GENEVA — Up in the convention center balcony on Day 1 of the World Health Organization’s tobacco treaty negotiations last week, two men posted invitations to a party on the lake.
The event, called the “Nicotine Is Not Your Enemy Soirée,” was held at La Potinière, a posh restaurant with views of the city’s soaring Jet d’Eau fountain and the Alps beyond.
There, guests enjoyed tapas and an open bar, passed around e-cigarette samples and listened to an industry advocate, Bernhard-Michael Mayer, scorn anti-vaping activists for insisting on proof that e-cigarettes aren’t harmful. It’s impossible, he said, to prove that even a piece of fruit is entirely harmless.
To Dr. Mayer and the party sponsor — the Consumer Choice Center, which is partly funded by the tobacco industry — the message was urgent. Down the road, delegates from 137 countries were debating whether to crack down on e-cigarettes and other nicotine delivery devices — or embrace them as safer alternatives to traditional cigarettes.
The delegates were there for the regular biannual session to update the health organization’s world tobacco treaty, formally known as the Framework Convention on Tobacco Control. Since it took effect in 2005, the treaty has had an enormous impact on public health. It is credited with reducing tobacco use in many countries through advertising bans, graphic package warnings, smoke-free workplaces, and tobacco taxes, among other controls.
But this year the delegates, along with public health regulators around the world, are facing a new, pressing question: what to do about the explosive growth of alternatives to combustible cigarettes. Among the devices being grappled with are e-cigarettes, through which users inhale flavored nicotine vapor; so-called heat-not-burn devices, which warm tobacco sticks but do not release carcinogens by igniting them; and new electronic products like Juul, a flash drive look-alike whose popularity has made it a scourge in American secondary schools.
All boast to be safer than traditional cigarettes because they do not create the toxic smoke that comes from burning tobacco. But there are unanswered questions about the health effects of the chemicals that users do inhale, and public health officials worry that the devices are luring too many nonsmokers, creating new generation of nicotine addicts.
“Every jurisdiction in the world is struggling with e-cigarettes,” said Dr. Judith Mackay, a longtime tobacco industry expert and senior adviser to Vital Strategies, the global health advocacy group, at the event. “Do they encourage young people to start smoking, and do they actually encourage smokers to quit? It will be a few years before we know the answer.”
The stakes are high for the big tobacco companies, which have increasingly bought up small vaping companies, and launched new alternative nicotine products in the face of declining smoking rates and threats to impose ceilings on nicotine in traditional cigarettes to reduce it to levels that don’t create addiction. Philip Morris International, British American Tobacco and other traditional tobacco companies now sell alternative nicotine delivery devices.
And so, though the negotiations were closed to corporate interests, the prospect of reaching 137 countries who control their fate brought industry representatives to this city in swarms.
“Ousting one group of companies from giving their views and sharing their expertise contradicts basic democratic principles,” said Michiel Reerink, a vice president of Japan Tobacco International, a funder of the group that held the “Nicotine Is Not Your Enemy” party.
Two of the party organizers, Fred Roeder and Yaël Ossowski, registered as journalists to get access to sessions and walked freely around the conference center wearing press badges. Later, the bureau overseeing the negotiations suspended their badges, citing “misrepresentation.”
Philip Morris International set up a “PMI Science Engagement Hub” to explain the company’s transformation from maker of Marlboro cigarettes to maker of Marlboro HeatSticks, and watch a machine compare cigarette smoke and heatstick vapor.
A group of people stood outside the convention hall handing out a glossy report titled “No Fire, No Smoke: Global State of Tobacco Harm Reduction.” It was written by Knowledge-Action-Change, an organization that receives funding from the Philip Morris Foundation for a Smoke-Free World. Its message: There is “a third way beyond quit or die.”
The W.H.O. maintains that the current wording of the treaty covers all forms of tobacco, including heat-not-burn devices, not just traditional cigarettes. The treaty does not officially cover e-cigarettes, however, because officials don’t define them as tobacco products.
