The World Health Organization is no longer just fighting smoking—it’s waging an ideological war against nicotine itself. In this blistering interview, former WHO official Professor Tikki Pang exposes how the global health establishment has become evidence-blind, influenced by Bloomberg funding, and driven by a moral crusade that erases the distinction between smoking and safer alternatives. From “harm is harm” rhetoric to regulatory capture, Pang warns that WHO’s stance is fueling misinformation, stifling science, and putting millions of lives at risk.
Featuring:
PROF. TIKKI PANG
Former Director, Research, Policy & Cooperation
World Health Organization, Geneva, Switzerland
Transcription:
00:02 - 01:03
[Brent Stafford]
Hi, I'm Brent Stafford, and welcome to another edition of RegWatch on GFN.tv. For years, the World Health Organization and Global Tobacco Control have waged a holy war, at first against smoking, but now against nicotine itself. In their zeal, they've lost sight of smoking-related disease and death, and are now focusing instead on eradicating every form of nicotine use, even much safer products such as vapes and pouches. It's a moral crusade, dressed up as public health, and now they've said the quiet part out loud. Harm is harm. Joining us today, direct from Geneva, to break down the ideological wall behind Harm is Harm, is Professor Tikki Pang, former Director of Research, Policy and Cooperation at the World Health Organization. Professor Pang, welcome back to the show.
01:04 - 01:06
[Tikki Pang]
Pleasure. Pleasure to be here.
01:06 - 01:16
[Brent Stafford]
So for those unfamiliar with your background, tell us about your role at the World Health Organization and what you observed inside its research and policy operations.
01:16 - 03:48
[Tikki Pang]
I was part of the World Health Organization following the appointment of Dr. Gro Harlem Brundtland in 1998. And she had a vision about WHO playing a central role in the use of scientific evidence for health policy formulation. So she established a new division within WHO called Evidence and Information for Policy. So my job during my 13 years with the organization was to really work with our member countries to sort of say, hey, when you want to develop and implement a particular health policy the first thing you should look at is what is the evidence for example that a particular new drug is safe and that it actually works so that was sort of the raison d'etre for the existence of that division and that's actually what brought me into the orbit of tobacco harm reduction because about five or six years ago and before that I was totally disconnected from this whole area of activity. But a colleague of mine brought to my attention the fact that despite the very strong scientific evidence that tobacco harm reduction could be a very important tool in helping to end the smoking epidemic globally, it wasn't being used and adopted by many, many countries. And that's what triggered my interest. Why is it that in spite of all the evidence, such an important public health intervention was not being adopted. So that took a long story short. But in terms of the broader part, the research policy division was also important in the context of ensuring that research in the WHO member countries followed good ethical guidelines, that it was transparent. We initiated a clinical trial registration, for example, and importantly, that WHO guidelines themselves are evidence-based. So that's the short take on that.
03:49 - 04:02
[Brent Stafford]
So within how the WHO was handling nicotine and tobacco products, at what point did you sense that there might be a clash or a tension between science and ideology within the WHO?
04:03 - 05:36
[Tikki Pang]
This, I guess, happened I mean, following the adoption of the FCTC, which is around 2003, 2005, there was a period when, you know, there was not really a particular emphasis on tobacco harm reduction. But I would say around, oh, I don't know, maybe five, six, seven years ago, when vaping became a little bit more mainstream, became a little bit more popular and sort of uptake of users around the world, that's when the WHO came out with a strongly anti-THR position. And that has in fact become more strong in the last few years. So it has been in parallel with the rise in popularity of electronic cigarettes, of heated tobacco products, and more recently of the nicotine pouches. So it's fairly recent that it has been a particular point of contention between the WHO position and those of us who want to see a more inclusive, let's say, discussion and a more, let's say, risk proportionate position of the WHO.
05:36 - 05:41
[Brent Stafford]
Is their position based on evidence or something like morality?
05:41 - 06:38
[Tikki Pang]
I wouldn't probably say it's mortality. It's probably more ideology, okay? And if you wanted to be polite, you would say that their position is misguided. It is evidence selective. And if you want it to be tough, you would say it's evidence blind. So, you know, it's sort of cherry picking the evidence to say that, oh, you know, we need more research there is evidence that says tobacco harm reduction is as harmful and to the extent of saying that nicotine causes lung cancer you know i mean this is just total nonsense it is really against all the evidence that's out there you know so yeah it's it's misguided it's evidence blind and it's ideological
06:38 - 06:45
[Brent Stafford]
Man, that's hard to hear, and I bet you most people would expect that not to be the case when it comes to the WHO.
