The World Health Organization refuses to debate tobacco harm reduction, but why? In this episode of GFN Interviews, former WHO official Professor Tikki Pang exposes how the WHO’s anti-vaping stance misleads governments and fuels misinformation. He calls out the organization for cherry-picking data, ignoring real-world evidence, and prioritizing ideology over science.
Featuring:
PROF. TIKKI PANG
Former Director, Research, Policy & Cooperation
World Health Organization, Geneva, Switzerland
Transcription:
00:10
Brent Stafford: Hi, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV. The fight over tobacco harm reduction is not just a battle over science, it's a war of ideology, politics, and power. Despite overwhelming evidence that safer nicotine products can save lives by reducing smoking-related disease, the World Health Organization, backed by billionaire activist Michael Bloomberg, has doubled down on a global campaign to vilify vaping and push governments toward banning life-saving alternatives to cigarettes. Why is this happening and what's at stake for millions of smokers worldwide? Joining us today to unpack the WHO's anti-vaping agenda is Professor Tiki Pang, former Director of Research, Policy and Cooperation at the WHO and a leading global health expert. For the past five years, Professor Peng has been at the forefront of advocating for evidence-based tobacco harm reduction. Professor Peng, welcome to the show.
01:11
Tikki Pang: Thank you. Nice to be with you.
01:16
Brent Stafford: You've had a long and distinguished career in global health, including 13 years at the WHO. What drew you into the issue of tobacco harm reduction?
01:26
Tikki Pang: It really is my background as a scientist. where really, you know, it's the scientific evidence that really should be driving sort of efforts to improve health. So my own background actually has nothing to do with tobacco or harm reduction. It's really infectious diseases. But about five, six years ago, I was made aware that despite the overwhelming evidence of the potential benefits of alternative tobacco products, these products were not being widely used to overcome the huge epidemic of smoking that we're seeing in different parts of the world. So that really just got to me as a scientist. Why are policymakers, the WHO, simply ignoring this, what I believe is very strong evidence that these products can actually save lives? So that's how I got into it.
02:28
Brent Stafford: So how big of an issue is smoking in Southeast Asia?
02:32
Tikki Pang: Southeast Asia accounts for maybe about 10% of the total burden of smoking globally. Now, you said Southeast Asia. If you include China and India, then, of course, the figure becomes much, much higher. So Southeast Asia, let's say the 10 ASEAN countries, accounts for about 10% of the total smokers in the world and also accounts for about 10% of the deaths. And the deaths, as you know, is about 8 million globally. So it's a pretty significant proportion in my part of the world, put it that way.
03:09
Brent Stafford: So including then as well, China and India, you know, how does it impact men?
03:16
Tikki Pang: Yes, I think across the board. And in fact, I think with maybe a couple of exceptions in some of the former countries of the Soviet Union, globally, I think there is a pretty similar trend that the prevalence is much much higher among the men compared to the women in my own country in indonesia for example we have the frightening statistic of about 65 percent of our men who are spoke smokers two out of three whereas amongst the ladies is three or four percent so yes it's a problem mostly among the men
03:59
Brent Stafford: So considering that the problem is so enormous, why do you think governments and public health organizations are so resistant to adopting harm reduction strategies?
