Twenty years after the WHO’s Framework Convention on Tobacco Control came into force, has the treaty lost its way? According to Jeannie Cameron, the answer is yes. Cameron is a tobacco policy expert with a background in international law who observed the FCTC negotiations from the beginning. She says a treaty once focused on reducing smoking-related disease has morphed into a global system hostile to tobacco harm reduction. From NGO influence and prohibitionist thinking to the demonization of safer nicotine products, tobacco control has drifted far from its original purpose and now risks lives.
Featuring:
JEANNIE CAMERON
CEO/Managing Dir., JCIC International Consultancy
Fmr. V.P. International, Juul Labs
Fmr. Head of International Advocacy, BAT
@JCICJeannie
Transcription:
00:02 - 01:22
[Brent Stafford]
Hi, I'm Brent Stafford and welcome to another edition of regwatch on GFNTV. The who's framework convention on tobacco control was designed to reduce the global burden of tobacco-related disease and death. But two decades on, it appears the FCTC has lost its way, more concerned with demonizing and prohibiting safer nicotine products than reducing the harms caused by smoking. So what happened? How does a public health treaty drift so far from its original purpose? Joining us today is someone uniquely qualified to answer this question, Jeanne Cameron. She's a policy expert with a background in international law who followed the FCTC from its earliest stages and brings deep knowledge of the industry from her time at British American Tobacco and Jewel Labs. Jeanne, it's great to see you again. Thanks for coming back on the show. Great to be here with you again, Brent. So as the FCTC was being developed, you were working on that framework. Please tell us about the FCTC Treaty, what is it, and take us back to when those negotiations began.
01:23 - 05:53
[Jeannie Cameron]
Yes, it was around the year 2001 that I needed a job and ended up working for British American Tobacco in London. Because I did have a background in, I worked for the Australian Government Department of prime minister and cabinet in the international legal area. And the job was coming up to look at this new treaty that was starting called the FCTC. Nobody really knew what it was about back in those days. And so I ended up getting the job and it was to really look at it, advise what might happen, how the process might unfold and what the impacts might be for a company that this was directed at. So I arrived there and I went down to Geneva to the first INB, which was called an Intergovernmental Negotiating Body. And generally there's six of these INBs over three years to a year to develop a treaty. And that's what was worked on with the WHO. I remember going to the first one and it was a bit like a carnival, as I remember. There was sideshows. There was a big death clock of how many people were dying from smoking related diseases. And there were, you know, think giveaway bags. There was lollipops, tobacco industry sucks, for example, and all these sorts of things. things and it was it was unlike any sort of international treaty negotiation i had been at before which i had been when i was in the government i'd been at some some earlier ones so i i was quite surprised by this sort of environment of like fun and activity and this was this was how it was when we went into the doors in geneva at the um the international uh convention center which is where the treaties were all or the FCTC treaty was negotiated, and many of the cops subsequently have happened. At that time, there was a lot of NGOs involved. The NGOs were able to sit in with the government delegates, and there were many of them. I just remember seeing, looking from the public gallery where I was sitting, and there was 20 seats in the public gallery available. And at that time, I really was one of the only one, one or two or three people were there. And the others, apart from me, were largely representatives of the local diplomatic school and things like that. There wasn't any big industry presence. participation or looking but because of my background I knew that you could go in there and observe and so I went down there to observe and it was it was as I said quite quite a carnival and um there were very wild claims at that point coming from uh from from delegations like um We need to put health over trade, which we need to increase tax to something really astronomical. Lots of sort of things being suggested, but without any real cohesion because the World Health Organization had never done this before. While trade departments and diplomatic entities will be very used to negotiating treaties, this was the first time that the World Health Organization actually had undertaken this process. It exercised Article 19 of its constitution to do this. But it was evident almost from that first IMB that they really did have no understanding of the process or how negotiations should happen and all of the factors that a government needed to deal with, not just health, needed to be factored in like trade and tax and other things. And I think the WHO realized that pretty early on because straight away, I think it was IMB 2 or 3, they brought in the heavyweights from the World Trade Organization to chair these IMBs. So, Sachs Correa and Celso Amorim, who were both Brazilian, very distinguished WTO negotiators, to actually try and make the process appear and become somewhat the way that an international treaty negotiation should be.
