Leading scientists from several countries accuse the WHO of discouraging smoke-free alternatives such as e-cigarettes, snus and nicotine pouches - products that research shows can reduce the risks of nicotine use and help millions of smokers quit. “It's like locking the fire escape because the steps might be a bit slippery,” says Norwegian researcher Karl Erik Lund.
Leading scientists from several countries are strongly criticising the World Health Organisation (WHO). They are concerned about the organisation's approach and messaging around products that can reduce the risks of nicotine use - such as e-cigarettes, snus and nicotine pouches. According to the researchers, the WHO is ignoring the growing scientific support for the relative risks of these alternatives and risks slowing down progress towards a smoke-free society.
WHO: “Harm reduction is a marketing ploy”
The WHO has long warned about e-cigarettes and other smokeless nicotine products, and is calling for tougher regulation globally, with a wide-ranging campaign urging policymakers to regulate them like cigarettes. It also considers concepts such as “harm reduction” to be a “marketing ploy” invented by the tobacco industry to launch new products.
But the 46 researchers, working in the fields of medicine, psychology and public health, argue that this approach does more harm than good. They point out that millions of people have already given up cigarettes thanks to e-cigarettes and similar products.
Via the analysis and media platform The Counterfactual 46 scientists and health workers now calls on the WHO to engage in an open dialogue on smoke-free nicotine products.
“WHO must return to its core values”
Ann McNeill, professor of tobacco dependence at King's College London, says the WHO risks undermining its own mission if it does not open up to a broader and more science-based discussion on harm reduction.
- The WHO already recognised in 2009 that cigarette smoking is a uniquely lethal form of nicotine use, when it classified nicotine replacement products as essential medicines. The evidence that other, smokeless nicotine products - such as e-cigarettes - can reduce morbidity and mortality cannot therefore be dismissed as a tobacco industry scam," she says.
Behind world-leading research
Since 2015, Ann McNeil has led the effort to summarise the research on the health effects of e-cigarettes in the report “Nicotine vaping in England”. It is the most comprehensive independent report to date on the state of research on electronic cigarettes. And Ann McNeil believes that the WHO should urgently bring together researchers with different perspectives from around the world to discuss the issue openly.
- Discussions should cover both the risks of different nicotine products and how they affect both individuals and communities. Most importantly, people with personal experience of nicotine use should be involved. It is time for the WHO to stick to its core values and take a more inclusive and compassionate approach," says Ann McNeil.
John Britton: “WHO has lost its grip on science”
John Britton, Emeritus Professor of Epidemiology at Nottingham University, also strongly criticises the WHO's approach to e-cigarettes.
- Health policy should be guided by science - not prejudice or dogma. "Vaping has already provided millions of people with an effective way out of smoking and benefits both public health and society.
He argues that the WHO's opposition to e-cigarettes is actually helping the tobacco industry.
- By trying to prevent access to less harmful nicotine products, the WHO is contributing to the continued death of millions of people from smoking. This is incomprehensible.
Peter Hajek: “WHO is working against its own public health mission”
Peter Hajek, Professor of Clinical Psychology at Queen Mary University of London, says the WHO's actions run counter to the organisation's stated aim of protecting human health.
- When smokers switch to e-cigarettes or nicotine pouches, their exposure to toxins that cause the greatest health risks is almost completely reduced. Yet the WHO advises smokers against switching, he says.
Peter Hajek led the first clinical studies on how e-cigarettes work in smoking cessation. He believes that progress towards a smoke-free society will still continue - but much more slowly than necessary.
- Future historians will marvel at how the World Health Organisation was able to thwart its own public health goals for so long.
Jean-François Etter: “The WHO's fight has become ideological”
Also Mr Jean-François Etter, Honorary Professor at the Faculty of Medicine, University of Geneva, says the WHO's line on e-cigarettes has lost its footing in science.
- The WHO's mission is to reduce disease and death caused by tobacco, which almost exclusively involves products that are burned. Their recommendations should be based on science," he says.
