FCTC: Does it work? #COP10

In this article we look at a report posted on the Documentation – Supplementary information page on the FCTC COP10 website.  Authored by the Secretariat, the report is titled: ‘Contribution and impact of implementing the WHO FCTC on achieving the noncommunicable disease global target on the reduction of tobacco use’. This report complements the ‘main document’ titled FCTC/COP/10/4: Global progress in implementation of the FCTC, which we wrote about here

This supplementary document does a far better job than the ‘main document’(10/4) in describing progress made against the ultimate objective, which is to reduce death and disease from smoking.  In contrast, FCTC/COP/10/4 mentions prevalence only twice and smoking is mentioned only once: in the context of the implementation of smoke-free laws.  However, although the report we are discussing today does better at describing the problem, it clearly shows the FCTC is not working.

This supplementary document tells us that global tobacco prevalence is estimated to have fallen from 29% in 2005 to 20% in 2022. What the report doesn’t tell us though, is how much smoking has fallen. Smoking is the key driver of death and disease, not tobacco use per se (just look at Sweden). The major problem here is that the metric is wrong – we need to know what is happening with smoking.

Second, whatever the FCTC is doing, it is not working. Only 30% of the countries which have ratified the FCTC are on track to achieve a decrease in tobacco prevalence by 30% by 2025.

This quote from the supplementary report sums up the situation:

“Trends evident from surveys completed by Parties, with projections to 2025, show that most Parties need to accelerate tobacco control activities in order to achieve the voluntary target of the Global Action Plan 2013–2030 to reduce tobacco use by 30% between 2010 and 2025. While the prevalence of current tobacco use among people 15 or older, averaged across all Parties, is estimated to have declined from 29% in 2005 to 20% in 2022, progress is uneven. Of note, 102 Parties are not on track to achieve the reduction target unless additional policies and stronger policies are urgently put in place and effectively enforced.”

This WHO response will be familiar to Copwatch readers: that we need to do more of the same (things that don’t work) and ban products that could actually help us reduce smoking. We respectfully disagree: Sweden, Norway, Japan, UK and New Zealand are achieving far more rapid progress in reducing smoking because consumers can access life-saving alternatives. Taking away these alternatives not only defies logic and common sense, but will also literally kill people.

Another anonymously-written WHO paper is misleading Parties to #COP10

The one where it is suggested nicotine pouches should be banned because they are popular

Two weeks ago, Copwatch drew attention to an anonymously-written paper designed to gaslight Parties at COP10 about disposable vapes.

There is a similar attempt at gaslighting going on with a second document in the same series, this time on nicotine pouches. It begins by setting out its stall. “As we will illustrate below, pouches are offered in an extraordinary array of flavours”, before misdirecting Parties as to the threat.

It claims that “Studies have shown that flavoured tobacco products disproportionately attract young people.(12) Flavours promote tobacco use among youthful starters and contribute to the onset of nicotine addiction.(13,14)”

The references are listed and it is clear they have nothing to do with nicotine pouches.

Pouches are not “flavoured tobacco products”. Nor are they e-cigarettes and there is no evidence that they are attracting children. If there was, surely the WHO would be quick to reference research to that effect. Evidently there is none, so some misdirection was required.

Starting with this false premise of a threat to youth, the anonymous authors then spend 19 pages just talking about flavours and colours as if they are inherently a bad thing. At no point is there any balance applied by giving the counterargument that they may attract smokers away from far more dangerous combustible tobacco.

Most of the recommendations derive from the FCTC/COP/10/7 report which we covered here. It claims to cover “technical matters related to Articles 9 and 10 of the WHO FCTC (Regulation of contents and disclosure of tobacco products, including waterpipe, smokeless tobacco and heated tobacco products)” but takes the opportunity – beyond its mandate – to make sweeping recommendations on banning nicotine pouches.

And what evidence do they cite in favour of complete prohibition? The first reason they give is that they are popular. Heaven forbid!

The WHO is also appalled that pouches “have attractive properties, such as appealing flavours, and can be used discreetly without the stigma of smoking.” One would have thought this is a winning combination for an alternative to combustible tobacco, especially as these products are virtually indistinguishable from nicotine gum in terms of health risks. They work in exactly the same way, after all.

