ICLE White Paper

Lessons from the WHO Framework Convention on Tobacco Control for the WHO Pandemic Treaty

Foreword^*

Martin Cullip and Roger Bate’s thoughtful and important piece provides compelling arguments about whether the World Health Organization (WHO) can be trusted with a pandemic treaty. I compliment their work by going beyond trust to highlight several realities that make a future effective pandemic treaty unlikely to be delivered.

Since its founding, there has been a tension between WHO addressing national needs with direct impact, and the development of international norms and standards. Two of the best examples of each from past eras are the eradication of smallpox and the adoption of the WHO Framework Convention on Tobacco Control. Their attainment led WHO to pursue polio eradication and development of a pandemic treaty. I highlight several macro realities that made the FCTC possible and several weaknesses of the FCTC process that hint at future failure of a pandemic treaty.

Polio eradication is slipping away; the initial completion date was 2000. The costs have exceeded $18 billion, with almost $5 billion required by 2026. This has made polio eradication the single costliest program in WHO history, by far. Failed eradication would be a global-health catastrophe. If WHO is unable to mobilize support and show leadership on polio, it is very unlikely it will succeed in other areas demanding more complex global partnerships.

A. Lessons from the FCTC

1. Macro realities

Geopolitics was “simpler” and more predictable during the period of negotiations (1998-2003) than today. Members of the United Nations Security Council rarely used vetoes. The G20 was starting to emerge as a political force. The political entity known as BRICS (Brazil, Russia, India, China, South Africa) had not yet formed. This all made multilateral negotiations easier than the fraught geopolitical reality we have today.

Global health was on the ascendency across the board, driven by the urgency to address HIV/AIDS. There was an exceptional alignment between the U.S. presidency, the World Bank, and WHO, as Director-General Gro Harlem Brundtland was highly respected as a political leader and as head of WHO. She drew on her leadership position to “encourage” political leaders to take the FCTC seriously. Optimism for progress in global health was also propelled by the creation of the Bill and Melinda Gates Foundation. Funding was not an impediment to progress.

Today, WHO’s budget is under pressure from two sides: greater support for humanitarian issues and a shift by many leading countries away from supporting multilateral organizations. There is no political traction for additional funding requests for a new treaty. Enthusiasm for international norms in an era of “enlightened self-interest” led to development of the environmental treaties that form the basis of climate-change efforts. The FCTC capitalized on this. That era, however, has passed.

2. FCTC specifics that point to pandemic-treaty impediments

Member states and WHO ignored innovation, patent ownership, and technological progress during FCTC negotiations, despite intense debates on these topics at World Trade Organization regarding access to AIDS treatments. WHO leadership never anticipated the development of harm-reduction products (THR) by the tobacco industry. Any pandemic treaty will similarly require deep WHO expertise in new areas of innovation that straddle biosciences, digital and AI developments, and their applications in lower-middle-income countries (LMICs).

The FCTC has failed to address equity issues related to basic financial support and national science capacity in LMICs. The anti-THR philanthropist and former New York City Mayor Michael Bloomberg has been able to “capture” WHO policy by stepping into this vacuum with his views unopposed. This equity failure is being reflected in the pandemic treaty negotiations and may well be a future treaty dealbreaker.

WHO had an explicit policy aimed at demonizing the tobacco industry and has expanded this through their “commercial determinants” work to include pharmaceutical and other sectors. This undermines the need for complex discussions required to address policies that improve access to medications, vaccines, and diagnostics so critical to any successful future pandemic treaty.

During the FCTC negotiations, WHO had strong senior leadership, highly competent international legal expertise on tap, the support of nonprofits committed to push governments to act for better health, and the support of the UN system. It is unclear which of these needed elements are in place today to ensure rapid development of a pandemic treaty.

3.  One final comment

The International Health Regulations were recently strengthened following the COVID-19 pandemic. Many countries and experts rightfully ask whether a weak and ineffective pandemic treaty is really needed, given the harsh realities of costs, the risks of watered-down text, and growing antagonism between negotiating parties.

