WHO Framework Convention on Tobacco Control Learnings.

We are pleased that the World Health Organization (WHO) is developing a pandemic treaty to improve the global response to future pandemics. In their article, De Luca and Ramirez rightly argue that a pandemic treaty should be informed by experiences with WHO’s existing treaty, the WHO Framework Convention on Tobacco Control (WHO FCTC), which came into force in 2005. However, the authors have mischaracterized the WHO FCTC and made criticisms that could hinder a productive discussion about a treaty for pandemics. The authors identify a limited emphasis on ‘‘harm reduction’’ as a key limitation of the WHO FCTC. However, the treaty itself includes ‘‘harm reduction strategies’’ in its definition of tobacco control. As the authors indicate, harm reduction encompasses actions ‘‘aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely or permanently.’’ The WHO FCTC and its guidelines for implementation—which include requiring smoke-free public places; banning tobacco advertising, promotion, and sponsorship; and reducing the attractiveness of tobacco products by limiting flavoring agents—allow the continuation of product use, while reducing the negative effects. Further, the treaty applies to all tobacco products, including products beyond cigarettes. The Conference of the Parties to the WHO FCTC, the governing body of the Convention, has outlined measures that Parties should prioritize to address the challenge of tobacco products, such as heated tobacco products, as well as policy objectives and options for Parties to consider in regulating electronic nicotine delivery systems and electronic non-nicotine delivery systems. It is also crucial to point out that the relationship between the tobacco industry and tobacco-caused death and disease is very different than the relationship of pharmaceutical and other companies to an infectious disease pandemic. The tobacco industry’s own products are responsible for the deaths and diseases the treaty addresses. This is not the case with a pandemic caused by an infectious agent. Tobacco companies are driven to sell their products and find new users, which is a fundamental and irreconcilable conflict