Instead, the WHO recommends that countries extend surveillance of these products, and regulate them to “to prevent all forms of marketing”.

They also suggest that countries “regulate non-therapeutic nicotine products in the same manner as products of similar appearance, content and use.” What does this mean, you ask? It means regulating nicotine pouches the same way as snus. And that means, in many countries, prohibition.

Frustratingly, it seems that the EU supports the WHO in making these recommendations, as revealed by MEP Charlie Weimers on social media.

So here we are in the familiar “quit-or-die” territory that the WHO and other tobacco control institutions are so fond of. If they have their way and nicotine pouches are banned despite no currently-known harms to their use, you can either go back to deadly smoking or buy them from the already dubious black market where there are no controls on ingredients and nicotine strength. Where child-friendly packaging is not only heavily prevalent but almost seems obligatory and where it is anyone’s guess who items on sale are made by.

Regulations, by their very nature, are supposed to reduce potential harms in the population. Yet these suggestions by an anonymous author of the nicotine pouches paper, and a WHO panel acting outside its remit, will remove products from the legal market which are significantly safer than smoking, enshrine illegal enterprises as the only supplier of a very simple-to-make product, while also offering protection for sales of combustible tobacco, the most dangerous nicotine delivery option out there.

Copwatch does not know whether this should be described as WHO personnel not thinking things through, or simply not thinking.

Human rights alert at #COP10

The FCTC Secretariat is working behind the scenes to impose a narrow view on human rights and tobacco within the UN system and amongst countries (the Parties to the Convention).

At a recent progress meeting of the UN Non-Communicable Disease Task Force Lynn Gentile from the UN Office of the United Nations High Commissioner for Human Rights emphasised that a ‘Human rights framework is indispensable to how we respond to health challenges such as NCDs and mental health’.

Tobacco was a key theme of the meeting. It was reported that Task Force members had agreed plans for ‘ensuring [a] successful conference and meeting of Parties on the Tobacco Control Framework Convention in Panama..’. This is an example of how UN officials work behind the scenes to influence the outcomes of Convention meetings.

It is also reported that the United Nations Development Programme (UNDP) and the FCTC Convention Secretariat are finalising a set of policy briefs that will provide governments with information about how tobacco control impacts different sectors. These documents will likely be made available at the last minute and are not on the published COP agenda.

Under its current leader Adriana Blanco Marquizo, the Convention Secretariat has anchored  its work across the whole UN system including on human rights. It presents a narrow view of tobacco control to other UN agencies which may have little specialist knowledge about tobacco.

The Secretariat report to COP (FCTC/COP/10/15)  on how human rights intersect with the work of the FCTC is one-sided and thin. It includes statements about protecting individuals from tobacco smoke, mention of the right to life, and mention of the highest attainable state of health and the rights of children and tobacco growers. The Secretariat fails to mention another stream of human rights work within the UN system, in which access to harm reduction resources is a key part of the right to health.  International human rights law supports harm reduction, a case initially made by the UN Special Rapporteur on the Right to Health and now acknowledged by many UN agencies who work on drugs and on HIV harm reduction. Access to safer nicotine products can be seen as part of the right to health in that people should be able to choose safer alternatives to smoking.

As Copwatch has been at pains to point out, tobacco harm reduction (THR) is, so far, absent from COP10. None of the documents nor reports intended to influence the Parties mention that safer nicotine products offer any opportunities for individual and public health. Safer nicotine products are presented as a threat to tobacco control, rather than as having potential to divert people from smoking and other risky tobacco use. 

The COP documents class all tobacco products together, and do not distinguish between high risk tobacco products and safer alternatives. We predict that the narrow human rights perspective proposed by the Secretariat will present safer nicotine products as much of a threat to the right to health as cigarettes. THR consumer advocacy groups are highlighting the right to access safer nicotine products. In an open letter addressed to the UN High Commissioner for Human Rights – Volker Türk – 52 civil society organisations highlight the urgency of adopting strategies based on harm reduction and the right to health (see here for the English version). They ask that the UN system recognises harm reduction as obligatory under the right to health and that he encourages the WHO to recognise the legitimacy of harm reduction in relation to smoking, to encourage states to adopt harm reduction policies, and to encourage the participation of consumer groups at COP. It will be interesting to see the reply.