05:54 - 06:07
[Brent Stafford]
So this is in 2003 is when the treaty was adopted and then went into force in 2005. What was the specific intent that the framers hoped to achieve with it?
06:09 - 07:27
[Jeannie Cameron]
The specific intent, as outlined in Article 3 of the FCTC Treaty, the objective is to reduce smoking and to the impact of smoking on health and to protect people from the harms of smoking. It's very clearly stated. It's still there today. That was the objective. And I think to go back to your previous question, I was working for BAT. We were not lobbying for anything then. We were just observing. So it wasn't as if even the tobacco industry had positions either for or against this treaty or what was happening. It was an observational thing, very quietly in the public gallery. And I think the other thing that I would say is at that time, we were very... well i decided being the first sort of tobacco industry person to to actually sit in the public gallery to be very transparent so when you filled in your form to say where you're from to enter the public gallery i very specifically wrote british american tobacco because i i didn't want it to be seen that i was hiding behind a consultancy so we were always very open in in that in that in that process because it directly at that time related to the smoking of cigarettes
07:28 - 07:41
[Brent Stafford]
Now, in 2007, and this is very interesting to me and I think for our viewers it will be, you published a legal thesis on the FCTC. What prompted you to take a deeper look at it?
07:43 - 11:29
[Jeannie Cameron]
What I found really interesting is when you look at the FCTC, harm reduction strategies were a very central part of harm reduction, demand reduction and supply reduction strategies is what governments needed to do. And it entered into force in 2005. So governments needed to start their national implementation. And I started to notice that you know, that it was things on the periphery of the health of the product that were being looked at and put into practice. And the WHO itself or the FCTC Secretariat started to what's called elaborate guidelines. Now, these guidelines in any sort of treaty thing are there to help governments interpret what they've agreed to. and these they they did one of these uh like two of them a year really and they started to look at areas on the periphery of the product and i started to notice that i felt that this was not really meeting the objectives of of the treaty and i and the more that this went on and the more that i looked at it i was getting concerned that this was moving away from the objective of the treaty and so i was doing a master's in law at um King's College in London. And I actually changed from you could do four subjects or you could do three subjects and a thesis. And I decided at the last minute, really, to choose this as my thesis area. And I spent two years researching it because this whole area of here was a treaty focused on health. that was starting to move away from health and look at all the periphery issues. And that was concerning to me at that time. Also, I might add, I did come back from this and I continued to advise the BAT board and the senior executives of this. I could see from my background how these things, they do develop slowly, but they will get there if all the right. bits are in place but unfortunately at that time there were not really many people that listened to me I guess and that was really across the whole industry at the time because by that time other people like myself in other companies had become involved and everyone was advising their their companies that this was going to impact the industry but as you can imagine back then the tobacco industry was very arrogant in many respects and nothing had really ever hurt it before. And I think it just thought this is another thing coming on that we'll just bat out of the way as the time comes. And I did find that really really disappointing and and and I kept sort of saying to myself one day they'll realize what is happening because you do build a regulatory wall in such a way that the bricks are put in place but you don't realize it until the wall is built what's there because everything is happening in different pieces and I I would often give presentations saying this that you know this is going to happen but it has happened so i i was proven right even though i was writing about this back in in the day uh you know 20 something years ago no no no just on 20 it was 27 2007 i published uh this and it's it's 15 since since preparing for this interview i have re-looked at it and and when you look at it it's exactly correct even as of today what what the situation is
11:29 - 11:41
[Brent Stafford]
One of the things I'd like to point out is that in your thesis, you argue that despite being an international treaty, the FCTC largely governs domestic behavior. So why does that matter?