04:11
Tikki Pang: Well, I think there are multiple factors involved in it. I just mentioned four, which I believe are probably the most important one. First is the influence of the tobacco control lobbies and you've already mentioned uh bloomberg they're very powerful they're very well funded and they're very anti-harm reduction so that's the first one the second one is the position of the who in many of the lower and lower middle income countries anywhere in the world who lack the capability to make, let's say, their own decisions as to the value of these products, they look to the WHO for guidance. And as you already mentioned, WHO has a very anti-THR position on that score. So that's the second reason, the stance of the WHO. The third is sort of the legacy of bad behavior. from the multinational tobacco companies. And unfortunately, that legacy has remained. And due to the fact that many of the multinational tobacco companies are actually actively involved in promoting and manufacturing tobacco harm reduction products, that's seen as a big sort of negative on the part of the tobacco control lobby. The fifth is really the economic reality of the tobacco industry in Southeast Asia. Sorry, the fourth factor. And that relates to the fact that in Indonesia, for example, tobacco manufacturing, tobacco farming is a huge driver of, let's say, the economy of the country. Approximately 10% of government fiscal income comes from tobacco taxation. So any attempt to reduce that comes across as being very, strongly resistant due to economic and political reasons. Sorry, I think the last important issue here is the level of misinformation that has gone around around tobacco harm reduction, which is also adding to the resistance on the part of many governments as well as WHO to actually be a bit more open about the potential of these products. man all those points are pretty insurmountable aren't they yeah pretty insurmountable and i think um in my own view it reflects sort of um i don't know i don't know how to put this a position which is almost in irreconcilable okay you have the tobacco control crowd who's objective is an aspiration towards nicotine-free societies. That to me is ideological. It's very unlikely to be reached. And then on the other hand, those of us in the tobacco harm reduction community have a much more pragmatic public health objective. And our goal is to reduce the health impact of smoking So one is ideological, one is practical public health. But to bring the two together, it's very difficult. The platforms that have attempted to discuss this have become very emotional, have become adversarial, have become very acrimonious in that regard. Because it's like when you're arguing about religion, it's a zero-sum game, nobody wins. So that is unfortunately what I think the situation is at the moment, because they're very powerful forces on either side. And, you know, how do we move forward? But once again, it's a question of always, always trying to bring people together. Okay. And I think, you know, as with all debates around, you know, what is the right thing to do based on the evidence? The evidence is like, you know, people like me believe we've seen the very provocative evidence for the potential of harm reduction. The other side will always do what we call cherry picking of the evidence. Science is inherently uncertain. So you can always find studies that say, oh, it's not as good as what the other guys say. So they cherry pick the evidence to support their position. And when you get into that situation, no matter what you say, It's just a complicated situation. But I'm optimistic. I think we should keep moving. We should keep trying to influence the people or the organizations who are most able to sort of move the needle and I think obviously because I used to work for WHO I think WHO as I mentioned to you before is really the elephant in the room okay so I think all of us we should keep hammering at the WHO and hopefully one day things will improve and I think this year with COP coming up okay that's that's one opportunity
09:49
Brent Stafford: You mentioned the religiosity that tobacco control is bringing to this debate. Isn't it startling, though, that you would bring that sense of acrimony to an issue like this? Why nicotine? Why does it bring that out in them?
10:07
Tikki Pang: I mean, there's a saying that says, perception is reality, whatever is the truth. So it is always the view of the tobacco control lobby that no matter what multinational tobacco companies do or say, at the end of the day, they are about maximizing their profits, by selling something that kills people. That's always been the argument. They do not see the reality that many of the multinational companies like BAT, like PMI, like JTI are actually now producing a lot of these alternative tobacco products and they should be seen as being part of the solution rather than being the cause of the problem. But they refuse to accept that. They just say that this is just a smokescreen on the part of the multinational tobacco companies to mask the fact that at the end of the day, all they want to do is continue selling cigarettes. And I think the other sort of what disturbs me about this is that many of the companies that are making some of these innovative alternative THR products are actually much smaller companies. They're not your big multinational tobacco. Some of them are small technical startups, many in middle-income countries. To lump them all together with big tobacco is just unrealistic in my view.
11:46
Brent Stafford: Well, anybody from North America would point out very quickly that, you know, it was independents, you know, people creating the vape industry that had nothing to do with tobacco companies at all.
11:58
Tikki Pang: Exactly.
11:59
Brent Stafford: And it was at least a decade before they got in in any measure.