FCTC budget: nice work if you can get it

Here Copwatch brings you what you need to know about the COP10 documents relating to the FCTC budget. This covers three documents, all posted on the COP10 main documents page:

FCTC/COP/10/17 Proposed Workplan and Budget for the financial period 2024–2025, 

FCTC/COP/10/18 WHO FCTC Investment Fund, and

FCTC/COP/10/19 Rev.1 Payment of Assessed Contributions and measures to reduce Parties in arrears 

The first thing you need to know is that 59 Parties have not paid their contributions. That’s around one third of the FCTC membership. You should also know that the biggest funder of the FCTC is China. As we know, China is also home to the China Tobacco monopoly, the biggest cigarette company in the world.

Second, in the 2024-2025 period, the FCTC plans to spend some 17 million USD in direct expenses, excluding recovery costs (10/19 Rev1).  Almost half of this is for the salaries of WHO bureaucrats. Some 2 million USD out of the 8 million USD budgeted for salaries is expected to be covered by “extra-budgetary” contributions.  It seems likely that the ‘extra-budgetary’ contributions will come from rich donors, who will set the agenda in line with their interests, not the interests of people who smoke or the countries they reside in.

The single biggest non-salary cost, by far, is… the hosting of COP11 at almost 1.7 million USD. Copwatch is confused! In August, it was revealed that there was outrage in Panama at the revelation that the Ministry of Health (Minsa) had spent “$4,881,732.20 for the organisation of a conference against tobacco.” Is this 1.7 million USD in addition to that?

Now, how do you like that as a taxpayer? Given how secretive COPs are, you certainly won’t be able to judge if you are getting value for your money. 

Third, we are guessing that the investment fund launched at COP9 is not doing well. But, we can only guess, as there is nothing written down about that, instead it is promised that “the Convention Secretariat will provide a verbal update at the Tenth session of the COP (COP10) on the status of investment for the Fund.” (10/18). 

These documents reveal that the FCTC has run into another problem – that nobody wants to serve on the two oversight committees (“it was challenging to attract qualified candidates” – see 10/18). One committee was intended to serve the WHO FCTC Investment Fund and the other committee was for the Investment Fund to support the implementation of the Protocol to Eliminate Illicit Trade in Tobacco Products (for which not a single person expressed interest to serve). As a result, the FCTC Secretariat proposes to merge the two committees into one, and will define its purpose, functions, authority, composition and selection, and various other administrative matters.

Here’s the problem with that proposal: the Oversight Committee members are supposed to be proposed by the Selection Committee. Who is the Selection Committee? The President and one Vice-President of the governing body of each treaty, as well as the Head of the Convention Secretariat. In other words, the people with the oversight are appointed by the very same people that they are supposed to oversee. Re-appointment of the Oversight Committee is again up to the Selection Committee.  

But does it really matter? We’re not so sure because the Oversight Committee is purely advisory and has no management, decision-making, or operational responsibility. It need only meet two times per year, and its recommendations can be fully disregarded by the COP and MOP. Finally, in line with the WHO’s ethos of covering things up, the minutes of the Oversight Committee meetings and their recommendations are to be provided to the COP and MOP bureaus only, and not shared with the COP or the MOP, or made public.

In summary:  the FCTC spends almost half of its money on its own salaries. The biggest funder is China, and some salaries are funded by wealthy donors (think Michael Bloomberg). The proposed rules ensure that no meaningful budget oversight will take place in the future. I think that we may have just solved the mystery of what is behind the WHO’s insane war on safer nicotine.

The WHO publishes anonymously-written papers designed to gaslight Parties at COP10

The one where COP delegates are invited to take opinions about vapes on trust

Copwatch has detailed many instances of the WHO and FCTC Secretariat playing fast and loose with evidence or cherry-picking research to suit its anti-harm reduction agenda. It is unscientific and shameful but nothing we have not seen before. But two new reports, on disposable vapes and nicotine pouches, have been published on a separate page to the main COP10 menu which seem specifically designed to mislead COP10 delegates based on nothing more than opinion. 