11:43 - 13:39
[Jeannie Cameron]
It does matter because an international treaty is, the purpose of a treaty is to encourage behaviors in governments where their behaviour will impact on another government. So things like the environment makes sense because what you might do in your country may impact another country by air or climate, you know, aviation, hazardous wastes, arms trafficking, these sorts of things impact across borders. But when it comes to this particular area, the smoking incidents and the harms from smoking really only impact directly in that country. So it really was the first treaty I'd seen or been aware of that actually encroached into a domestic issue and how governments should domestically handle that because it didn't actually have an international aspect outside of that. Perhaps you could argue that advertising, television advertising and and magazines that may have had an advertisement in it may be seen in another place. But apart from that, really, there wasn't anything that impacted another country that was done in your country. Now, the NGOs at the time said, well, yes, advertising is the vector. It's what's carrying cross-border advertising. But, you know, I think most countries, at least... Australia certainly by then and many others had removed cigarette advertising on television and so and on anything that was broadcast internationally so that really wasn't an issue and not a significant enough one to make a massive health treaty over and so that's where I think it differed from other treaties and still is different to other treaties.
13:39 - 13:50
[Brent Stafford]
Is it a matter of a global, unelected organization having undue influence on national issues, national sovereignty?
13:51 - 15:33
[Jeannie Cameron]
Definitely. I think the national sovereignty issue is a really important one. Governments need to be able to make policies that impact them in the way that they understand their population. So I do remember back at the time, I think it was Bangladesh said, look, we will agree to the Article 11 proposals on packaging and labelling, but in our country, people don't actually see the packets because the cigarettes are sold individually or they're sold in a different way. So we're not gonna object to it, but really we'd like to do our policy of how we apply what is needed here in our own way. And so you saw that a bit. But what has happened with the WHO is they've taken those rules and rules, those that that that document and and pushed it out to countries to try and make them implement things which may not necessarily apply to actually solve the problem in that particular country. So governments should be allowed if they're looking at their health issues domestically and they're addressing smoking, they should be allowed to implement their understanding of the relevant elements of the FCTC into their national law in their own way, in a way that will work for them. But the WHO has become very... dogmatic and very stringent in the way that it wants to apply things. And of course, that leads to unintended consequences, which don't actually meet the health objectives of what governments are trying to do.
15:34 - 15:46
[Brent Stafford]
So focusing on today, as you just mentioned, I mean, if you would give it a rating, how are they delivering on its original objective of reducing smoking related harm?
15:48 - 17:33
[Jeannie Cameron]
I'd give it not much at all, maybe one out of 10, because honestly, if the objective was to reduce smoking rates, that has not happened in 20 years. And part of the reason why that is, is because it's shifted focus away from smoking towards nicotine and to other things. And in my mind, it's following the money. I think we have to look at back in the FCTC, the negotiating times 10 years ago or even earlier, the pharmaceutical industry was very involved with the WHO in terms of anti-tobacco activity. And they were a large funder of the WHO's FCTC back in the day. because they were trying to ensure perhaps that their nicotine cessation products and the, I can never say the word, the drugs and things. And that was all related to nicotine addiction and things like that, which were, and actually have ended up, there is the payback in the FCTC where governments are required to work with the pharmaceutical industry to address nicotine addiction, but that's the only reference to it. But I think as time has worn on and where we're up to now, The focus has shifted to be much broader than smoking. In fact, it's almost become focused not on smoking and cigarettes, but on the newer novel nicotine products that we have, which is completely the opposite of what the treaty was about, which I do find very concerning.
17:34 - 17:37
[Brent Stafford]
Is the FCTC now demonising nicotine?
17:39 - 18:57
[Jeannie Cameron]
Yes, I think it is. Nicotine has become the buzzword for the WHO when it never was. It was smoking, which was a legitimate reason. Smoking was causing so many deaths and diseases, and we still know that that's the case. But as newer products have emerged, they have shifted that to cover anything where they can continue to have the remit. And the focus is no longer on smoking. It's on nicotine. And it's a complete... completely ignores any science and evidence that is coming from anywhere or any entity in the world, even in the UK, the Royal College of Physicians, many US other significant health bodies who will tell you and have done years of studies that safer nicotine is safer. It is not as harmful of smoking. And yet the World Health Organization, as the world's leading or should be health body, is completely ignoring all of that science and evidence, which is there has to be another reason, because if the science and evidence is there, why would you ignore it? Are you being paid to ignore it?
