CAPHRA red flags WHO’s recent policy shift against tobacco harm reduction

The Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA) has cautioned that the World Health Organization’s (WHO) recent policy shift against tobacco harm reduction not only contradicts decades of evidence but ‘disproportionately’ harms countries like India—where the consequences are far more complex and far-reaching than in high-income settings.

With the largest number of tobacco users globally, India faces a uniquely diverse and informal tobacco landscape, it said.

India’s tobacco economy, unlike the cigarette-dominated markets of the West, includes over 200 million smokeless tobacco users, millions of bidi smokers, and an informal value chain that supports more than 45 million livelihoods—from farmers and bidi rollers to small retailers and micro-enterprises, many led by rural women, it added.

A transition to manufacturing safer nicotine products with readily available raw materials and resources would protect those livelihoods and address the public health harm from combustion and dangerous oral products, it further said.

“This isn’t just a public health misjudgment—it’s an act of economic and public health harm, an economic blow to the most vulnerable,” said Nancy Loucas, Executive Coordinator of CAPHRA in a statement.

“WHO’s donor-influenced policy shifts that prioritise cessation-only approaches may work in Manhattan or Oslo, but in Munger or Malda, they can exacerbate health inequities and erode India’s right to decide its own policy path,” she said. 

According to CAPHRA the WHO historically supported a three-pillar approach: prevention, cessation, and harm reduction. Its own tobacco regulation group, TobReg, once acknowledged that alternatives such as e-cigarettes and heated tobacco products, when properly regulated, could save lives—especially for people unable or unwilling to quit.

“But in recent years, under the growing influence of philanthropic donors like Bloomberg Philanthropies and the Gates Foundation, WHO has shifted toward a prohibitionist agenda—rejecting innovation and undermining the very tools that once showed promise for global tobacco control” CAPHRA said. 

CAPHRA has argued that this shift reflected a “dangerous global double standard”.

“While countries like Japan and Sweden have seen smoking rates plummet due to legalised safer alternatives, WHO now urges low- and middle-income countries to ban the very tools that others are using to succeed,” it said.

“If WHO’s position is truly grounded in science and health equity, then why has it failed to impose these bans in high-income countries like the United States, United Kingdom, or Japan? The reality is that in those countries, prohibition is politically infeasible, economically disruptive, and socially unpopular,” it added.