During the session, the industry advocates, along with some public health experts, were pushing for the delegates to officially embrace all types of alternative devices as harm-reduction tools to help smokers quit — and to exempt heat-not-burn and others from the treaty’s restrictions.
While countries have been generally unified in their approach to regulating traditional cigarettes since the treaty took effect, regulation of alternative nicotine devices including e-cigarettes varies widely around the world.
Australia has banned the sale and marketing of liquid nicotine used in e-cigarettes. Israel has banned Juul specifically, because of the high concentration of nicotine in its flavor pods. In Japan the IQOS, the heat-not-burn device from Philip Morris International, has a 15 percent tobacco market share, the company says. But in the United States, the Food and Drug Administration has not yet allowed the IQOS on the market.
The F.D.A. is also in the midst of a crackdown on e-cigarette makers and retailers for not keeping the products away from minors. It has demanded that Juul and other makers turn over troves of marketing and research documents. In September it conducted a surprise inspection of Juul headquarters in San Francisco and carted away more records. The agency also recently gave Juul 60 days to prove it could keep its devices away from youths, or risk a ban on its products.
Despite drops in smoking rates around the world, seven million people still die each year from tobacco-related diseases. In a letter to the W.H.O. director general on the first day of the negotiations, 72 academics and public health specialists urged the delegates to give more weight to the benefits of new, noncombustible devices, and added that “uncertainty about long-term effects should not be a reason for paralysis.”
“We believe it is time for tobacco control to embrace tobacco harm reduction,” the group wrote. “We propose that W.H.O. and related stakeholders adopt a more positive approach to new technologies and innovations that have the potential to bring the epidemic of smoking-caused disease to a more rapid conclusion.”
David B. Abrams, a New York University addiction specialist who has discussed the issue with Juul and others, said tobacco control advocates are overlooking the benefits of alternatives to traditional cigarettes.
“I believe history will prove them wrong as the whole truth and the strongest science will emerge in the long run, as it always does,” Dr. Abrams said.
Others, among them Francis Thompson, executive director of the Framework Convention Alliance, a coalition of roughly 500 organizations devoted to supporting treaty implementation, asked members not to let the e-cigarette debate divert them from the larger issue of industry interference in carrying out the treaty.
“We have a really good treaty,” Mr. Thompson said. “The problem is when you actually look at the implementation level, you realize it’s maybe one-fifth implemented.”
“The urgent issue,” he said, “is that millions of people are dying from tobacco products already on the market.”
Down the street from the convention center, at the N’vY Hotel, Philip Morris International was trying to reinforce that message to anyone venturing into its Science Hub, with a touch screen that told the company’s story of moving into the harm-reduction business. Plates of colorful macarons were positioned at the entry.
Moira Gilchrist, a vice president of Philip Morris International, said the company was trying to promote the business’s new policy of transparency to the delegates and anyone else at the meeting.
“Anyone who is interested in alternatives to cigarettes that can be offered to the world’s billion smokers is invited here to see the science we have, which we believe is really promising,” Ms. Gilchrist said. “Part of why we are here today is encouraging policymakers not to treat every single tobacco product as the same.”
Addressing lingering suspicions about the role of Big Tobacco, Ms. Gilchrist said: “We are absolutely not asking people to believe us. We’re asking people to replicate our science, to review our science and come to their own conclusions.”
“We’re not asking for forgiveness,” she added.
But many delegates interviewed at the convention remained wary of electronic nicotine delivery devices, and as the session wrapped up on Saturday, they approved a directive affirming that heat-not-burn products should continue to be subject to the same restrictions as other tobacco products, like cigarettes. They declined to offer an endorsement or special treatment to any alternate nicotine delivery systems.
“It’s not a victory for vaping,” said Matthew L. Myers, president of Campaign for Tobacco-Free Kids, who took part in the long debate Thursday night. “They would like to be treated differently in every respect.”
So the debate will continue.
“We believe there is room for these alternative products and believe it has to be well studied and well investigated,” said Dr. Ghazi Zaatari, a delegate and medical school professor in Lebanon, who oversaw some of the conference’s research. “We have been fooled before.”
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