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Filipino vapers slam WHO for 'atrociously erroneous' info on e-cigarettes

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Local vaping groups criticized the World Health Organization (WHO) for publishing “an atrociously erroneous” question and answer (Q&A) page on electronic cigarettes (e-cigarettes or vapes). 

“The Q&A has nine questions and every answer the WHO provides is filled with false, misleading or simplistic information,” said Peter Paul Dator, president of The Vapers Philippines. “Stubbornly clinging to their myopic belief that the only way to reduce smoking is for smokers to ‘quit or die’, the WHO conveniently ignores the science supporting e-cigarettes as a less harmful alternative to conventional cigarettes and shamelessly stoops to the level of falsity, propaganda and fearmongering.”

“We have always questioned the WHO’s competence in tobacco control, particularly in recognizing tobacco harm reduction as a public health strategy and the potential for new technologies, such as e-cigarettes, to reduce smoking-related harms. By publishing this disgraceful Q&A on e-cigarettes, the WHO violated every precept of responsible science communication and sound policymaking,” said Joey Dulay, president of the Philippine E-cigarette Industry Association (PECIA).

Dator and Dulay condemned the WHO’s “reckless and irresponsible” decision to publish the error-ridden Q&A. They called on responsible and sensible tobacco control advocates and journalists to speak out and debunk the Q&A with scientific facts.

Initially published on the WHO website on January 20, 2020 and distributed by e-mail to journalists in several countries, the Q&A triggered a barrage of harsh criticisms from vaping advocates who accused the global health organization of misrepresenting the science about vaping risks by exaggerating claims of e-cigarette harmfulness. Faced with mounting criticism, the WHO revised the Q&A on January 29, somewhat backpedaling on its claims against e-cigarettes. The WHO did not e-mail the updated Q&A to journalists.


Half-truths and non-sequiturs 

In his online blog “World Health Organisation fails at science and fails at propaganda - the sad case of WHO's anti-vaping Q&A”, Clive Bates debunks the claims against e-cigarettes in the original Q&A published by the WHO. Bates is a former chief of the U.K. charity Action on Smoking and Health (ASH) and an advocate of e-cigarettes as a smoking cessation tool.

To the question, “Are e-cigarettes and other vaping products dangerous?” the WHO responds by stating that there are many different types of e-cigarettes in use, with varying amounts of nicotine and harmful emissions. Bates points out that the WHO employs a series of half-truths and non-sequiturs that confuse relative and absolute risk and ‘safe’ and ‘much safer’, with the seeming aim “to confuse the reader about the comparison of smoking-vaping risks. There is little evidence that vaping emissions are or are likely to be a cause of serious harm, and certainly, nothing comparable to cigarettes, explains Bates. “A product that has 5% of the risk of smoking is five times the risk of a product with 1% of the risk. But for all practical purposes, it is the 95-99% reduction compared to cigarettes that matters for policymakers and consumers.” 

The Q&A claims that “[e-cigarette] emissions typically contain nicotine and other toxic substances that are harmful to both users and those exposed to the vapors secondhand.” This conveys a basic misunderstanding of nicotine, according to Bates, explaining that it is not the nicotine that causes serious harm, but the smoke produced by combustible cigarettes. “Nicotine is a legal and relatively mild and innocuous recreational drug with perhaps 1.3 billion users worldwide. [E-cigarettes] enable users to use nicotine with a tiny fraction of the risk associated with smoking tobacco. Smoking is by far the riskiest way of consuming nicotine and the cause of most of the tobacco-related non-communicable diseases that WHO is supposed to be trying to reduce.” 


Vaping not a gateway to smoking

The Q&A claim that young people who use e-cigarettes are more likely to use conventional cigarettes is true but highly misleading, according to Bates. “[E-cigarette use] does not cause cigarette smoking. Far more likely is those same influences that incline young people to smoke also incline them to use e-cigarettes.” These factors, explains Bates, might include genetics, family circumstances, mental health, school environment, delinquency, and risk-taking behavior, among others. “This is known as ‘common liability’. It also means that [e-cigarettes] are more likely to be beneficial to the young people who use them because vaping may be diverting them away from smoking.”

According to Public Health England (PHE), “the evidence does not support the concern that e-cigarettes are a route into smoking among young people”, noting that “youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked.” Experts attribute this to how the UK government has embraced a harm reduction approach with good effect while also effectively regulating access to vaping products in order to protect the youth. 


Illicit additives, not e-cigs, to blame for US vaping-related lung disease outbreak

The Q&A claims that there is growing evidence to show that e-cigarette use could cause lung damage, referring to the outbreak of vaping-related serious lung disease cases in the US last year. “This is a shameful and outright falsehood. On the contrary, there has been growing and now conclusive evidence that this outbreak has nothing at all to do with e-cigarettes.” 

In its breakthrough report released in November 2019, the US Centers for Disease Control and Prevention (CDC) identified vitamin E acetate oil in illicit refillable e-cigarette products as the culprit. According to Bates, vitamin E acetate is used in cannabis (THC) oils to ‘cut’ or dilute the liquid without reducing its viscosity. “This appeared primarily in the US illicit supply chain and was done for fraudulent economic reasons, i.e. to make more money from expensive THC oil by diluting it.”

The PHE noted that e-cigarettes containing nicotine are more tightly regulated in the UK than in the US. THC and vitamin E acetate oil are not permitted in e-cigarettes in the UK. The agency said that similar restrictions on e-cigarettes apply across Europe under the European Tobacco Products Directive. To date, no vaping-related cases like in the US have been reported to the European Union Early Warning System Network.


Glaring conflict of interest

In October 2018, 72 independent experts with no connections to the tobacco industry wrote to the WHO Director-General urging the Geneva-based organization to embrace innovation and more actively include tobacco harm reduction (THR) in its strategy to tackle the burden of smoking-related disease. The experts appealed to the WHO and Parties to the Framework Convention on Tobacco Control (FCTC) to advance THR in the biennial Conference of the Parties (COP) of the FCTC. 

The WHO FCTC is an evidence-based treaty that reaffirms the right of all people to the highest standard of health. The COP is a biennial gathering of all the tobacco control delegates from signatory countries to discuss and decide on action plans with regards to the treaty. The funding for the activities of the WHO, specifically the FCTC comes from numerous sources, such as contributions from member countries/signatories, the World Bank, and private donations. This is not unusual given that the WHO is a nongovernmental organization (NGO). 

“What is unusual is the lack of transparency on the private donations and whether or not these funding sources have any undue influence on the workings of the WHO FCTC in its decision-making process,” writes Nancy Loucas in her article "Things that make you go hmmm…" in the Aotearoa Vape Community - NZ Vape Advocacy website. Loucas looked at the WHO FCTC budget for 2020-2021 and found a glaring conflict of interest: of the $22M WHO FCTC budget, $10M was contributed by private funders who are anti-vape.  

“WHO ignores a giant conflict of interest embedded in its operations,” writes Bates. “WHO’s work in this field is also built on a conflict of interest that should be a source of real concern to those involved in WHO governance. 

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