Experts see tobacco accord as flawed reference for pandemic treaty


Two international public health experts view an existing accord on tobacco control as a flawed framework for a global pandemic treaty, as they underscored the need for a more flexible and inclusive agreement that acknowledges scientific evidence.

In a paper published on the journal Health Security entitled “A Pandemic Treaty: Learning From the Framework Convention on Tobacco Control,” Dr. Michael De Luca and Dr. Mario L. Ramirez said a new treaty seeking to address the shortcomings of the world’s COVID-19 response would fail if it would follow the model of the World Health Organization’s Framework Convention on Tobacco Control (FCTC).

 “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,” Dr. De Luca and Dr. Ramirez said.

“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,” said Dr. De Luca, a Disaster and Operational Medicine Fellow at Department of Emergency Medicine of The George Washington University and Dr. Ramirez, an Emergency Medicine Physician at the Department of Emergency Medicine of Inova Fairfax Hospital.

The authors of the paper said a pandemic agreement should 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,” they said.

They said the FCTC is 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. 

A treaty patterned on the FCTC is also viewed to limit a country’s sovereign authority from rapidly responding to similar Covid outbreaks in the future.

“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,” they said.

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, supported the paper’s conclusion.

“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,” said Dr. Castillo.

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.

Dr. Castillo said that as the pandemic treaty aims to address the world’s existing shortcomings related to pandemic response and preparedness, “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.”

“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 authors of the paper said the FCTC committed three main blunders which should 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 public health experts said the new treaty should be flexible to keep up with scientific developments. 

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 percent 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.

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