A former official of the World Health Organization (WHO) has called for a new approach to tobacco harm reduction in Asia-Pacific, where smoking prevalence remains the highest in the world.

Professor Tikki Pang, a senior global health consultant for the Center for Healthcare Policy and Reform Studies in Jakarta and a former Director of Research Policy and Cooperation at WHO, spoke at a webinar hosted by the Asia Forum on Nicotine (AFN) on Aug. 17. The event, “The WHO FCTC, 20 years on,” examined tobacco control efforts and the future of harm reduction in the region.

"The fact is that Asia-Pacific, specifically Asia, has the highest number of global tobacco users. The number is staggering. It is 781 million people. That represents 63 percent of the global total of people who use tobacco," said Nancy Loucas, executive coordinator of the Coalition of Asia-Pacific Tobacco Harm Reduction Advocates (CAPHRA).

Loucas said the provisional agenda for the upcoming WHO Framework Convention on Tobacco Control (FCTC) conference in November wrongly dismisses harm reduction as a tobacco industry narrative.

"Despite the fact that Article 1 of the convention implicitly includes harm reduction as a component of tobacco control, there is a failure to acknowledge and support the use of safer alternative tobacco products as an important strategy and tool to end smoking," Pang said.

He added that the WHO’s position runs counter to the evidence. "Despite the overwhelming evidence of the safety, efficacy and cost-effectiveness of these products, and the fact that 130 million people are actually using these safer alternatives, the WHO, FCTC and the COP have adopted a very strong anti-tobacco harm reduction stance, actually stating that these products are as harmful as combustible cigarettes and calling on its member states to ban them and actually giving awards to countries which have done so," Pang said.

The FCTC, which came into force in 2005, has been credited with helping to avert millions of deaths worldwide. But Pang noted its limits. "The Asia-Pacific region bears a very significant burden of these harmful effects of smoking," he said.

Around 8 million people still die annually from smoking-related causes, with most of those deaths in low- and middle-income countries.

Rather than waiting for the WHO to change its stance, Pang suggested that harm reduction advocates in Asia-Pacific create independent, evidence-driven platforms of stakeholders, including producers, consumers and investors. He pointed to the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) as a possible model.

"In the years that I've become a supporter for tobacco harm reduction, and aside from the overwhelming scientific evidence of its value and benefits to health and smoking, I have been struck by the support the cause has received from many quarters, senior former colleagues at the WHO, highly respected academics and professional societies, physicians on the front lines, civil society, consumer groups, and of course, industry," Pang said.

"Reflecting on that, I sometimes wonder, we can't all be wrong. The second reflection comes from Alex Wodak in Australia, and I quote Alex, 'WHO's position on this issue is now as irrelevant as the position of governments in Eastern Europe and the Soviet Union in the 1980s on the future of central command economies. WHO's position will collapse at some point, but I don't know when,'" he said.