[By Taco Tuinstra | 2Firsts] Jeannie Cameron: Taking Stock of Tobacco Control: The FTCT at 20
As part of its media partnership with the Global Forum on Nicotine (GFN), scheduled for June 19-21 in Warsaw, 2Firsts reached out to several scheduled speakers, and asked them about their respective fields of expertise.
Jeannie Cameron is the founder and managing director of JCIC International Consultancy, which specializes in advocating for harm reduction policy.
A specialist in treaty law with a postgraduate degree from King’s College London, Cameron is an expert on the World Health Organization’s Framework Convention on Tobacco Control (FCTC).
In addition to writing a dissertation on human rights, harm reduction and the FCTC, she attended all negotiating meetings to create the FCTC during 2001 and 2003. In this interview, she shares some of her insights as the treaty as it reaches its 20th anniversary.
Jeannie Cameron. Image courtesy of Jeannie Cameron
2Firsts: Do you consider the FCTC a success? What have been the treaty’s biggest accomplishments and its gravest shortcomings?
Jeannie Cameron: There are three measures of treaty success or effectiveness: 1) Has it met the legal requirements; 2) Has it met the national implementation requirements; 3) Have the treaty’s objectives been met? It certainly has been effective in terms of the first measure as it has been one of the fastest multilateral treaties to enter into force globally within a year of being open for signature and ratification. On measure 2 it has also been relatively successful in terms of governments implementing most of its provisions in terms of advertising bans, tax increases, public place smoking bans etc. But in terms of measure 3 it has failed—the FCTC’s objective of eliminating smoking has not been achieved and smoking prevalence has not been reduced.
It’s gravest shortcoming is the lack of acceptance of the harm reduction measures in the FCTC. National governments, all 183 of them that have ratified the treaty, have an obligation to implement supply, demand and harm reduction measures, but only a few have truly embraced and implemented anything to do with harm reduction as a measure to eliminate smoking. This is a complete failure of the treaty to actually address the health and disease caused by smoking—a position led by the WHO, which has global influence on public health policy. A complete denial of the science and evidence that clearly demonstrates that a harm reduction approach is the most effective means of reducing smoking. The tragedy is that smoking could have been almost eradicated in the past 20 years had the science and evidence been embraced by the WHO and national government public health bodies.
Perhaps the biggest accomplishment of the treaty is that it has attracted a great deal of funding to support its implementation—only it has been focused on misinformation and denial of the facts, leading to a public health disaster.
2Firsts: How has the FCTC impacted the development of next-generation products worldwide?
Cameron: It is the interpretation of the FCTC rather than the FCTC document itself that has impacted the development of next-generation products gaining global acceptance. National regulations being brought in by misinformed governments applying the same restrictions on safer alternatives like vaping, nicotine pouches and heated tobacco products that were intended for cigarettes, is preventing them from bringing about the global smoking decline that would occur if they were embraced and permitted. WHO literature continues to frame these innovations to national governments as threats rather than tools.
We’re seeing real-world progress in countries like Sweden, Norway, Japan, and New Zealand, where safer alternatives like vaping, nicotine pouches, and heated tobacco have dramatically reduced smoking rates.
Sweden is the only country in the world deemed smoke-free by the WHO. Sweden permits and encourages the use of nicotine pouches and noncombustible snus, which has been used in Sweden for hundreds of years. When Sweden joined the EEC [European Economic Community] in the 1970s it negotiated a derogation to enable it to continue to permit snus—a policy that has led to it having the lowest tobacco related deaths in Europe and globally.
Japan was an early adopter of heated tobacco products and evidence shows that the smoking rate in Japan dropped significantly. Between 2011 and 2023, per capita and total cigarette sales declined by 52.6% and 52.7%, respectively. Vaping is banned in Japan but shows that heating tobacco rather than burning it is having a significant positive impact in the decline of smoking. PMI, the largest producer of heated tobacco products, now has 43% of its revenue from safer alternatives.
Most vapes on the market in the U.S. are said to be illicit due largely to the prohibitive costs and regulatory hurdles of the FDA [Food and Drug Administration] to gain legitimate market access, resulting in a market full of illegal vaping products. However, evidence is showing that counterintuitively it is this illegal market for vapes which is bringing about a remarkable reduction in smoking in the U.S.
The New Zealand government has strongly embraced a harm reduction approach and its government website provides important information for smokers encouraging them to switch to safer alternatives. This government support for tobacco harm reduction (THR) is showing positive results and smoking rates are dropping commensurately. This is in significant contrast to its near neighbor Australia, which follows the WHO approach.
2Firsts: How do you explain the COP’s hostility to tobacco harm reduction? Is there reason to believe the organization’s stance may shift?
