With the World Health Organization, the United States Should Get What It Pays For

Next month, the World Health Organization (WHO) will convene the eighth meeting of parties to the Framework Convention on Tobacco Control (FCTC) in Geneva, Switzerland. The United States is sending a delegation to this international meeting; however, our nation’s representatives will only be able to participate under observer status since the Senate never ratified the FCTC. This does not mean Congress and the Trump administration should ignore what WHO is up to in the realm of tobacco regulation, particularly given America’s status as the largest contributor to the international body.

The WHO, part of the United Nations (UN), through the FCTC has adopted severe restrictions and borderline antagonistic positions regarding interaction with the tobacco industry. This is in complete contradiction with the policies of the US government regarding efforts to mitigate the public health harms associated with tobacco consumption. While the FCTC text itself does not suggest this kind of behavior, subsequent guidance documents and interpretations of the FCTC, released many years after its initial adoption, have progressively ratcheted up the language of exclusion towards the tobacco industry.

The “Model Policy” of the WHO, and the UN more broadly, now states that “engagement with the tobacco industry is contrary to the United Nations system’s objectives, fundamental principles and values.” The Model Policy also calls for a ban on “any person employed by or providing consultancy or other services to the tobacco industry to be a member of any committee, advisory or expert group or governing board delegation.”

If engagement with the tobacco industry is indeed contrary to the UN’s objectives, fundamental principles, and values, it begs the questions as to what these objectives, principles, and values are exactly. This is because the science patently shows that tobacco products do not present a uniform risk to public health. Nicotine, which is not a necessarily dangerous substance in and of itself beyond its addictive qualities, can be delivered in ways that are demonstrably and significantly less harmful than conventional cigarettes. There’s no need to debate such science here, as the US Food and Drug Administration (FDA) has already endorsed this position by acknowledging what is known as the “continuum of risk” for tobacco products.
In July of 2017, FDA Commissioner Scott Gottlieb, made the following remarks in a speech regarding FDA’s new regulatory approach following a seven year, half a billion-dollar investment in scientific research on tobacco products:

“We believe in the concept of a continuum of risk related to tobacco products, and we believe there is a role for modified risk products. Further, we want to preserve e-cigs as one among a number of possible options for adult smokers and believe that fully transitioning smokers to [electronic nicotine delivery systems] can reduce the morbidity and mortality associated with tobacco use.”

The stark contrast between FDA’s and WHO’s positions is far more than a matter of semantics or difference of opinion. There are serious problems with WHO’s policies towards the tobacco industry, not the least of which is the fact that it is not supported by the science and data. The fact of the matter is that hundreds of millions of people worldwide are not served by the “just quit” approach, whether they are trying to quit or, like many, have no desire to quit. Failing to address this significant segment of the smoker population will lead to worse overall public health outcomes over a strategy that seeks to reduce the harm that inevitable tobacco usage causes these people.

Then there is the matter of US funding of WHO. From 2010 to 2017, American taxpayers, including thousands of farmers, firms, and workers in the tobacco industry, poured nearly $2.8 billion into the WHO’s coffers—by far the largest of any nation. Nearly 70 percent of these funds were voluntary contributions by the government.
The US government should not be funding international agencies driving policies contradictory to those of its own.

FDA has not only embraced the continuum of risk on tobacco products but has been explicitly instructed by Congress to work with the tobacco industry to facilitate the development of reduced-risk products. Yet nearly six times the amount of money spent on tobacco products research over the last eight years was poured into an organization actively undermining the global tobacco industry’s ability to develop reduced-risk products.

This isn’t just bad management. There are legitimate constitutional problems with the US government enabling international organizations that silence the speech rights of Americans, such as the WHO’s Model Policy does.

While it remains to be seen what exactly will come of the WHO FCTC meeting next month, the pretext is beyond disconcerting. Congress and the Trump administration should demand a redress of WHO’s stance towards the tobacco industry and demand the organization adopt an approach in line with FDA’s. The US delegation should not hesitate to remind WHO of America’s outsized role in funding the organization. If these concerns aren’t given sufficient consideration, there needs to be a serious discussion in Congress as to why America taxpayers are “voluntarily” contributing hundreds of millions of dollars beyond existing commitments to WHO.