- Instead, they have launched an ideological battle against smokeless nicotine products, despite the fact that scientists have repeatedly pointed out that this strategy is counterproductive.
Karl Erik Lund: “Closing the escape route is dangerous”
Karl Erik Lund, senior researcher at The Norwegian Institute of Public Health in Norway, summarises the risks of banning or restricting access to smoke-free alternatives in an apt analogy.
- "Closing the life-saving emergency exit that smokers can find in nicotine pouches, snus and e-cigarettes is like locking the door to the fire escape - because the steps can be slippery," he says.
Mr Karl E Lund has also written a comprehensive scientific compilation on the history and development of e-cigarettes, published in 2024.
Ethan Nadelmann: “WHO repeats old mistakes”
Ethan Nadelmann, founder and former director of Drug Policy Alliance in the United States, sees parallels between the WHO's current stance on nicotine and its previous approach to drug policy.
- The WHO took far too long to embrace harm reduction when it came to drugs. Hundreds of thousands of lives could have been saved if they had acted earlier," he says. "Now, the WHO is repeating the same mistake in dismissing technological innovations that could dramatically reduce the harms of nicotine use. Leaders must dare to follow the science - not the politics.
He warns that the world risks a global tobacco and nicotine prohibition regime, with the same failures and costs as international drug prohibition and the infamous ”war on drugs”.
Lion Shahab: “E-cigarettes help people quit”
Also Lion Shahab, Professor of Health Psychology at University College London, is critical of the WHO's latest statements on e-cigarettes. Among other things, the WHO says there is no evidence that e-cigarettes work in smoking cessation.
- There is strong evidence that e-cigarettes are as effective as smoking cessation medicines and have helped millions quit smoking for good, writes Lion Shahab. Quitting smoking is notoriously difficult, and every year millions die needlessly because of tobacco. We must be guided by science.
Lioin Shahab has been researching the health risks of e-cigarettes, particularly in relation to smoking, for almost a decade, by measuring biomarkers in non-smokers, smokers and e-cigarette users.
- E-cigarettes are not risk-free, but they are significantly less harmful than cigarettes. If smokers switch completely to e-cigarettes, the richness of nicotine use is radically reduced. The WHO should support all tools that contribute to a smoke-free society - including e-cigarettes.
Neal L. Benowitz: “Rules are needed - but adults can choose”
Neal Benowitz, Professor Emeritus of Medicine at the University of California, San Francisco, highlights both the risks and opportunities of smokeless nicotine products.
- The biggest concern about nicotine use is addiction, especially among young people - something that obviously requires clear regulation. At the same time, smokeless nicotine products can play an important role in helping people to quit smoking, especially if cigarettes are lowered in nicotine content through legislation, writes Neil Benowitz.
- However, nicotine can also have some positive effects, such as improving concentration in people with attention deficit disorders or other cognitive problems. Adults should therefore be able to make a conscious and rational choice to accept the relatively small risks of smokeless nicotine products in order to realise these benefits.
Neil Benowitz is considered one of the world's foremost experts on nicotine and nicotine use.
A global issue with Nordic relevance
Researchers agree that non-combustion products - such as e-cigarettes, snus and nicotine pouches - can play a role in reducing the risks of nicotine use. At the same time, opinion is divided on how these products should be regulated, and how important they really are for public health.
In the Nordic countries, progress has been rapid, with Sweden close to reaching its target of less than five per cent daily smokers - partly thanks to smoke-free alternatives. Even in countries like New Zealand and United Kingdom In recent years, e-cigarettes have replaced cigarettes as the most popular way to use nicotine. Many experts believe that this experience can provide valuable insights for the global debate.
E-cigs and nicotine pouches in focus in 2025
As the WHO and its member countries review their guidelines on tobacco and nicotine, the issue of e-cigarettes, snus and similar products is expected to become increasingly important in international public health policy.
Sources for this article:
Expert Wall: statements on FCTC and tobacco harm reduction (2025) - The Counterfactual (ed. Clive Bates)
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