18:58 - 19:36
[Brent Stafford]
Well, you bring up a great question. I mean, we do know there's a lot of money coming in from, say, Michael Bloomberg and many of the NGOs that are interacting with the FCTC are Bloomberg funded. So is it possible that the group that. Wales, to use, I think, a very strong word about tobacco influence on these processes are simply unconcerned about the influence that's coming from cultural society, you know, billionaires and so forth. Why is that not influence to be worried about?
19:38 - 21:44
[Jeannie Cameron]
Yeah, it is very concerning and it's really hard to try and work out what is the rationale because the evidence is so clear and yet it is twisted and it is demonized and it is... Every which way that is possible, even the people, the scientists, the doctors who talk about it or talk about what has happened to their patients or consumers who've had very significant success stories of giving up smoking, using safer nicotine products. are demonized themselves they're they're targeted as being uh shrills of the tobacco industry and and almost that argument is no longer valid at all because you know not that there were ever any connections with with the tobacco industry but what they have successfully managed to do is put a very significant us and them uh divide around this debate and and interestingly in the past where you had the tobacco industry almost isolated as being the producer of cigarettes and causing the harms, understandably. Now you've got consumers and the tobacco industry and doctors and scientists and evidence-based institutions and the tobacco industry on the same side against a body that is supposed to be upholding the human rights of health of all and the highest attainable level of human health. All these things are in the treaty. And not just that, not even in just the FCTC treaty. They are in significant human rights treaties from 1966 that most governments in the world are party to. The WHO constitution itself requires that. And yet they're forcing alliances of the good and they are treading what I would call a very bad and unhealthy and un... undemocratic approach to this whole issue.
21:44 - 22:01
[Brent Stafford]
It appears to us in our coverage and to many in tobacco harm reduction that the FCTC and WHO have been leading a campaign of misinformation around safer nicotine products. And in fact, have they not become merchants of doubt?
22:03 - 26:29
[Jeannie Cameron]
Merchants of doubt and merchants of death themselves. They used to claim that the tobacco industry was the merchants of death, but they have become the merchants of death. They have become what they set out to challenge. And I don't even know if they realize that. It's quite incredible because there is so much overwhelming evidence that shows that death and disease continues to be caused by smoking and cigarettes. And yet the most successful product or the most successful way to avoid that is being denied by the health, the world health organization and all of the various NGOs and its funders and its supporters. And I think one of the things that is truly concerning about this is that there's no real challenge to... There is lots of challenge from all of the consumers, the doctors, everywhere, but it's not resonating with policymakers. And that is a huge problem. Why is that happening? And I used to say that... you know, maybe five years ago that this was not happening due to the fact that the harm reduction side was not as well organized as the other side. They certainly don't have as much money, but there were different messages going out. There were all the right messages, but you'd have doctors talking, um, their language, you'd have consumers talking their language. Everyone would be talking language of the right things, but it never was clear, strong and consistent messages from one side of the argument, which from a public affairs perspective is a limitation. Whereas the other side talking against nicotine, talking against safer nicotine products is very well organized. It is very well funded. They are on message. And even back then when I wrote my thesis, and I still believe today, it will become a textbook case of how to do something. They have been so successful. with the wrong issue. But I think the tobacco harm reduction side is getting better. It is understanding more about how to connect those arguments together, how to speak the same language. Because when I go to events and things, you do hear the same sorts of messages. You see much more clever campaigns about how to get this message across. You see targeted You see things that are really conveying the right arguments in the right way, which is causing them to actually fight back all the more. But I think we saw at COP 10 last year for the first time, where I've always pointed to the only way you can change this policy is through national governments at the international level. And you started to see national governments actually standing up to the WHO and the mantra And why is that? That is because doctors, consumers, all of the relevant bodies in those countries got their message across to their governments. And that's the only reason that that would have... Governments wouldn't just dream up we're going to change and now support harm reduction. They were pushed to that by their own... domestic consumers, doctors, et cetera, and listening to evidence and having that information pointed to them to say, hang on, maybe we need to look at this a little bit different because we're acting against the evidence. And I think I'm absolutely hoping that at the next COP, COP 11, that that will happen all the more. And so I do think things are starting to get traction and I'm really hoping that that's the case.
26:30 - 26:52
[Brent Stafford]
So you've talked a bit about the kind of maybe undue influence that's happening on the national delegations. Are they being bullied when we look at something like the Dirty Ash Tree Awards, which just doesn't meet common sense? How much pressure is really being put on national delegations? And is that coming from the NGOs?