Cameron: The hostility of the WHO and FCTC administrators toward tobacco harm reduction is rooted in a deeply ideological mindset that sees all nicotine use as inherently bad, regardless of the health outcomes. Instead of focusing on reducing the toll of combustible tobacco—the leading cause of preventable death worldwide—the WHO has adopted a puritanical, prohibitionist stance that ignores evidence, consumer experience and common sense.
As for change, it’s hard to be optimistic without significant reform in how the FCTC Secretariat engages with science, evidence and affected populations. Right now, the process is closed, unaccountable and overtly dismissive of harm reduction voices, especially those of consumers. Until that changes, the WHO’s stance is unlikely to shift, no matter how many lives these products could save.
The chief scientist at the WHO has made public comments that all WHO work needs to be rooted in sound science and evidence, but if that is the case he needs to take a closer look at what is happening in the WHO FCTC Secretariat—as its rhetoric is based on ideology rather than any sound science and evidence.
2Firsts: Are there opportunities to engage with COP despite the WHO’s determination to exclude the industry?
Cameron: The COP is the “Conference of the Parties”—the group of 183 national governments that have ratified the treaty. It is the governments that make up the COP, will attend COP11 in November this year and make the decisions. There is always opportunity to engage with government delegations before they set off to a COP meeting; however, this has become increasingly difficult due to pressure from the WHO to prevent consumers, scientists, doctors, industry and other harm reduction advocates to present alternative arguments, present the science and the lived experience of what works to quit smoking.
2Firsts: What do you expect of the delegations from THR-receptive countries, such as the U.K., at the upcoming COP? Will they cite their achievements in reducing smoking as examples of effective regulation, or will other considerations prevail?
Cameron: Decision-making at a COP is based on consensus—unless there is an objection the decision will be in the affirmative. In an environment where there is huge pressure from the WHO, the FCTC Secretariat and the Chair of proceedings to toe the ideological line it is a very brave government that will speak up. Some do and have done over the years at COPs but in general they won't speak up until COP proposals intrude on government red lines or areas that seriously breach national policy.
Diplomatically, they won't rock the boat until their own policies are threatened. If they can just nod along at COP and not have to change anything, because they are already doing things at home, they won't stand up for THR unfortunately. At COP7, the decision documents show that e-cigarettes were accepted as an innovation that could address public health concerns, but this appears to have been glossed over by the documents prepared by the FCTC Secretariat for COP8 and not addressed further.
2Firsts: From a THR perspective, what would be the best-case outcome from COP11, and what would be the worst-case outcome?
Cameron: The best-case outcome from COP11 would be if a number of governments did speak up about the need to accept safer alternatives to address the public health impact of smoking, and to cite the positives that accepting a harm reduction approach would bring, as St Kitts and Nevis did at COP10 last year. One small country put forward a proposal to this effect, which was a significant breakthrough. If this could be replicated at COP11, and ideally across various WHO regions, and if a proposal at COP 11 was tabled and it gained traction among countries to bring about a COP resolution to elaborate guidelines to for governments to implement Article 1(d) on THR it might be the start of an international shift. This is exactly how all other guidelines for FCTC implementation were brought about over the years. Another best-case outcome would be if government’s included harm reduction experts or consumers on their delegations, not just public health officials and diplomats, it might enable more discussion of lived experience and real-life example and lead to better public health outcomes.
A worst-case scenario would be if the FCTC Secretariat were to issue in the COP11 papers 60 days before the start of the COP, WHO-backed papers that seek to guide governments formally toward more stringent restrictions and policy on THR, and to treat next-generation nicotine products similarly with combustible tobacco. Unfortunately, that is the current trajectory.
Editor’s Note:
Jeannie Cameron’s interview offers a compelling and thought-provoking perspective. The contrast between the U.S., New Zealand, and Australia clearly shows how differing policy approaches toward harm reduction products are directly shaping national smoking trends.
Her views serve as a wake-up call: as the FCTC marks its 20th anniversary, the WHO-led path of tobacco control is facing a serious crisis. On one hand, we must ground policy discussions in science and evidence, rather than allow ideology to justify an outright rejection of nicotine. On the other, policymaking must open itself to diverse voices—from consumers, experts, and the industry—instead of continuing down a path of exclusion. The WHO’s monopoly over the global tobacco control narrative is beginning to show its cracks.
This may well be the most urgent lesson—and the greatest challenge—that the FCTC’s two-decade journey has left for the world.
—Alan Zhao, Co-founder and CEO of 2Firsts
2Firsts has been a media partner of the Global Forum on Nicotine (GFN) for three consecutive years.
2Firsts welcomes article submissions, interview opportunities, or commentary. Please contact us at info@2firsts.com or connect with 2Firsts CEO Alan Zhao on LinkedIn here.
