoke on how taxation and policy frameworks in jurisdictions such as Singapore are not risk proportionate.
“The ultimate effect is a low uptake of these products. Because of that, prevalence remains static. Our 70 percent prevalence in males has not moved for many years, and there is an increasing trend among young people,” added Professor Pan.
He noted that Indonesia has a vibrant domestic tobacco industry, with over a million tobacco farmers and a million workers directly employed. He said there are both economic and political issues tied to tobacco in Indonesia, although WHO remains the major obstacle to broad adoption of Tobacco Harm Reduction initiatives.
Indonesia also maintains one of the highest taxes on smoke-free products at 57 percent, which Professor Pan described as retrogressive and inconsistent with the level of risk associated with these products.
He cautioned that although WHO is the elephant in the room, it remains an important organisation that must be engaged constructively.
“WHO is very important to me. However, in the context of Tobacco Harm Reduction, that is a blind spot for WHO. They are blind to evidence. The first issue is a legacy issue, the legacy of bad behaviour from multinational tobacco companies during the development of the FCTC. Multinational tobacco actively and inactively tried to sabotage the whole process of developing the FCTC. That is a legacy of bad behaviour. The second issue is the money. Some philanthropies have a strong hand on how WHO approaches tobacco control policy,” he said. He added that the situation has been made worse by the withdrawal of funding from WHO by the United States government.
Meanwhile, countries that have embraced harm reduction are seeing faster declines in smoking and higher quit success rates. The United Kingdom and New Zealand, for instance, have integrated vaping into cessation programs and report year on year increases in quit rates among smokers who use e-cigarettes. The 2022 Cochrane analysis notes that smokers given e-cigarettes in trials are more likely to quit than those using conventional therapies. Population studies have also shown higher quit success among smokers who vape compared to those who do not use any cessation aid.
A recent report by Dr. Derek Yach and physician Dr. Delon Human, titled the ‘Saving Lives Report’, shows that integrating 21st century innovations into tobacco control- including Tobacco Harm Reduction products, improved cessation support and early disease detection- has the potential to significantly reduce smoking related mortality by 2060.
The study reviews current smoking patterns and models the impact of broad adoption of safer nicotine alternatives such as e-cigarettes, heated tobacco and snus, assuming an 80 percent reduction in toxic exposure and a 70 percent reduction in harm among those who switch.
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The report suggests that embracing harm reduction alongside conventional measures could double the number of lives saved compared to current policies alone. Across 23 countries analysed, more than 14 million additional premature deaths could be averted by 2060. Extrapolated worldwide, over 100 million lives could be saved, preventing more than 3 million deaths a year. With the exception of vaccines, there are no other health interventions capable of achieving such large and affordable health gains.
The consistent finding is that millions of premature deaths could be averted by 2060 through the added impact of harm reduction and related innovations. For example, an analysis presented by experts in 2025 covering 23 countries projected that integrating Tobacco Harm Reduction, improved cessation and lung cancer screening could save more than 14 million additional lives by 2060, which is 25 to 50 percent more than relying on FCTC measures alone.