26:54 - 31:21
[Jeannie Cameron]
Yes, it is coming from the NGOs. And I mentioned about the carnival event. type environment that existed in the early days. There was the Dirty Ashtray and the Golden Orchid Award and the Marlboro Man Award. There were quite a number of these awards that would come out from different NGO groups competing in those days, NGO groups. And they would award these dirty ashtrays to the country that they felt had sort of let down the side from their side and wasn't doing enough to be against smoking. And governments certainly depended culturally, of course, would be very sensitive to that. If you were, say, Japan, it hit a lot harder than if you were, say, Australia. And people, they didn't like to be outed like that in terms of the governments. It wasn't looking good. So people tried to avoid it. And it did certainly exert a lot of pressure. I think in those early days, you did see a lot of governments and especially at that point, those that did have tobacco industry like Japan and China and Egypt and others that were very, very, very concerned that a lot of pressure was on them because they were tobacco industry sorts of governments. Zimbabwe and Malawi is growing countries. And that pressure was definitely put, but now the pressure has moved away from from that to almost every country that is even considering a harm reduction approach. And they're now the ones who are receiving the dirty ashtray awards because they're, you know, ostensibly trying to water down the treaty. Well, it's got nothing to do with the treaty. My personal view is the treaty is a very good document because it is there to be a framework for governments to address uh the harms of smoking and cigarettes the problem is the interpretation of that treaty and that is where the political side of it has come in because governments are being pushed to interpret it in a way that it was never intended to be but a lot of people say we need to throw the fctc out and come back with something else i would i would say no do not do that because in this day and age you would never get a document that permits harm reduction in the way that the fctc does that actually focuses specifically on smoking and it almost outlines all of the human rights to health that we should be addressing. Use that document as a leverage for what governments should be doing. This is what you signed on to. Why aren't you addressing harm reduction strategies? Why are you not letting consumers in the room when the document says consumers have a vital voice in what is going on? Show them that. That's what you signed to. All these guidelines and other things and other puffery that WHO has taken from that document and used to extrapolate their own agenda, should be almost like put that aside go back to the original fctc which is against smoking permits harm reduction um recognizes all of the things that harm reduction side want to recognize and build on that that's where i would say it it is perfect document the fctc in that sense don't renegotiate it you'd never get that again today And the fact that it doesn't allow amendments and it doesn't allow reservations made it that any government that signed or ratified that treaty has agreed to all those things in there. And 20 years ago, it's still there. And as I've mentioned earlier, the 1966 treaties have been there a very long time. And all those human rights agreements that are enshrined in that. Many governments, of course, abide with and even apply them now. Why not the FCTC in what its original objective was? And that's where I think our pressure should be. Use that document, push governments to agree and do something about what they actually signed on to in 2003 to 5.
31:22 - 31:49
[Brent Stafford]
Jeanne, as you know, the 13th edition of the Global Forum on Nicotine, the annual conference on safer nicotine products and tobacco harm reduction, takes place again this year in Warsaw, Poland from June 3 to 5, 2026. The conference theme is Prohibition and Public Health. In your mind, what are some solutions to address how prohibitionist thinking has come to dominate public health policy around nicotine?
31:50 - 33:04
[Jeannie Cameron]
It's certainly, Prohibition is certainly where things are getting to. If we listen to the mantra and what is coming out of the World Health Organization and the FCTC Secretariat and the NGOs associated with that and Bloomberg, that is definitely there. That is the end game, I think, of where they're getting to. And we need to turn that around. We all know what happened in the US with prohibition of alcohol. We all know it is not the right direction. But we need to really, really fight that at this point. And I think discussing that in Warsaw, discussing some of the solutions that are possible to do that, I have some ideas of certain things that could be done. Consumers will have other ideas of what can be done. We all, from our different perspectives over this issue, have different ideas. And if we can come together in Warsaw, put all those together with some thinking caps on, I think we can actually come out of Warsaw with some clear plans and ideas, having people, everyone having heard discussions that can hopefully move the argument forward, pro harm reduction and safer nicotine products.