Former directors of the World Health Organization (WHO) are calling for a major reform of the Framework Convention on Tobacco Control (FCTC), saying that adopting a tobacco harm reduction (THR) strategy could save more than 100 million lives globally by 2060.

The urgent call, published in a relevant report, proposes a "reset" in global tobacco policy to embrace innovation and low-risk alternatives like e-cigarettes and heated tobacco products.

The authors, former WHO Policy Research function director Tikki Pang and Derek Yach, a key figure in creating the WHO's tobacco policy in the 1990s, alongside economist Chris Snowdon of the Institute for Economic Affairs and Peter Beckett, co-founder of Clearing the Air, warned that failure to act would cause decades of immense health and economic strain for low and middle-income countries.

The report projects that if 20 percent of the world’s smokers switched to low-risk alternatives in the next 10 to 15 years, smoking-attributable deaths could be cut in half by 2060.  Across 23 countries analyzed, the study suggests over 14 million additional premature deaths could be averted by 2060 compared to current policies.

Extrapolated worldwide, integrating THR, improved cessation support and early disease detection could prevent over 3 million deaths per year, they said.

“Our findings suggest that embracing harm reduction alongside conventional measures could roughly double the lives saved compared to current policies alone. 

Across the 23 countries analyzed, over 14 million additional premature deaths could be averted by 2060. Extrapolated worldwide, over 100 million lives could be saved - preventing over 3 million deaths a year,” the report says.

“With the exception of vaccines, there are no other health interventions that can achieve such massive and affordable health gains,” it says.

The former directors called for courage from governments and health leaders to challenge old dogmas at the 11th FCTC’s Conference of the Parties meeting in Geneva on November 17, 2025, where they expect calls to pile restrictions onto safer nicotine products.

“Low and middle-income countries face decades of immense health and economic strain if urgent measures are not taken,” they said. “It is in this sobering context that we believe COP11 must confront a pressing reality: harm reduction for tobacco is not a theoretical debate but a proven strategy with lifesaving outcomes.”

They point to countries like the United Kingdom, Japan and Sweden as examples where the rapid uptake of vaping, heated tobacco products or smokeless tobacco like snus has led to rapidly falling cigarette prevalence and low smoking rates.

“Heated tobacco product use has surged in Japan, South Korea, Italy, Poland, and Germany…vaping has fast gained ground in the United States, United Kingdom, Russia, and Romania, where cigarette prevalence is falling rapidly as millions transition to lower-risk alternatives,” they said.

They noted that in Sweden, Norway, Denmark, and Iceland, the widespread use of snus and nicotine pouches has pushed smoking and cancer rates to some of the lowest levels recorded globally.

“These countries demonstrate that human behavior can be redirected in safer ways when consumers are presented with viable alternatives,” they said.

By contrast, they note that male smoking rates in countries such as Indonesia, China, Egypt and Jordan still exceed 45 percent.

The report notes that scientific societies and journals must recognize their ethical responsibility to ensure that the benefits of harm reduction are widely understood among healthcare professionals.

“Uninformed or misinformed clinicians remain a key barrier to adoption," they said.

They said that just as public health embraced needle exchange programs and opioid substitution therapy, it is time to apply similar pragmatism to nicotine.

The authors said the opportunity to save countless lives is unprecedented but hinges on bold innovation and committed leadership in global tobacco policy.