12:02
Tikki Pang: Sure, sure, sure, sure. So, yeah, I mean, that's, I think, the battle that we face. And I think what I've seen in the last five or six years since I've been involved in this, there are many, many platforms nowadays that are trying to advocate for tobacco harm reduction. But interestingly, some of these platforms that are open to industry participation are being shunned by the mainstream, certainly by WHO, like the Conference of the Parties, which is part of the FCTC. They do not welcome any tobacco companies in terms of their dialogue. They don't even welcome any of the NGOs, civil society, representing consumers who want to quit smoking. It's just, don't even talk to us. We don't even welcome you. So to me, it's a very extreme position that really needs to change. And I've been alluding to some of your other questions. This is where I think some of the bigger countries like the UK, like Japan, for example, even the United States could take the lead in telling WHO, hey, You know, let's be a bit more open about this, at least discussing this, because at the moment it's not even on the agenda. It's just straight out condemning THR. You know, so the only and you know, I work for the WHO for 13 years. The only thing that will move WHO is the voice of the member countries. okay i can gather 30 scientists 30 nobel prize winners right to the who about thr nothing's going to happen but if the countries make a move that is going to be that is going to be what's going to tip the needle towards the tipping point
14:06
Brent Stafford: Professor Pang, provide us a state of play in Asia, not just Southeast Asia. From what you know, what countries have banned vaping and that are most hostile and which ones are welcoming?
14:19
Tikki Pang: Okay, it's a whole spectrum of, let's say, regulatory laws and regulations which are in place. On one extreme, you have countries like Thailand, and Singapore, which have basically outright banned vaping as well as other alternative products. And basically, there are countries where there is sort of readily available availability of these products with little or sort of no regulation. And there are countries in the middle which are like the two examples. There would be the Philippines and Malaysia and Indonesia, interestingly, where these products are readily available, but with regulations which are either not very rational or a little bit fragmented. And at the moment, these countries' governments are struggling with how best to regulate the market for vaping products. And I would say the most progressive country here would be the Philippines in this region. They've introduced something called the vape law. So they have actually a law to promote and to sort of, let's say, regulate vaping in a way that would address some of the concerns and yet not completely ban the product so that people who want to quit, adults who want to quit, can actually have access to it. Okay, so it's an entire spectrum of activity. And once again, the countries that have banned it have really taken the position that has been promoted by the WHO. And basically, their attitude is, you know, I just even heard this recently from a Ministry of Health official in Indonesia. Basically, this official actually said that vaping is as harmful as smoking. You know, I mean, that is totally against the evidence. But, you know, they would pick and choose. And they would sort of pick on nicotine rather than on all the toxic products that are released by burning a cigarette. I mean, I'm the first to admit that nicotine is not totally harmless. Of course, there are health hazards. And of course, at the end of the day, it's still a form of addiction. But it's much, much less harmful. So, you know, for adults who want to quit, to switch to vaping, you know, the impact on their health and avoiding premature death is just enormous.
17:17
Brent Stafford: Just a few weeks ago, the government of Pakistan took an extraordinary move banning the operations of both Campaign for Tobacco-Free Kids and Vital Strategies. Pakistan froze their bank accounts and heavily criticized Bloomberg's malign influence in the affairs of other countries. What do you make of this? It's pretty strong actions by the government of Pakistan.
17:40
Tikki Pang: they probably see through what those Bloomberg funded organizations are doing, which is truly, I mean, completely ideological and goes against the evidence. I mean, that's in big contrast to the situation in India, which is very strongly anti-THR. So, you know, I mean, I'm happy to see that development in Pakistan. But if you were cynical about it, you would also say they took that position simply because the Indians took the opposite position. So whatever the Indians do, the Pakistanis will do the opposite. But that's a promising move. And I think it probably sends a message to many of these Bloomberg candidates. funded organization that some people are actually pushing back and in southeast asia going back to to the region okay there is a very powerful organization here called sitka i don't know you've heard of them uh sitka is southeast asia tobacco control alliance and they've been very active they've been very vocal they've gotten to the point of actually personally attacking some of us in the region that have been advocating for THR. I don't want to make a big issue out of this to the point that, for example, they've written to people who are employing some of us to say, why is this person advocating for something? that the government is totally against. So it gets pretty ugly. It gets pretty personal. And it's worrying. I mean, we are just voicing our opinions as academics. Here is what the evidence is saying. Why are you not being open about it?
19:29
Brent Stafford: Is the WHO aware of those kinds of tactics? And do you think they might even sanction them?
