The WHO’s War Against Nicotine Hampering Discussions on Real Solutions to Tobacco Harm Reduction

The World Health Organisation (WHO) has stepped up its tobacco control fight, by taking the war not only to tobacco but to nicotine. According to the WHO, tobacco companies use nicotine to hook young people into long term smoking. This war on nicotine, has seen the WHO put its focus on curbing and possibly stopping the use of Electronic Nicotine Delivery Systems (ENDS) and Electronic Non-Nicotine Delivery Systems (ENNDS). Although ENDS/ENNDS do not contain nicotine, the world health body argues that ENNDS are not completely nicotine free and that “Even where ENNDS are nicotine-free there are other concerns related to the e-liquid they use, which contains harmful and potentially harmful constituents, which when inhaled may have long-term health impacts”.

Now for some perspective, Medical News Today states that Nicotiana tabacum, the type of nicotine found in tobacco plants, comes from the nightshade family. Red peppers, eggplant, tomatoes, and potatoes are examples of the nightshade family. It also states that nicotine can be produced synthetically. Based on the above, for one to completely stay away from nicotine, they would have to give up not only smoking, but eating certain foods.

It then comes as a surprise that the WHO warns that Electronic Vapour Products (EVPs) and other novel nicotine products threaten progress in the fight against tobacco use across the globe. Research has shown that nicotine is only one of more than 7,000 chemicals, many of which are poisonous, found in the smoke from tobacco products. As tobacco researcher, Michael Russell noted in 1976 “People smoke for the nicotine but they die from the tar”.

Whilst it is agreed that quitting smoking is the best decision any smoker can take, the reality is that millions have tried and failed to quit smoking. This shows that the control and quit measures the body has been prescribing all these years have not worked. Logically, that would dictate a change in strategy. In this case, getting as many people off tobacco products as possible. The change of strategy requires discussing the actual problems being addressed and possible solutions driven by empirical evidence. 

A review of 56 studies on adult smokers by Cochrane Library found that nicotine e‐cigarettes help more people to stop smoking than nicotine replacement therapy or nicotine‐free e‐cigarettes.  Public Health England (PHE) has not only proved that vaping is 95% less harmful than smoking, but it has also found that e-cigarettes are the most popular smoking cessation tool used by smokers trying to quit in England in 2020. As a result, the United Kingdom (UK) has adopted e-cigarettes as part of its tobacco harm reduction measures and has gone to the extent of handing out e-cigarette starter packs in hospitals to help smokers quit smoking. The UK, as a result of its permissive stance on e-cigarettes, has witnessed a significant reduction in the number of smokers over the past decade. They have also put in place strict measures to ensure that young people do not take up vaping. Data from the 2021 ASH YouGov Smokefree Youth GB survey suggest that while some young people experiment with e-cigarettes, particularly those who have tried smoking, regular use remains low.

The solution is appropriate regulation that ensures that ENDS/ENNDS are available to smokers who want to quit and young people are prevented from accessing these products. The WHO’s demonising of nicotine as the evil that tobacco companies use to hook customers to their products is highly misplaced. As a result, the body is waging a war on nicotine and missing the greater battle of decreasing smoking rates that have been stubbornly high for decades. The sooner it is realised that ENDS/ENNDS are not the enemy, the better, as it would afford all stakeholders the environment to discuss real solutions on how the harm related to tobacco can be reduced and ultimately assist smokers to stop smoking for their health’s sake.