Adult Smokers Can Switch Habits if Given Appealing and Lower-Risk Substitutes— Researcher on Global Health, Roger Bate

Roger Bate, researcher on global health, pharmaceuticals and regulatory governance contends that World Health Organisation’s Framework Convention on Tobacco Control (WHO FCTC) began with noble ambitions — “to coordinate a global response to the tobacco epidemic through evidence-based, transparent cooperation.”

And under early leadership, it promised inclusivity and scientific rigor but over two decades later, “the FCTC has evolved into a closed process — hostile to scientific dissent, opaque in its deliberations, and resistant to consumer-driven innovation in tobacco harm reduction (THR).”

He made the observation on the first day of the Good Conference of the Parties (COP) 2.0currently underway and that sets the tone for a week of spirited and detailed discussion about evidence-based harm reduction and reform within the WHO’s FCTC.

Attendees heard from leading voices including David Williams, Kurt Yeo, Prof. Tikki Pangestu, and Roger Bate, who discussed and debated the future of the FCTC and its implications for global public health.

In their paper, Bate argues that the FCTC “has become a cautionary model for global public-health governance, its pathologies echoed in the WHO’s COVID-19 response and ongoing pandemic-treaty negotiations.”

“Unless checked, this model risks entrenching an authoritarian and anti-scientific impulse across public health. The THR community must lead the counter narrative — to reform tobacco control and safeguard the integrity of evidence-based policy making.”

At a glance, the four experts recommend: (1) opening WHO FCTC COP proceedings and publishing comprehensive records; (2) elevating comparative evidence on THR tools; (3) building cross-cutting alliances — including nations wary of excessive WHO centralisation; (4) maintaining humility and updating positions if new evidence emerges; and (5) positioning THR as a constructive, consumer-led model for ethical, effective health outcomes.

It was stressed that “despite institutional hostility, consumers continue to adopt safer alternatives and where THR products are widely available and regulated proportionately, smoking rates have fallen faster.”

The UK was used as an example of its steady decline of smoking rates amid broad vaping use; Japan’s large reductions in cigarette sales with heated-tobacco uptake; and Sweden’s near-smoke-free status linked to oral nicotine products.

“These trends are consistent with the core logic of harm reduction,” says the paper. “If you give adult smokers appealing, lower-risk substitutes, many will switch. Evidence from randomised trials and meta-analyses indicates that e-cigarettes roughly double quit success rates relative to NRTs or unaided attempts, with higher user satisfaction and persistence.

“Markets, unlike bureaucracies, are unforgiving about what doesn’t work and they amplify what does. Independent THR researchers and consumer advocates — untied to monopolies or bureaucratic agendas — constitute a remaining bastion of scientific independence in public health. That independence is both a strength and a responsibility.”

The paper maintains that the WHO FCTC’s evolution from scientific collaboration to ideological enforcement “is a warning to global health — a treaty built to reduce smoking-related death now too often functions as a gatekeeper with privileging orthodoxy over outcomes.”

“If replicated through WHO’s pandemic-treaty architecture, this governance model will entrench centralisation, exclude dissent, and make course correction difficult even when evidence demands it.”

There is a better way, says Bate, “Re-anchor global health in openness, proportionality, and pluralism; evaluate tools by results, not by ideology. Let the THR experience — consumer-driven, evidence-oriented, and ethically humble — serve as a positive template for reform.”

“Global health does not need less coordination; it needs better governance,” concludes Bate, who is a Fellow at the International Centre for Law and Economics and a long-time researcher on global health.

His work has focused on counterfeit medicines, tobacco harm reduction and international health institutions. He has a PhD in Economics from the University of Cambridge and has written over 40 peer-reviewed articles and over 1,000 shorter articles.