Executive Summary

The World Health Organization (WHO) was formed after World War II to reduce disease and generally improve global public health. Early successes came from “vertical programs” that addressed specific diseases, such as malaria, yaws, leprosy, and smallpox. From 1979, WHO switched focus to help nations build domestic health systems, but for myriad reasons, this approach failed, and donor fatigue set in.

Beginning in 1998, under the leadership of Gro Harlem Brundtland, the WHO shifted focus again, developing new programs to address noncommunicable diseases. A signature program from this era was the Tobacco Free Initiative, under the auspices of which the WHO established its only global treaty, the Framework Convention on Tobacco Control (FCTC).

The FCTC’s primary aim was to lower the burden of disease from smoking, the largest preventable cause of death worldwide. But a combination of ideological opposition to tobacco consumption in any form and pressure from vested interests has led the FCTC to oppose technologies used by tens of millions of smokers to help them quit, such as snus and e-cigarettes, even though these technologies are far less harmful than smoking. By spreading misinformation and promoting prohibition and excessive regulation of harm-reducing technologies, the FCTC is now likely having the opposite effect to its stated intention of reducing smoking.

During the COVID-19 pandemic, the WHO followed a similar pattern, impeding the open sharing of information and promoting harmful interventions, including lockdowns. It ignored evidence from nations such as Sweden that did not follow lockdowns and other mandates, and joined in attacks on scientists who sought the truth. It also conspired with former Chief Medical Advisor to the President of United States Anthony Fauci and others to hide the true origins of COVID.

Yet despite its failings and its baroque (if not opaque) funding, the WHO is now pushing for an even greater say in how society should combat future pandemics. Specifically, it is attempting to push through a new pandemic treaty by the end of 2024. Society needs a vaccine to protect it from this sort of misbehavior.

I. What Is the WHO For?

The United Nations’ (UN) World Health Organization (WHO) has a unique role to play in fostering better global health by coordinating action among member nations. It could, for example, facilitate the sharing of information on dangerous, rapidly transmitted infectious diseases, such as avian flu, severe acute respiratory syndrome (SARS), Ebola, and COVID-19. It could also call attention to global health problems and help to establish standards to address those problems.[1]

In practice, while the WHO has attempted to perform these roles and has sometimes been successful, it has also often fallen short. In part, its failures have been a result of mission creep. In greater part, they have been the result of the short-run priorities of funders, who increasingly are not nation-states but unaccountable—if well-meaning—non-governmental organizations (NGOs).

This chapter traces the development of the WHO, with its initial focus on “vertical” health-care interventions, the shift in focus to primary health care following the Alma Ata Declaration in 1978, and the subsequent growing focus on special programs and reliance on voluntary contributions.

A. The WHO’s Constitution and Early Operation

The WHO’s Constitution defines its objective as, “the attainment by all peoples of the highest possible level of health.”[2] This is to be achieved by undertaking “all necessary action to attain the objective of the Organization,” including “to propose conventions, agreements and regulations, and make recommendations with respect to international health matters and to perform such duties as may be assigned thereby to the Organization and are consistent with its objective.”

Broad oversight of the WHO was granted to the World Health Assembly (WHA), a gathering of representatives of UN member nations that takes place each May in Geneva. The WHA decides budgetary and other matters. Meanwhile, management of the WHO was placed in the hands of a permanent secretariat based in Geneva.

1. The vertical model of health-care delivery

Initially, the WHO’s focus was on combatting infectious diseases and, for its first 30 years of existence and with varying degrees of success, it assisted in combatting leprosy, yaws, onchocerciasis, malaria, tuberculosis, and smallpox. The WHO’s modus operandi during this period has been described as a “vertical model” of health-care delivery, wherein doctors and nurses from relatively wealthy countries travelled to poor countries to vaccinate or treat specific diseases.[3]

Originally, the WHO was funded by core donations from nation states and allocated resources based on disease burden and country requests. But in the 1970s, the WHO began to develop “special programs” that would attract specific funding from donors. The first of these was the Special Programme of Research, Development and Research Training in Human Reproduction, established in 1972, which was essentially a population-control program.[4] This was followed in 1974 by the Special Programme for Immunization (a vertical program for immunizations) and, in 1975, by the Special Programme for Research and Training in Tropical Diseases (a multi-agency program to improve understanding of “tropical diseases” and their treatment).[5]