19:36
Tikki Pang: I wouldn't go so far as to say they sanctioned them. I'm sure you're aware of this. What is interesting is that quite a few former WHO officials, I'm just one of them, I have two former colleagues who are both directors at the WHO in different parts, and even a former assistant director general who was actually responsible for the Framework Convention on Tobacco Control. who have become strong advocates of thr so when we look at this and we when we look at the many independent academics people like david swinger in canada people like uh clive bates in the uk people like anne mcneil okay our our position is we can't all be wrong in in this you know so i think we continue as academics as people outside of the two, especially outside of WHO, to continue advocating through the various platforms that will advocate for THR. I don't think WHO is actively Certainly, they've not been actively trying to counter the arguments that we've put forward. As I said, I'm sure they're aware, but they're just avoiding the debate because opening the debate may mean that they may be forced into a position where they would have to sort of open the debate okay at a formal level such as the cop okay and i can tell you that the only way that is going to happen is if the parties who are members of the cop will actually request who look this is the evidence for thr we want you to have you know, an agenda item on THR, we want you to maybe form a working group to objectively look at the evidence and, you know, come up with some recommendations. Okay. So I hope something like that will happen.
21:53
Brent Stafford: And that brings me to my question is, does the WHO, I mean, do they allow dissent on the issue?
22:01
Tikki Pang: They don't. And basically, you know, This attitude of we don't want to even hear from the people who have something to say about this, it's not even on the agenda to be formally discussed. And certainly any of the COP, even the World Health Assembly, multinational tobacco companies are just completely out of it okay you can't even be in official relations with the with the who unlike pharmaceutical companies you know pharma companies are always well represented they can be observers at who meetings tobacco companies are in the same category as Arms manufacturers don't even talk about it, okay? No, no way. So, you know, you can't even bring it up. So that's the problem.
22:55
Brent Stafford: So how does the WHO, how does COP and the FCTC handle the countries that have the largest state-owned tobacco companies in the world? China's, I mean, how is that dealt with?
23:10
Tikki Pang: it's dealt with in a way that they can they will always focus on the traditional tobacco control strategies of course you know they know very well that china tobacco is completely 100 government owned but they would at cop they would always focus on the parts of the Framework Convention that focuses on reducing supply and reducing demand. But it doesn't include tobacco harm reduction as a possible tool to reduce the prevalence of smoking. So they will continue talking about increasing prices. They will continue talking about education activities. They will continue talking about alternative crops for tobacco. They will continue talking about reducing illicit trade. They will continue talking about a legal limit for buying cigarettes or everything else. but tobacco harm reduction, okay? No, they were aware. Indonesia, China, a few of the African countries are economically, they are economically important tobacco producers. But yet they don't see DHR as part of the problems to reduce the prevalence of smoking. So I've said tongue in cheek, the Framework Convention on Tobacco Control, the name should be changed to Framework Convention on Smoking Control, not Tobacco Control. Once again, it's that ideology of nicotine-free versus public health harms of smoking.
24:57
Brent Stafford: Professor Pang, as you know, the rescheduled COP10, the Conference of the Parties to the WHO Framework Convention on Tobacco Control, happened last February in Panama. During the opening session, the WHO's Director of Health Promotion, Dr. Rudi Kretsch, made a startling statement. I've got a clip here. Let's have a listen.
25:18
SPEAKER_01: The overarching theme for the FCTC COP10, together promoting healthier lives, is an extremely important narrative that is not only a priority for WHO General Programme of Work, for the next couple of years, it also serves as a good basis for mainstreaming WHO-FCTC into various health and development paradigms. While significant progress has been made in recent years, there is no room for complacency as this program is uneven. The moment a government believes it has won the battle against tobacco, the industry seizes the opportunity to manipulate health policies and promote their deadly products. E-cigarettes are the exception to these positive trends. Here, we are increasingly seeing data showing a rapid increase in uptake by children and young people. For this reason, WHO issued a Call to Action in December 2023, which urges strong, decisive action to prevent the uptake of e-cigarettes based on the growing body of evidence of its use by children and adolescents. We continue to need a health promotion approach to tobacco control. Countering tobacco industry tactics necessitates the successful promotion of health and well-being through complementary and essential approaches, such as health in all policies, whole-of-government approaches and whole-of-society approaches.