06:45 - 06:47
[Tikki Pang]
Exactly, exactly.
06:47 - 07:20
[Brent Stafford]
One of the things that we hear often, and when we were just in Warsaw for Global Forum on Nicotine, just this last June, it was an interview with a South African rep from a THR rep, and she spoke about how they're plainly, that tobacco control people in South Africa are reacting to tobacco harm reduction with the concept that harm is harm, and it's just as simple as that. What does that mean? And is there danger in that approach?
07:22 - 10:10
[Tikki Pang]
You know, I think the sort of the message that I'm hearing is the fact that the people who say harm is harm are totally ignoring what I would sort of say is the concept of relative harm, relative risk. And it's always this conflating of the argument about the fact that nicotine does have harmful effects, okay? But it's significantly by two orders of magnitude less harmful than smoking cigarettes, okay? So when you say harm is harm, you're equating nicotine basically with cigarette smoking, which once again is really flies completely in the face of all the evidence. So, you know, and it translates to the sort of the fact that a lot of the regulations around these products are not proportionate to the risk that these products pose to human health. I mean, I'm not denying that Nicotine is totally harmless. It is not, okay? But compared to cigarette smoking, it's two orders of magnitude less harmful. So harm is harm, but yeah, it's got to be seen in the proper balance. Well, it's such an absolute position. Yeah, I mean, to me, the problem is the perception, okay? Because there are many, many people who will continue to send the message, for example, that nicotine causes lung cancer, okay? And nobody denies the fact that nicotine is an addiction. But in the same way, you know, it's a psychoactive substance. In the same way, I would like... people to think of it in the same way that you look at alcohol the same way you look at coffee you know these are substances which are psychoactive it makes you feel good it reduces stress it relaxes you okay so to me it is not an absolute argument it's seeing it in the right perspective that yes alcohol is not completely harmless in excess it's the same with nicotine you know and it's the same with uh with caffeine i guess if you take you know 20 cups of coffee a day it definitely would have some health impacts so i don't think it's an absolute it's really a relative it's a spectrum i guess
10:11 - 10:25
[Brent Stafford]
If you could, try to unpack for us the impact that funding, certainly from private funders like the Bloomberg Philanthropies, what kind of impact are they having on WHO? And is it an ideological impact?
10:26 - 12:31
[Tikki Pang]
Yes, I basically think so. And, you know, the fact that the WHO gave birth to the FCTC, okay, it's like, you know, you're very protective of the baby. that you gave birth to. And Bloomberg, of course, has been very active in supporting the tobacco-free initiative within WHO. And at the end of the day, and especially during the times, I would say the last 10, 20 years, including the years I was at WHO, the organization was very strapped for resources. And the fact that Bloomberg were able to give very significant amounts of funding to the WHO for the Tobacco Free Initiative, in a way that had sort of a big influence on shaping their position. And also remember that during the development of the FCTC, there is a legacy of bad behavior on the part of big multinational tobacco companies, in the sense they were actively trying to sabotage the FCTC. Okay, the convention itself. So in a sense, WHO's distrust of the tobacco industry goes a long, long way back. And, you know, the tobacco control lobby with all the resources at their disposal. And the thing is, it's not just WHO. I mean, they support so many other initiatives, NGOs around the world that take this very strong tobacco control approach. And, you know, in a sense, the tobacco harm reduction community are completely outdone in terms of available support and resources and in terms of visibility and how loud their voices are.
12:32 - 12:39
[Brent Stafford]
Oh boy, I sure can agree with you on that. Would you say that tobacco control is a global industry?
12:41 - 13:41
[Tikki Pang]
Absolutely. I think that the whole perspective that we are seeing at the moment, which is this aspirational unattainable goal of a nicotine free world or nicotine free societies it's it's definitely a global sort of movement which is you know being maintained by as you know this shift away from ending smoking to nicotine and addiction okay and um you know totally ignoring the fact that you know it is something that is part of everybody's lifestyle. It's just, as I said, just like alcohol and coffee. And it is, I think, difficult to overcome that perception that nicotine is as harmful as the newer, safer alternative products.