There is much that could be challenged in them, but the problem would be who to approach considering they are written anonymously. Are senior government officials attending the meeting in Panama from around the world expected to just take the misinformation on trust? 

Let’s discuss the first which concerns single use vapes (which the document charmlessly calls D-ENDS) and contains a number of unreferenced assumptions. 

Without any link to research, it claims that “there is a risk that [the] metal coil will release heavy metals in the heating process.” There may well be a risk, but there also may not. Students are discouraged from referring to Wikipedia for their studies, but at least entries there are rejected if an assumption is not backed up by a credible source. This WHO document does not concern itself with such probity despite being designed for the much more important role of educating government representatives about a vital area of public health. 

It asserts that “the addition of flavourings increases the toxicity of ENDS aerosol in a significant manner”, again without any evidence by way of back up. A Wikipedia reviewer would add [citation needed] but the WHO doesn’t seem to think it necessary. 

The document complains that “we also observe a strong industry lobbying activity to regulate newer products (heated tobacco products, or HTPs, snus and nicotine pouches, and ENDS in all its forms) as little as possible”, which those who recognise the significant benefits of harm reduction would find sensible. Parties are told to ignore this though because – and this may make your jaw drop – the WHO accuses industry of “insisting on rhetoric pretending that they are a “safer” alternative to tobacco products.”

Pretending? There is absolutely no doubt that those products are less harmful than combustible tobacco, with acres of scientific research to support the difference in risk. There is no pretence about it. The only fantasists here are the authors if they believe lower risk nicotine delivery is not safer. If so, how can they be qualified to write papers for the WHO? 

It is also worth noting that consumers and independent scientists are also in favour of light touch regulation, not just industry. Put this down as another flimsy attempt to cast harm reduction as an industry plot rather than a significant public health opportunity. 

It further criticises EU regulations on the strength of nicotine liquids, claiming that 20mg/ml “is already considered a strong concentration” but fails to say by whom. Many would disagree. No reference is given. 

Then the anonymous author or (authors) delve further into cloud cuckoo land. They “stress” that surveys show “D-ENDS prevalence was significantly on the rise and for most other products (HTPs, snus, nicotine pouches) prevalence had increased, and that no significant decrease was observed in cigarette prevalence.” 

Japanese sales of tobacco have declined by around 50% since heated tobacco products hit the market and the UK government recently agreed that vapes “are up to twice as effective as the available licensed nicotine replacement.” One must also wonder how the anonymous authors have missed the fact that Sweden is about to reach the EU smokefree 2040 target of less than 5% smoking prevalence 17 years early thanks to snus use. The WHO document also dreams that “young people could hyperventilate with a D-ENDS”[citation needed], and that “it is usually considered that an Elf bar 800 gives a nicotine equivalent of 60 cigarettes.” This is a regularly-cited snippet of disinformation amongst those opposed to vaping which has been succinctly dismissed as a myth by Action on Smoking and Health in the UK.

After cataloguing red herrings, myths, unsubstantiated opinion and unscientific rumour, our anonymous authors sum up by recommending that “many policies effective against tobacco should be implemented against disposable ENDS as well (plain packages, flavour bans, taxation, full advertisement bans, selling only under a licence system, etc.)”

Copwatch would like to ask a few questions. Who wrote this? What are their qualifications? Why are they offering nothing more than opinions without adequately backing them up with links? Why should Parties believe assertions which are supported by less evidence than would be considered necessary for a half-decent blog? 

The WHO and FCTC Bureau should not be in the business of publishing opinion pieces, which is the only way this document can be described. 

Most importantly, it would be dereliction of duty for Parties to COP10 to take this unevidenced, unprofessional, and superficial guidance seriously when contemplating recommendations in Panama for global regulations.