2. The failed shift to primary health care

By the late 1970s, vertical programs had become unpopular, especially among the political elites in poorer countries, who wanted a greater say in how WHO budgets were spent and, specifically, that a greater proportion should be spent on their health-care systems. This led to the Alma Ata Declaration of December 1977, which called on governments to spend fewer resources on armaments and more on health care in order to achieve “an acceptable level of health for all the people of the world by the year 2000.” This more “horizontal” approach became the core construct of the WHO’s Health for All Initiative.

Unsurprisingly, this attempt to fund the health-care systems of poorer countries through a central global system run by WHO was not a resounding success. By the late 1980s, it had become apparent that Health for All was not delivering health care to all, and public-health experts were beginning to argue for a return to the vertical model.[6] In 1987 and 1988, the WHO established two new special programs:

• The Global Programme on AIDS (1987), which was established to coordinate the global response to the AIDS crisis (replaced in 1996 by UNAIDS).[7]
• The Polio Eradication Initiative (1988), launched in collaboration with Rotary International.[8]

Since then, WHO special programs have gradually grown in importance, such that they now comprise the vast majority of the WHO’s funding and expenditure. [9] In 2022-23, only about 13% of WHO’s total budget of $7.8 billion came from assessed contributions.[10] The remaining $6.8 billion, or 87%, came from “voluntary contributions,” often given to support special programs.

The four largest contributors—responsible for a combined 45% of WHO funding—were the United States (15.6%), the Gates Foundation (12.7%), Germany (11%), and the Global Alliance for Vaccines (7.4%). Nearly 8% is provided by other intergovernmental organizations, such as the World Bank and the United Nations Children’s Fund (UNICEF). And roughly 30% is provided in small amounts (under 1% each) by other corporations, NGOs, and dozens of nations.

Former WHO scientist David Bell describes how this funding model distorts the organization’s priorities:

The WHO is an organization that receives roughly a quarter of its funding from the pharmaceutical industry and major pharmaceutical investors. These same sponsors have profited greatly from the Covid-19 response and are strongly aligned with the WHO’s current pandemic preparation and response proposals. The largest country-based funders are the USA and Germany, also heavily invested in Pharma. German public money backed BioNtech, the developer of the Pfizer mRNA Covid vaccine.

Most of the WHO’s funding is ‘specified,’ meaning that it does what the funder specifies. The WHO has now become a tool of vested interests for much of its work. Approximately 75% of its total funding works this way. This is a completely different type of organization than the WHO of 75 years ago. When originally set up, its budget was based on ‘core’ funding from countries, and the WHO decided its priorities based on disease burden and country requests.[11]

This increasingly heavy reliance on voluntary contributions has undermined the WHO’s financial independence. Speaking last year, WHO Collaborating Center on National and Global Health Director Lawrence Gostin noted that “[c]urrently, WHO has full control over only about a quarter of its budget.”[12] Significantly, Gostin observed that “WHO therefore can’t set the global health agenda and has had to do the bidding of rich donors, not only rich nations in Europe and North America, but also rich philanthropies such as the Gates Foundation.”

Gostin’s remarks raise important questions and cast doubt on whether the WHO is setting global health priorities, rather than decisions being guided in the interests of private agendas, especially considering some of the WHO’s recent activities.

II. NCDs and the FCTC

During her stint as director general of the WHO from 1998 to 2003, former Norwegian Prime Minister Gro Harlem Brundtland re-energized the organization. An enthusiastic proponent of special programs, Brundtland oversaw the establishment of the Roll Back Malaria partnership; the Global Alliance on Vaccines; and the Global Strategy for Non-Communicable Diseases (NCDs).[13] She also oversaw the development of the WHO’s first (and, for now, only) treaty, the Framework Convention on Tobacco Control (FCTC).