13:41 - 13:48
[Brent Stafford]
Certainly framing nicotine that way helps protect their funding and their jobs, does it not?
13:49 - 15:48
[Tikki Pang]
Yes, absolutely. And in a sense, because the tobacco harm reduction industry has not been vocal enough to, for example, say we are transitioning away from combustible cigarettes to safer alternative products. It's not as if the multinational tobacco companies are protecting jobs which are actually continuing to make combustible cigarettes you know that message has already come across i mean pmi is leading the way in the sense that 42 percent of the revenue now comes from safer alternative products but of course the the the bigger problem are those tobacco companies like china in china national tobacco company which is 100 owned by the government okay and you know that obviously the there are a very strong part of the tobacco control community. And once again, they're not protecting just the jobs of the people who manufacture cigarettes, but importantly, the tobacco farmers. And that's a particular problem in my own country of Indonesia. Whenever people try to sort of counter the tobacco control lobby, the counter argument is, well, what about the one million tobacco farmers? They're going to be out of work. What about the one million people who work in the tobacco manufacturing industry? What about the loss in fiscal income that comes from taxation on cigarettes. So it becomes a lot more beyond just scientific evidence in all these arguments, political, economic, social. It's complicated, it's complicated.
15:49 - 16:14
[Brent Stafford]
Professor Pang, at the recent World Conference on Tobacco or Health, even nicotine and tobacco research editor Caitlin Notley warned that the end game has gone off the track from a smoke-free goal to a nicotine-free crusade, which you've mentioned. What does this tell us about the state of tobacco control? I mean, she's prominent with Inside Tobacco Control.
16:15 - 19:13
[Tikki Pang]
No, I mean, you know, the end game strategy is for me a very rational way of, you know, time-based strategy. so that if you're born within a certain time, you are not able to buy cigarettes anymore. But once again, that is really, at the end of the day, in different countries, it's a question of enforcement. And the unintended consequences of that is really what I'm concerned about. In the same way that you would do if you increase the price of cigarettes, for example. Like in Australia, I heard cigarettes are like 40 to 60 Australian dollars a packet. And on top of that, they have banned electronic cigarettes. The minute you go the prohibition step, you end up with an illegal black market. ending up with violence, with firebombing of pharmacies, etc. The Australian situation is particularly bad. So I think, you know, Clive Bates during the GTNF had a very good message. And he said that the future, you know, and the tobacco endgame strategy is part of this. The future strategy should be consent rather than coercion. So anything to do with prohibition or banning or punitive action is always going to end up with unintended consequences. So the idea is to have consent to get consumers to basically buy to buy into the idea of make nicotine use much safer in the long term. So in other words, instead of smoking cigarettes, you transition to the reduced harm products like e-cigarettes and heat not burn. But I think overall, fctc cop 11 i don't see any improvements in in that and i think especially if bloomberg continues to be able to support who to the to the level that it has been and remember who is in very serious trouble at the moment because of the withdrawal of the united states i mean they've got like a 20 hole in the budget so if bloomberg if bloomberg being of private philanthropy will be able to continue supporting the tobacco control lobby within WHO, it makes them even more influential because the WHO is going to be even more dependent on funding from philanthropies rather than from governments.
19:13 - 19:27
[Brent Stafford]
Walk us through, Professor Pang, what the repercussions are when ideology does take control. You've written distorted national policies, misinformation loops, loss of trust. How do these all play out?
19:28 - 21:13
[Tikki Pang]
Yeah, I think the biggest play out is that, given all my years at the WHO, I'm very aware of the influence the organization has on 193 countries around the world. And in more than, I would say, 70% of those countries, which are low, low, middle income, even middle income countries, which lack the capacity to independently assess the evidence, and therefore use that kind of evidence to shape their own policies, In a way they take the easy way out. If this is what WHO says, we will just follow what guidance they provide to us. Okay. And on top of that, it's exacerbated by the fact that they do not have their own research within their own country in order to sort of make whatever policy they want or they need to make around THR sort of context specific. So the repercussions are huge, especially in low, lower middle income and middle income countries, because, you know, it's the WHO, the brand of the WHO is still so powerful. that countries will just say, okay, if this is what WHO says, it must be right. And that's the worrying part. It's wrong. They're looking at a policy position that's totally evidence blind. And it's not that the countries fear WHO. Countries don't fear WHO. Countries look up to WHO for guidance. Unfortunately, in this case, it's the wrong kind of guidance.