COP10 documents guide: FCTC/COP/10/4

The one where everyone marks their own homework

Here we continue the Copwatch guide to the documents provided to ‘educate’ national delegations at the COP10 conference in November, with a look at FCTC/COP/10/4

Produced by the Convention Secretariat, the subject for the report is ‘Global progress in implementation of the WHO FCTC’. The report is based on data submitted by the Parties (countries) and measures their progress in implementing the Framework Convention on Tobacco Control Treaty into their national policy and regulatory frameworks.  

The Secretariat defines progress according to how far countries have implemented the FCTC  MPOWER measures, i.e. Monitoring tobacco use, Protecting people from tobacco smoke, Offering help to quit, Warning about dangers of tobacco use, Enforcing bans on tobacco advertising, and Raising taxes on tobacco.

The report notes that implementation of the FCTC has been generally slow.  However, four countries are singled out for praise for adopting the FCTC MPOWER measures to the highest degree —Brazil, Mauritius, the Netherlands and Turkey .  

But, here’s the thing – the adoption of the MPOWER measures is not helping these countries to meet the crucial objective, i.e to reduce smoking.    

In Turkey, the prevalence of smoking is very high and has actually been increasing in recent years.  In  Brazil smoking is declining very slowly, from 10.8% in 2014 to 9.1% in 2021,  Mauritius also shows a tiny decrease from 19.3% in 2015 to 18.1% in 2021The Netherlands, home to a powerful tobacco control lobby, also performs poorly on smoking prevalence rates.   

All four countries, championed by WHO as best practice, perform well on MPOWER measures but perform badly on reducing smoking rates. Is it a coincidence that all four countries have also banned or severely restricted the availability of safer nicotine products?   

In comparison, countries where consumers have been switching to safer nicotine products in large numbers – Japan, New Zealand, Norway, Sweden, the UK – have seen dramatic drops in smoking prevalence.  These successes are not celebrated by WHO. 

Lars M. Ramström, the eminent tobacco control researcher, politely points these uncomfortable truths out in his recent Commentary:

“The measures for Demand Reduction and Supply Reduction recommended by the WHO are certainly valuable tools. But the fight is not maximally effective without the third pillar stated in Article 1d of the FCTC – Harm Reduction.”
[Commentary] The WHO strategies to reduce tobacco-related deaths are insufficient, Lars M. Ramström 

Do read Professor Ramström’s short commentary in full. And, revisit our article from last year, where we reported that Robert Beaglehole and Ruth Bonita, both independent experts with formerly senior roles in WHO, had said much the same thing:

Back to the COP10 official documents – these only confirm that the WHO and FCTC have forgotten about the 1 billion people who smoke, a number unchanged over three decades. WHO and the FCTC secretariat will not be part of the solution while they stubbornly continue with their ineffective MPOWER measures and obstruct tobacco harm reduction.

#COP10 documents guide: FCTC/COP/10/9

The one where the WHO tries to redefine smoke and hides inconvenient evidence

To continue the Copwatch guide to documents being provided to ‘educate’ national delegations at the COP10 conference in November, here is a look at FCTC/COP/10/9, published in July. 

This document deals with heated tobacco products but, as we shall see, it is not very impressive. It claims to “examine the challenges that novel and emerging tobacco products are posing for the comprehensive application of the WHO FCTC … as requested in paragraph 3 of decision FCTC/COP8/(22).”

But a quick look at the COP8 decision they refer to shows this does nothing of the sort. In 2018, the WHO asked the FCTC Secretariat:

“to prepare a comprehensive report, with scientists and experts, independent from the tobacco industry, and competent national authorities, to be submitted to the Ninth session of the COP on research and evidence on novel and emerging tobacco products, in particular heated tobacco products, regarding their health impacts including on non-users, their addictive potential, perception and use, attractiveness, potential role in initiating and quitting smoking, marketing including promotional strategies and impacts, claims of reduced harm, variability of products, regulatory experience and monitoring of Parties, impact on tobacco control efforts and research gaps”

Phew, quite a workload! 

The COP8 decision further requested, after that large body of work had been completed, that a report be drawn up to “subsequently propose potential policy options to achieve the objectives and measures” of the FCTC treaty. 

