Global health experts believe it is high time the World Health Organisation (WHO) reconsidered its Tobacco Control Policy, the WHO Framework Convention on Tobacco Control (WHO FCTC), which they say has failed to reduce smoking rates, diseases, and deaths over the past two decades.
At its inception 20 years ago, the WHO FCTC outlined strategies to reduce global smoking rates by addressing both the demand and supply of tobacco products. Some of the key strategies included the implementation of price and tax measures to reduce demand for tobacco, protecting people from second-hand smoke through smoke-free policies, offering accessible cessation support to help users quit, and controlling illicit trade of tobacco products to reduce availability, among other measures.
Data from the Tobacco Atlas, 7th Edition, 2022 shows that most people who smoke want to quit, but quitting smoking is incredibly challenging because nicotine is highly addictive. Therefore, most would-be quitters require multiple attempts and adequate support to quit successfully.
Despite the clear roadmap under FCTC, the world continues to lose millions of people due to cigarette-smoking every year. When work on the treaty began 25 years ago, the WHO estimated tobacco-related deaths at 4 million per year. Twenty years after its adoption, the world now loses an estimated 8 million people annually, according to the latest WHO data. About 7 million of these deaths result from direct tobacco use and 1.2 million from exposure to second-hand smoke. Approximately 80 percent of the 1.3 billion smokers globally are from low- and middle-income countries.
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Speaking during a Taxpayers Protection Alliance Webinar, global health expert and WHO FCTC architect, Dr Derek Yach said many of the WHO FCTC strategies have failed to address the core problem.
“The question is, what has WHO through the Framework Convention done to provide better access to lung cancer treatment, to COPD treatment, to tuberculosis treatment, and to ensure that the smokers who have those conditions are given the support needed? The answer is zero. There is no report on progress at all,” said Dr Yach.
He added that even though several interventions have been implemented, including heavy taxation and cessation programmes, little has changed.
“I have made that point a few times, saying that as an international treaty, it differs from other international treaties in the fact that, yes, it does get buy-in from many different countries, and it will produce guidance on what parties can do, but it does not actually measure the outcomes and assess if these things are working, which all the other international treaties do.”
He also blamed the WHO for lacking transparency regarding cigarette-smoking prevalence rates while focusing narrowly on tobacco use reduction.
“There was a study that came out recently, however, what the WHO does not seem to do is focus on reducing the toxicity of products. I think this is tied to the fact that it ignores Harm Reduction as an approach. They say we need to stop people smoking, but they are not keeping up with the increase in population size,” he added.
While the WHO maintains that progress has been made on tobacco control, experts have raised concerns over persistently high smoking rates in many parts of the world. For instance, smoking rates among men in Indonesia exceed 60 percent, while in China they are over 50 percent.
“In many parts of the world, smoking rates among men are 40 percent or higher. That is not success, these are the same rates Europe recorded 60 years ago. When we look at women, the story is a bit different,” he said.
Despite growing evidence, global efforts to implement Tobacco Harm Reduction remain stagnant. Experts note that older, long-term heavy smokers, who make up about 70 percent of tobacco-related deaths and cigarette consumption, stand to gain the most from Harm Reduction approaches. However, little progress has been made on safer nicotine alternatives or nicotine replacement therapy, even as studies from Australia show that vaping can effectively help this hard-to-reach group of smokers, particularly those over 40 or living with depression.
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Speaking during a panel titled “Reflections on the Framework Convention on Tobacco Control at 20” at the 2025 Global Forum on Nicotine (GFN) in Poland, Professor Tikki Pangestu, former WHO Director of Research Policy and Cooperation, said the WHO FCTC has disempowered low- and middle-income countries from making their own Tobacco Harm Reduction decisions.
“The elephant in the room is the WHO. First of all, there is the lack of capacity within many of these countries to independently evaluate their evidence and make their own decisions on policies that are useful to deal with their problems,” said Prof Pangestu.
He also said there is little to expect from the upcoming COP11, apart from more repressive and tighter regulations that will stifle Tobacco Harm Reduction.
“WHO has taken a very strong anti-Tobacco Harm Reduction position. It has continued on that path. In fact, during COP10, it was actually strengthened, and current indications are that it may not change much with COP11.”