A. The WHO’s Work on NCDs and Tobacco

The WHO had a long history of work on noncommunicable diseases (NCDs), with work coordinating research into NCDs such as cancer starting in the 1970s.[14] It also played a leading role in defining addiction to tobacco as a disease.[15] Indeed, it had long advocated for the view that, since tobacco consumption is inherently addictive, tobacco consumption itself is a disease and widespread tobacco consumption is thus an epidemic.[16] As discussed below, while its intentions were honorable, by framing the genuine problems associated with tobacco consumption in this monochromatic way, the WHO effectively painted itself into a policy corner from which it has not been easily extracted.

B. Origins of the FCTC

While the FCTC can be traced back to these earlier efforts, work really got going in 1999 when Brundtland established the Tobacco Free Initiative (TFI) and appointed as its head Derek Yach, a South African public-health expert and early advocate for international collaboration to tackle tobacco use.

Following a 1999 WHA resolution, the TFI coordinated negotiations among the WHO’s 193 member governments. This work resulted in a draft treaty presented to and unanimously adopted by the WHA in May 2003.[17] The FCTC formally entered into force Feb. 27, 2005, making it the world’s first health treaty and the WHO’s only international treaty to date.[18]

C. The FCTC’s Purpose and Modus Operandi

The objective of the FCTC, as set out in Article 3:

… is to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for tobacco control measures to be implemented by the Parties at the national, regional and international levels in order to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke.[19]

Meanwhile, by “tobacco control” it means:

a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke.[20]

Administration of the treaty is overseen via biennial Conferences of the Parties (COPs) and a permanent convention secretariat, who is assisted by the FCTC Bureau.[21]

D. Implementation and Effectiveness of the FCTC

The treaty was rapidly ratified by the vast majority of WHO member states.[22] There are currently 183 member-state parties to the treaty, with only 14 nonparties.[23] The United States notably remains a nonparty, in that it has signed but not ratified the treaty.

While there is some evidence that the FCTC helped to drive implementation of certain tobacco-control policies in member states, it is difficult to quantify what practical effect these have had, or how much, if any, reduction in smoking and other harmful tobacco use can be directly attributable to the FCTC.[24] When the FCTC went into effect in 2005, there were 1.1 billion tobacco users in the world; there are now 1.25 billion.[25]

A 2019 British Medical Journal study from a team led by Steven Hoffman, then at Harvard University’s School of Public Health, found “no evidence to indicate that global progress in reducing cigarette consumption has been accelerated by the FCTC treaty mechanism.”[26] In 2022, two former senior WHO officials wrote an op-ed in The Lancet arguing that “globally, the overall number of tobacco users has barely changed,” and that “The FCTC is no longer fit for purpose, especially for low-income countries.”[27] In January 2024, a panel of 15 international experts analyzed the Global Progress Report the WHO had released ahead of the 10th FCTC Conference of the Parties (COP10) and declared the treaty, “an abject failure.”[28]

E. What Went Wrong?

Given the broad enthusiasm among public-health advocates for establishing the FCTC, and the common belief that it would help dramatically reduce the burden of disease from tobacco consumption, it seems reasonable to ask: what went wrong?

A significant part of the problem can be traced to the initial conceptualization of the problem as related to tobacco consumption per se, rather than harmful tobacco use (i.e., primarily smoking, but also some harmful forms of smokeless tobacco). This has led the FCTC secretariat and its allies to attempt to eliminate all tobacco use, regardless of harm. This is perplexing, not least because, by 2003, studies had already established that lower-risk tobacco products were contributing to dramatic reductions in smoking.[29]

1.  Snus and the tobacco-harm-reduction revolution

Snus is a form of oral tobacco that is pasteurized and kept refrigerated, thereby dramatically reducing levels of harmful chemicals relative to most other forms of oral tobacco.^[1] In 2002, the Journal of Internal Medicine published a study that evaluated data on rates of smoking and snus use among men and women in Northern Sweden, derived from a series of WHO surveys, which found:

Amongst men ever-tobacco use was stable in all survey years at about 65%, but the prevalence of smoking declined from 23% in 1986 to 14% in 1999, whilst snus use increased from 22% to 30%. In women the prevalence of smoking was more stable in the first three surveys (approximately 27%) but was 22% in 1999, when snus use was 6%. In all years men showed higher prevalence of ex-smoking than women. A dominant factor was a history of snus (PR = 6.18, CI = 4.96-7.70), which was more prevalent at younger ages.[30]

The following year (2003), Tobacco Control published a study led by Jonathan Foulds, then at the Tobacco Dependence Institute of the University of Medicine and Dentistry of New Jersey, and three coauthors. The researchers reviewed the effect of snus use in Sweden and concluded that:

Snus …is dependence forming, but does not appear to cause cancer or respiratory diseases. It may cause a slight increase in cardiovascular risks and is likely to be harmful to the unborn fetus, although these risks are lower than those caused by smoking.[31]

Moreover, Foulds et al. noted that, as a result of increased use of snus in Sweden:

There has been a larger drop in male daily smoking (from 40% in 1976 to 15% in 2002) than female daily smoking (34% in 1976 to 20% in 2002) in Sweden, with a substantial proportion (around 30%) of male ex-smokers using snus when quitting smoking. Over the same time period, rates of lung cancer and myocardial infarction have dropped significantly faster among Swedish men than women and remain at low levels as compared with other developed countries with a long history of tobacco use.][32]

2.  WHO and the precautionary principle

While the WHO has been strongly supportive of harm reduction in other contexts—e.g., advocating methadone substitution and the use of condoms to reduce HIV transmission—it has been far less supportive of tobacco harm reduction.^[33] Indeed, over the course of the past two decades it has consistently opposed THR through its publications, advocacy work, and policies. For example:

• In 2006, the WHO released a document titled “Tobacco: Deadly in Any Form or Disguise,” which as the title implies failed to differentiate among the harms of different tobacco products.^[34]
• In 2012, the secretariat of the FCTC published a report on smokeless tobacco in which it raised concerns that snus could be a gateway to smoking, even though the evidence showed the exact opposite effect.[35]

More generally, the WHO has applied a version of the precautionary principle to THR, asserting in “Tobacco: Deadly in Any Form or Disguise”:

For new products and for those under development, additional research is needed to understand more precisely whether their risks are the same as the products they would replace. Such research will take years, or even decades. Until such research is completed, the most prudent course is to assume that their health risks are extraordinarily high compared with any ordinary consumer product and to make every effort to prevent their use along with all other tobacco products.[36]

Given that decades of data were already available on the effects of snus by the time of the document’s publication, one wonders if any amount of data would ever be sufficient to persuade the WHO of the merits of harm-reduction products. The WHO has also applied this same approach to vape products. For example, the organization tweeted in 2013 that: “Until e-cigarettes are deemed safe, approved by competent national regulatory body, consumers should be strongly advised not to use them.”[37]

Two years later, in 2015, Public Health England—the body then empowered to advise the UK National Health Service on matters relating to public health—published an extensive report on e-cigarettes that concluded “the current best estimate” is that vaping is “around 95% safer than smoking.”[38] Similar reports have been produced by numerous other organizations, and Public Health England and its successor body has frequently updated its analysis, always coming to similar conclusions.[39] Thus, e-cigarettes have repeatedly been deemed safe and approved by a competent national regulatory body. And yet, in a section of its website devoted to e-cigarettes, the WHO answers the question, “Are e-cigarettes more or less dangerous than conventional tobacco cigarettes?”[40] with the following mealy-mouthed assertions:

Both tobacco products and ENDS pose risks to health. The safest approach is not to use either.

The levels of risk associated with using ENDS or tobacco products are likely to depend on a range of factors, some relating to the products used and some to the individual user. Factors include product type and characteristics, how the products are used, including frequency of use, how the products are manufactured, who is using the product, user behaviour – user’s puffing style – and whether product characteristics are manipulated post-sale.[41]

Indeed, the WHO remains steadfastly opposed to smokers switching to these products and congratulates[42] countries[43] that choose to ban them.[44]

More generally, since commercially viable low-risk nicotine-containing alternatives to combustible tobacco emerged as a viable route for smokers to quit, the WHO has worked hard to dismiss their potential benefits and criticize countries that allow them to be sold. FCTC reports suppress the scientific evidence on such products by ensuring that only opposing views are represented in official documents considered for the COP. Emblematic of this tendency is the latest WHO Study Group on Tobacco Product Regulation (TobReg) report,[45] which recommends that all alternatives be treated in the same manner as cigarettes and excludes any reference to these products’ harm-reduction potential.