It has been 5 years since COP8 and that decision, but in that time the FCTC Secretariat and their laboratories (known as TobLabNet) appear to have done next to nothing to expand the evidence base. FCTC/COP/10/9 regularly boasts about how very little they know on the subject. 

“Independent … data on the health and environmental impact of these novel tobacco products is incipient” (that’s a posh word for just beginning)

“The knowledge of these novel and emerging tobacco products has been rapidly increasing, but information on their long-term health effects is limited”

“[T]here are limited data available on uptake of HTPs by adolescents, as well as former smokers and non-smokers.” 

It begs the question what, if anything, has the WHO been doing in the last five years since COP8? Countries who have ratified the FCTC treaty do not pay large amounts of taxpayer money for the WHO’s institutions to just sit on their hands for half a decade. Perhaps delegations at COP10 should be asking some searching questions of the Secretariat on the matter. 

Having airily skipped over the yawning chasm of missing research that they were supposed to have gathered on heated tobacco in just four pages, the FCTC/COP/10/9 document then spends the rest of the 18 pages discussing what bans and restrictions should be put in place. Predictably, they demand that heated tobacco should be treated exactly the same as combustible cigarettes, despite HTPs having been found by the UK Committee on Toxicity and the Food and Drug Administration in the United States to be far less harmful than smoking. 

Copwatch also noted the authors of FCTC/COP/10/9 putting on their philosopher’s hat and promoting strange theories of what constitutes smoke. “Can the aerosols of novel and emerging tobacco products qualify as “tobacco smoke?”, they theorize, before answering their own question with a far-fetched explanation. “Yes … strictly speaking, visible aerosols deriving in whole or in part from thermally driven chemical reactions qualify as “smoke”, even when combustion is not involved in the process.”

They are very certain about this, further explaining that “these aerosols are clearly within the scientific definition of “smoke”, and any smoke emitted by HTPs is unambiguously “tobacco smoke.”

The definition of unambiguous is “not open to more than one interpretation” according to Oxford Languages, which will be a surprise to German and Swedish courts who have both found otherwise. 

In September 2021, a decision in a German court struck down the German government’s classification of heated tobacco as “tobacco products for smoking”. A hearing on the merits of a Philip Morris product resulted in the court ordering the Federal Office for Consumer Protection and Food Safety to annul their prior decision and to classify them as “smokeless tobacco products” instead.

A similar case in Sweden in September 2022 came to the same conclusion. The Swedish Public Health Authority (PHA) had decided to classify heated tobacco as “tobacco products for smoking” but was ordered to change this by the court, which held that the PHA’s decision was not in line with any scientific definition of combustion. The court concluded that heated tobacco is not consumed through combustion and “is therefore rightly a smokeless tobacco product.”

Neither the German or Swedish governments appealed the decisions and the definitions are now final and binding in both countries.

Copwatch believes that the WHO is well aware of these court decisions, but just chooses to ignore them. At the foot of the FCTC/COP/10/9 document is an annex which details “several approaches to classify or regulate” heated tobacco in a number of different countries. Note that it says “several” and not all. This is because Germany and Sweden are not amongst them. 

Countries which have ratified the FCTC are allowed to regulate heated tobacco as they wish, smokeless or not, but there are not many cases testing whether the aerosol is smoking or not. In Germany and Sweden there were such cases and the courts decided it is not smoke. 

It would be incredibly inconvenient if the WHO had to admit in its annex that their “unambiguous” definition of smoke is not unambiguous, after all. So they just hide the information from delegates instead. 

To sum up FCTC/COP/10/9, the WHO repeatedly says it does not know much about heated tobacco, but at the same time it is apparent that no work is being done to find out. It recommends treating less harmful products the same as combustible tobacco based on a definition of smoke which is not borne out when tested in court, and it gives the delegations which will be attending COP10 all the information they need to make decisions, except information which the WHO finds inconvenient. 

And we pay for this?

The road to FCTC #COP10

COP10 preparations are advancing when it comes to the FCTC Secretariat. The provisional agenda and some other documents were published earlier this month.

Going from the agenda we can expect a fully packed discussion on substantive items. Readers will remember that COP9 was virtual and that although discussions were tortuous (refresh your memory with our COP live reporting), there was no discussion on ‘substantive items’. This in person COP10 in Panama promises to be a proper bun fight – and we just wonder whether the allotted week will be sufficient. 