21:14 - 21:20
[Brent Stafford]
So WHO, like no doubt, is shaping regulations in these countries.
21:20 - 23:02
[Tikki Pang]
Oh, absolutely. Absolutely. It's shaping regulation. But I think the other thing that is also striking to me is the following argument, tobacco harm reduction is i would say technologically still a fairly new field okay okay you can say that electronic cigarettes maybe 15 years even 20 years heated tobacco products much more recent nicotine pouches much more recent so the view here and this was i mentioned at the gtnf in russell's is that the regulators have not been able to keep up with the technology it's moving so quickly they're scrambling okay they're just doing knee-jerk sort of reaction in terms of what regulations they feel is needed so that's why you end up around the world with this hot sports mix of regulations you know from no regulation at all some regulations all the way to complete bands okay and the technology is just moving so much faster than what the regulators are able to keep up. You know, it's exactly like what's happening now with artificial intelligence, okay? It's moving so quickly, you know, that even the people doing AI, they can't keep up themselves, let alone those who are supposed to regulate it. You know, so we're living in this kind of world where the regulators are just, I don't know, 10 steps behind the technology.
23:03 - 23:54
[Brent Stafford]
Professor, the Conference of the Parties, COP 11, is shaping up to be the most consequential tobacco control meeting in a decade. A leaked EU document reveals that Brussels plans to back language treating nicotine itself as a public health hazard, on par with or even worse than tobacco smoke. Under Agenda 4.5, the EU reiterates its support for strong regulation of ENDS and nicotine pouches, which could include a ban. The World Vapors Alliance calls this a willful denial of science and a reckless disregard for millions who rely on harm reduction. And what's striking, Professor, is that this agenda reframes nicotine to be essentially as bad or worse than smoke. What do you make of that?
23:56 - 28:41
[Tikki Pang]
Oh, wow. I mean, it's just perpetuating the fact that this basic misunderstanding that, yes, nicotine is not completely harmless, but the relative harm compared to smoking is two orders of magnitude less. And how do you counter that? it's like you know if you look at the history of the smoking of combustible cigarettes you know people who smoke i mean they do that because they have pleasure okay it's a psychoactive substance nicotine is the psychoactive substance that makes people feel good it helps them relax it's um fuels or social interactions, okay? But people forget that it's not the nicotine that causes heart disease, lung cancer, diabetes, et cetera, et cetera. It's what you release when you burn the cigarette. And it's sort of always going back to sort of the argument that if we can't attack smoking will attack nicotine. That's been the shift and will attack addiction. But addiction is a very difficult human behavior to change. You can't always pursue the cold turkey I mean, it works for some people. Some people have the willpower, if you like, the determination to just quit cold turkey. But for the majority of smokers, all these other, the nicotine replacement therapies, the chewing gum, the nasal sprays, very strong evidence that they don't work. Whereas the evidence for THR, helping people quit smoking, is overwhelming. this conflating of the arguments just continues and continues okay and once again you know i'm it's like i'm repeating myself when the argument is ideological rather than pragmatic public health then it's like never the twins shall meet okay that's what's frustrating about it you know it's it's like When you're in a dinner conversation and you're arguing about religion, okay? It's a zero-sum game, okay? And one of my friends, THR Arthur Kidd, he actually tells me, you know, don't waste your time arguing with these people. Just let them be wrong. I mean, you can take that path because it's like when during COVID, when I tried to talk to people who refused to accept the vaccine on ideological grounds, okay, it's my body, it's my human right not to take the vaccine. I can't, despite all the evidence I throw at them, it's not going to change their mind. It's the ideology. It's an emotional issue. The entire tobacco harm reduction community to come together to form a stronger united platform working together across a range of different stakeholders to be able to slowly change the overall narrative which is i think i've put it very nicely okay which is make nicotine use much safer, okay? Not directly confronting the WHO, but, you know, basically, I think my main concern is that at the moment, many of us, there are many of us expressing our own voices, many of us through our own channels, but we are very fragmented. What we need is a more united effort across all stakeholders, perhaps identifying a common goal like make nicotine use safer, and together as a force across all those stakeholders be able to I keep saying this, to make the WHO position irrelevant. You know, walk around the barrier.