27:17
Brent Stafford: So Professor Pang, in your opinion, does concern over youth uptake of e-cigarettes warrant a whole of government and a whole of society approach?
27:30
Tikki Pang: I would say it actually discriminates and is actually against the whole of society approach. By focusing on youth uptake, you are totally ignoring the much bigger population of adult smokers who are going to suffer the ill effects of smoking and are going to be a big burden on the healthcare system and then die prematurely. What he said is a typical example of conflating the arguments between what I believe to be a hypothetical risk of youth vapers becoming smokers And on the other side, the potential benefits of THR for adults who want to quit smoking. There are two totally separate issues, but WHO, as everybody else in this field, is conflating it. To me, it's totally hypothetical. There's plenty of data from at least six or seven different countries that have shown that when prevalence of vaping amongst youth goes up, prevalence of smoking goes down. That's been replicated in six or seven countries. That's real world evidence. And yet this conflicting of the arguments, this focus on youth, to me is totally against whole of society, health for all. In fact, to me, it's a very obvious example of inequitable sort of policy. Because you focus on one population and you ignore the big proportion of people who can benefit for it to me that's inequity that's social injustice in fact that is actually an abuse of human rights to put it strongly you know that's what it is let me ask you how can public health shift from an ideological goal of nicotine-free societies to a more pragmatic approach focused on reducing harm and saving lives Okay, I think the public health community probably has a big responsibility. And the responsibility here lies, I think, in two areas. In doing the right kind of research, okay, to, let's say, convince the policymakers that they have to look into this, okay? And the kind of research that needs to be done is really very local, very context-specific. You know, the Indonesian Ministry of Health is, yeah, I mean, they might look at the results of research in the UK or in Japan or in the US, but what they really want is what about the research in the context of Indonesia, which has some special unique circumstances. Okay, so promotion of research, public health research into not just the benefits, but the potential harms of THR products. That's number one. Number two is really the bigger issue of communication. and advocacy? How do you get over this ideological resistance on the part of policymakers in government to start becoming more open to evidence? And unfortunately, on that score, countries like the UK, I'm not sure what the situation is in Canada, certainly in the United States, you have very influential professional organization. In the US, it's the National Academy of Science, the Institute of Medicine. In the UK, it's Public Health England, or what used to be called Public Health England, or the Royal College of Physicians. These bodies have very influential impact on government policy. Those bodies are lacking in many of the developing countries. So, you know, academics do not have the same credibility and influence on policy the same way that developed countries have.
31:46
Brent Stafford: Professor Pang, as you know, the 12th edition of the Global Forum on Nicotine, the annual conference on safer nicotine products, takes place again this year in Warsaw, Poland, from June 19 to 21, 2025. The conference theme is challenging perceptions. Professor Pang, in your mind, what are some solutions to addressing the misunderstandings, misconceptions, and mischaracterizations that are holding back progress for safer nicotine products?
32:18
Tikki Pang: I think the biggest barrier really is to get over this perception that the tobacco industry is not being honest. is not being sincere in their efforts to actually be part of the solution. That perception is so difficult to overcome. There is suspicion, there is mistrust, there is just simply a lack of willingness to be open about it. Now, you know, maybe you can be skeptical, like I visited BAT in December of last year, and the kind of research they're doing in their labs in Southampton on THR products is just simply amazing. They got the best scientists, they're doing the best science. and its CEO actually made a statement. Whether you believe him or not, that's another story. He said that their corporate strategy is that by the year 2030, 50% of their revenue is going to come from THL products and not from cigarettes. Now, of course, the tobacco control lobby will just say, this is just a typical multinational CEO tobacco talk and we're not going to believe in whatever he does. That's the beauty of the GFN in Warsaw, which makes it a little bit unique. There are a couple of other of these THR platforms where they actually say absolutely no industry participation. let alone having speakers from industry. No. Okay. There are platforms like that. GFN is open. Okay. The focus is they allow industry to speak, but to speak on the science, not to speak on the marketing or anything else. Speak on the science, on the research they're doing on THR products. And if more and more of those platforms are allowed to showcase literally the good science that industry is doing. And if those platforms can start to attract policymakers from government, that would be wonderful.