We will be analysing the available documentation and will share our thoughts on those with you in the coming weeks. In the meantime, here are some of our quick observations.

The documents already published show we can expect substantive discussions on these subjects: 

  •  Articles 9 (Regulation of the contents of tobacco products) and 10 (Regulation of tobacco product disclosures).  There are  two reports published so far: here and here.  Non-combustible safer alternatives to smoking will be affected.
  • Discussion specifically on ‘novel and emerging tobacco products’, i.e. the safer alternatives to smoking, such as vapes, nicotine pouches, Heated Tobacco Products and snus. 

As you might have already noticed, whilst the Secretariat has been so generous with some documents there are some key pieces of the puzzle that are still outstanding, including:

  • Reports on Articles 9 and 10 (FCTC/COP/10/7),
  • Reports on novel products (FCTC/COP/10/9 and FCTC/COP/10/10),
  • and the draft decisions attached to those.

These missing pieces will show the direction WHO wants to go for alternatives to smoking. Will WHO be dismissing the science behind alternatives to cigarettes yet again? Keep an eye on COPWATCH for analysis and updates. 

And here’s a reminder – should your organisation wish to apply for Observer status please be aware that the deadline to apply is 22 August:


Do let us know how you get on. 

Big trouble in little Panama

The World Health Organization is often criticised for incompetence in a number of its policy focuses, not solely for its calamitous, head-in-the-sand position on lower-risk alternatives to smoking. But in the practice of handing awards to its buddies, it can only be described as a triumphant global expert.

To celebrate World No Tobacco Day in May, WHO Director-General Dr Tedros liberally dished out a number of motivational gongs to high-ranking members of its secretive club, and spoke in particularly glowing terms about a Special Recognition Award to Reina Roa Rodríguez, who is almost royalty in the WHO cabal. 

Dr Roa is Panama’s Focal Point for Tobacco Control, and Vice President of the WHO’s Bureau of the Meeting of the Parties to the Protocol to Eliminate Illicit Trade in Tobacco Products (MOP), but you may remember her more for featuring in two previous Copwatch updates. 

In April, Copwatch reported that Dr Roa was being investigated by Panamanian authorities for “administrative irregularities” over a conflict of interest in her role as an “independent” adviser to the Ministry of Health. Questions arose over the Panamanian Coalition Against Tabaquismo (COPACET), of which she is founder, accepting a Bloomberg Philanthropies Award for Global Tobacco Control as a reward for successfully designing public policies which aligned perfectly with the goals of, you guessed it, Bloomberg Philanthropies.

The investigation did not get very far as she promptly resigned. 

Now Dr Roa is embroiled in more controversy. In her capacity as National Coordinator of Tobacco Control of the Ministry of Health, she is responsible for arranging transport for patients in critical or serious condition to hospitals located in remote areas, for which reimbursement payments are made. 

It is alleged that there have been many discrepancies in her book-keeping for these services. Billed hours did not match those recorded on transfer request forms, invoices were found without proof of patient admission in medical records, and incomplete request forms have been discovered, with no information which correlates with the transport required.

According to a letter processed by the Court of Accounts, Dr Roa is facing an order to freeze her assets, pending repayment of $87,930. 

Panama was rocked last year by a series of nationwide protests and blockades. They were prompted by cost-of-living concerns, exacerbated by deep-seated mistrust of government officials accused of feasting on taxpayer funds, and complaints about poverty, inequality and corruption in the country. 

Dr Roa has been a Ministry of Health employee since 1986, with latest filings showing she is paid $4,294 per month, roughly five times the average Panamanian salary. In the current political climate, with the Panamanian public angry at how their leaders are behaving, it is surely unimaginable that such a stalwart of upstanding public health, a WHO high priestess and recent awardee, no less, would stoop to feathering the nest further by doctoring (no pun intended) documents for health services. 

We are sure this is merely a simple misunderstanding which will be cleared up before criminal charges are filed against Dr Roa. 

Or perhaps she could just resign again.