As the World Health Organization works on the creation of a global treaty to address the shortcomings of the world’s COVID-19 response, international public health experts warned that it is doomed to fail if it will be patterned on the framework of an existing accord on tobacco control.
The experts cited the WHO’s Framework Convention on Tobacco Control as an example of a global public health agreement that is no longer fit for purpose after ignoring voices of certain key stakeholders and refusing to acknowledge latest scientific advances.
They cautioned that the pandemic treaty should not duplicate the defects of the FCTC to achieve public health goals. A treaty patterned on the FCTC would also limit a country’s sovereign authority from rapidly responding to similar Covid outbreaks in the future.
Dr. Rafael Castillo, a renowned Filipino cardiologist who served as president of the Philippine Heart Association-Philippine College of Cardiology and the Asia Pacific Society of Hypertension
“Ultimately, WHO and the global public health community would benefit from understanding and addressing the critiques of the FCTC, which could perhaps serve as the closest structural model upon which to build a pandemic treaty,” said Dr. Michael De Luca, a Disaster and Operational Medicine Fellow, Department of Emergency Medicine, The George Washington University and Dr. Mario L. Ramirez, an Emergency Medicine Physician, Department of Emergency Medicine, Inova Fairfax Hospital in their paper published on the journal Health Security entitled “A Pandemic Treaty: Learning From the Framework Convention on Tobacco Control.”
Dr. Rafael Castillo, a renowned Filipino cardiologist who served as president of the Philippine Heart Association-Philippine College of Cardiology and the Asia Pacific Society of Hypertension, agreed. “As the WHO mulls over the creation of a Pandemic treaty to address the perceived failures of the COVID-19 response, review of existing global health treaties such as the Framework Convention on Tobacco Control is crucial to avoid repeating the mistakes of past.”
In December 2021, the World Health Assembly of the WHO agreed to draft an international instrument to strengthen pandemic preparedness and response.
The FCTC is a global treaty on tobacco control under the auspices of the WHO and governed by the Conference of Parties (COP) composed of representatives from all countries signatory to the agreement. The FCTC is set to conduct its 10th biennial meeting in November this year to discuss the progress of the treaty’s implementation and policy recommendations.
“The pandemic treaty is meant to address the world’s existing shortcomings related to pandemic response and preparedness. As such, it must allow for greater flexibility than the FCTC, which not only failed to consider innovative solutions to the smoking problem, but also marginalized relevant stakeholders,” Dr. Castillo noted.
Dr. De Luca and Dr. Ramirez, meanwhile, point to three main blunders with the FCTC that must be addressed if it to be used as reference for the pandemic treaty, harm reduction policies, private-sector involvement, and its impact in low- and middle-income countries (LMICs).
Citing the FCTC’s treatment of novel tobacco products like heated tobacco and vapes, which studies conclude as significantly less harmful compared to smoking and are considered part of harm reduction approach, the doctors stressed that the pandemic treaty should be flexible to keep up with scientific developments. “A pandemic agreement will need to be flexible enough for future technological developments and novel approaches that possibly include harm reduction provisions. Harm reduction methods have been applied successfully in other public health crises such as intravenous drug use and in infectious disease control, most notably with HIV/AIDS.”
“The FCTC continues to fail meeting its targets. The noble public health goal of the tobacco control treaty is to reduce cigarette-related deaths in adults, but it ignores the latest scientific and technological developments on smoke-free products that were developed to reduce smokers’ exposure to toxic chemicals in tobacco smoke. The FCTC is a cautionary tale and clearly shows what not to do for a global pandemic agreement,” Dr. Castillo said.
The paper also noted the FCTC COP’s exclusion of private industries unlike other international agreements, such as the COP on Climate Change which includes a variety of stakeholders. The authors said “perhaps there are more collaborative approaches with private industry that can help make a pandemic treaty more effective,” as the non-collaborative approach of the FCTC COP is not effective.
They also referenced the uneven global impact of the FCTC, stating that although some studies demonstrate a reduction in smoking associated with the FCTC, this association has not been found in low- and middle-income countries. “In these countries, increased consumption above what would have been anticipated without the adoption of the FCTC has been found and according the WHO 80% of the world’s smokers are in LMIC countries,” Dr. De Luca and Dr. Ramirez said.
“One principal role of a pandemic treaty will be in the amelioration of the global inequities in pandemic preparedness and response, particularly in terms of diagnostics and countermeasures… Reflecting on the results of studies assessing the impact of the FCTC, it is essential that a pandemic treaty prioritize measures relevant to LMICs and support sustainable technical and financial assistance to implement these measures,” they said.
The authors concluded, “The FCTC is an important but imperfect model for a pandemic treaty. Ultimately, WHO and the global public health community would benefit from understanding and addressing the critiques of the FCTC, which could perhaps serve as the closest structural model upon which to build a pandemic treaty.”
“Ultimately, a pandemic treaty will be judged on how well it has performed in reducing morbidity and mortality, social discord, and economic damage associated with an infectious disease threat,” they said.