In December 2023, the WHO issued a bizarre press release that attempted to gaslight governments into banning vaping products (but not cigarettes) by peddling demonstrably false claims about their use.[46] The technical note to which the WHO referred contained heroic cherry-picking of research, including claims that “e-cigarettes are harmful,” which failed to recognize that vapor products are orders of magnitude less harmful than combustible tobacco.[47]

The WHO also claims that “electronic cigarettes as actually used in the population as consumer products have not been proven to be effective for cessation at the population level,” which is simply untrue. But the Cochrane Review, considered the gold standard in systematic reviews of evidence, “found the strongest evidence yet that e-cigarettes, also known as ‘vapes’, help people to quit smoking better than traditional nicotine replacement therapies, such as patches and chewing gums.”[48]

Perhaps the most extreme example of this anti-THR campaign came in the form of a June 2024 WHO post on X.com asserting that e-cigarettes are “designed to kill.”[49] And this was not the first time the WHO had made bizarre false assertions about e-cigarettes. In January 2020, even as COVID-19 cases began to appear around the world, the WHO spent its time publishing a thread of 14 tweets about the dangers of vaping.[50] The many blatant falsehoods in that thread included claims that e-cigarette liquid is highly flammable (it is non-flammable) and that second-hand vapor is lethal to bystanders (there is no evidence that it is at all harmful to users, let alone others).

F. Hostage to Fortune

This opposition to THR can be traced to the WHO’s initial conceptualization of the problem—namely, that tobacco use is addictive and hence a disease in itself, which can only be cured through the elimination of tobacco use. But that overly simplistic view might have been open to change had it not been reinforced by three other agents: “civil society,” vested interests, and outside donors.

1. Uncivil society

Common conceptions of “civil society” usually include the broad swath of organizations and individuals who create the invisible glue that underpins societies’ institutions. It is the companies and individuals who provide us with goods and services. It is the charities that provide food, temporary shelter, and medical care for the poor. It is the nonprofits that help those with mental and physical disabilities. It is the pro-bono lawyers who defend indigents against criminal charges. It is the philanthropists who offer prizes to those who solve intractable problems.

But that is not how the United Nations thinks of civil society. To become a UN-affiliated civil-society organization, it is necessary to register with the body’s Economic and Social Council (ECOSOC), which takes about two years. Moreover, the registration process is only open to NGOs that meet specific criteria, including that they “must have a democratic decision-making mechanism.” That clearly excludes the vast majority of actual civil-society organizations (and, obviously, individuals).

But the WHO takes an even narrower view of civil society. In the context of the FCTC, it is a single organization: the Global Alliance for Tobacco Control (GATC). Originally named the Framework Convention Alliance (FCA), GATC was formed in 1999, when FCTC negotiations began, as a confederation of nearly 500 organizations from more than 100 countries that banded together to support negotiation, ratification, and implementation of the proposed treaty.

This led to the drafting of Article 4 (7) of the FCTC, which declares: “The participation of civil society is essential in achieving the objective of the Convention and its protocols.” In practice, this actually means the participation of GATC. NGO membership of GATC is only ever granted to those organizations that agree with every aspect of the WHO’s ideological stance on tobacco control. Disagreement or dissent is ruthlessly stifled.

2. The anti-Big Tobacco smokescreen

To those who believe that all tobacco use is a disease, the primary vector of that disease is the tobacco industry. To be fair, for decades, tobacco companies did their best to reinforce this view by claiming that smoking is not harmful. But in recent years, some of those companies have attempted to reform, and to provide less-harmful products to their consumers.

