Why the World Health Organization’s anti-nicotine policy could keep millions smoking

The World Health Organization (WHO) is pushing for countries to regulate e-cigarettes, nicotine pouches, and heated tobacco just as strictly as traditional cigarettes, even suggesting outright bans. If these recommendations are put in place, they could discourage millions of smokers from switching to these safer alternatives, leading to more deaths and diseases from smoking instead of reducing them. 

Promoting a new position paper titled “WHO Position on Tobacco Control and Harm Reduction,” Director General Dr. Tedros Adhanom Ghebreyesus claims e-cigarettes aren’t promoting harm reduction, via transitioning smokers to a safer source of nicotine, but are instead encouraging a new wave of addiction among young people.  

Instead of switching to e-cigarettes or nicotine pouches, the WHO recommends smokers make use of quit helplines and nicotine replacement therapies. But both these methods have notoriously low success rates and are not readily available or affordable in low- and middle-income countries (LMIC) where the majority of smokers live. LMICs often lack the public health infrastructure of countries like the United Kingdom or New Zealand, which have independently and successfully embraced products like e-cigarettes for tobacco harm reduction. LMICs are often more reliant on bodies such as the WHO for health and regulatory advice, placing a great responsibility on these organizations to provide sound, evidence-based guidance.   

In 2019, the WHO congratulated India, where there are more than 250 million tobacco users and around one million tobacco-related deaths per year, for its ban on e-cigarettes. In 2024, the WHO honored Brazil’s National Health Surveillance Agency with an award for reaffirming a ban on e-cigarettes. E-cigarettes are also banned in Argentina, Thailand, Brazil, Vietnam, and Mexico, where more than 70 million tobacco users live. Cigarettes, which are by far the most dangerous way of consuming nicotine, remain legal in all these countries. 

The WHO paper doesn’t provide any evidence that e-cigarettes or nicotine pouches are, in fact, just as or more harmful than smoking. The safer profile of these products is not just some self-serving claim from the tobacco industry trying to sell these alternatives. That vaping is safer than smoking is acknowledged by some of the WHO’s largest funders, such as the United States, the United Kingdom, and Canada. These countries have different regulatory regimes for nicotine products, but all of their leading health agencies, the Food and Drug Administration, the Office for Health Improvement and Disparities, and Health Canada, agree that e-cigarettes are safer than cigarettes. The gold standard for evidence-based medicine, the Cochrane Review, consistently finds e-cigarettes to be more effective than nicotine replacement therapies for smoking cessation. 

The UK’s National Health Service (NHS) and Cancer Research UK consistently promote e-cigarettes to smokers, regularly debunking the myths that these products are just as or more dangerous than cigarettes. The NHS even offers some smokers free vape kits as part of its “swap to stop” initiative. 

These efforts are bearing fruit. Smoking rates in the UK have declined significantly since the rise of e-cigarettes. In November 2025, the number of vapers in the UK surpassed the number of smokers for the first time. The spread of e-cigarettes, nicotine pouches, and heated tobacco products has given tens of millions of smokers who want to quit— but have failed through other methods—an alternative. Sweden has the lowest smoking and lung cancer rate in Europe because those who wish to use nicotine typically choose snus, an oral nicotine product that doesn’t involve combustion or inhaling smoke. 

There is also a wide-ranging body of evidence demonstrating that the kinds of restrictions Tedros is calling for, whether in the form of higher taxes or bans on e-cigarette flavors consumers prefer, result in more smoking of traditional cigarettes. That’s not a prescription for better public health.

Despite the overwhelming evidence that vaping is dramatically safer than smoking, the WHO persists in its demands that if countries don’t ban e-cigarettes outright, they should be subject to the same taxes and regulations as cigarettes. It should be commonsensical that products presenting vastly different risks should be regulated differently. But the WHO’s advice to put vapes, nicotine pouches, and other nicotine alternatives on a level playing field with cigarettes, if implemented in more countries, will only prolong and sustain death and disease among smokers who want to quit but don’t have the right options that might help them succeed. 

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