Many in the tobacco-control movement are nonetheless unable to move past tobacco-company executives’ historic misbehavior and continue to believe that tobacco companies have nefarious motives, even when those companies are seeking to offer harm-reduction products. This opposition to industry blinds many to the potential for THR.

Concerns about the potential for the tobacco industry to influence policy led to the inclusion of Article 5.3 of the FCTC, which states:

In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.

Taken at face value, this seems like a reasonable conflict-of-interest policy. Derek Yach—who had been a key early advocate for a global tobacco-control treaty and who, as head of the WHO’s TFI, was arguably the lead architect of the FCTC—has noted that, in the FCTC’s early years, Brundtland recognized the need for collaborative stakeholder input, including from the tobacco industry:

Despite our concerns about these clear differences in position, we are committed to hearing how the tobacco companies do propose to reduce the harm that their products cause. […]. We have invited tobacco company scientists to provide their views on product modification to this Committee…[51]

But the FCTC secretariat, various member states, and the FCA/GATC have used Article 5.3 as a smokescreen (pun intended) to stifle debate. For example, starting with the FCTC’s fourth Conference of the Parties (COP4), the secretariat closed the public gallery during the opening session, excluding the media and the public from participation,[52] ostensibly to prevent undue industry influence. This is unlike the process for any other meetings under the auspices of the United Nations.

NGOs affiliated with the GATC cite Article 5.3 as justification for prohibiting participation by groups whose opinions differ from their own. For example, the STOP: Expose Tobacco[53] organization, which sends observers to FCTC COP meetings, bans the public from participating in their events if they have links with industry to the “4th degree of consanguinity.” This is despite the fact that Article 5.3 does not apply to GATC or any NGOs and that, even if it did, it would not logically prohibit even Big Tobacco from participating.

While the decisionmakers in the FCTC process are the parties (national governments), the GATC has considerable influence over them. Delegates to COP are subject to regular intimidation through daily GATC bulletins. The organization also hands out “Orchid” and “Dirty Ashtray” awards to countries it deems to be behaving well or badly, respectively, with the aim of pressuring delegations to agree with the FCTC secretariat’s wishes and not to show dissent or disagreement. For example, in 2012, the then-FCA gave an Orchid Award to the Philippines “for excluding the National Tobacco Administration (NTA) from the official delegation to the 5th Conference of Parties (COP5).”[54] But at COP10 in January 2024, the GATC gave a Dirty Ashtray award to the Philippines, “for its brazen use of tobacco industry tactics of obstinate dispute and delay throughout the COP.”[55] Its putative crime was support tobacco harm reduction.

Due to this McCarthyite dismissal of open debate, there is little appetite for pushing back against the excesses of the WHO FCTC administration. Those who do are routinely smeared as being in league with the tobacco industry, without any supporting evidence; are excluded from public health events; denied grants; and, on occasion, hounded out of their careers. There is no ombudsman to evaluate this treatment, leaving the WHO, FCTC secretariat, and their allies in the GATC effectively unaccountable.

3. Misunderstanding conflicts of interest

The WHO in general and FCTC in particular seem deeply confused about the notion of conflicts of interest. On the one hand, they apply exclusions relating to manufacturers of tobacco products far too broadly. For example, at COP5, the FCTC denied observer status to Interpol, the international crime agency, for having the temerity to deal with the tobacco industry for a global initiative to combat trans-border crime and the elimination of all forms of illicit trade in tobacco products.  Even more absurdly, in 2022, the WHO refused[56] to accept a Canadian COVID vaccine into the COVID-19 Vaccines Global Access (COVAX) program simply because Philip Morris International owned a minority share in the company that developed it.

On the other hand, they appear overly willing to embrace other vested interests, including those who raise funds on the back of their opposition to THR (i.e., members of the GATC) and those who sell products that compete with THR (i.e., the pharmaceutical industry). As former WHO Directors Robert Beaglehole and Ruth Bonita note, the WHO, “is unduly influenced by vested interests who promote nicotine abstinence.”[57]

For example, the Tobacco Free Europe campaign was funded in part by grants from three pharmaceutical companies with a direct interest in selling smoking-cessation products: Pfizer, Johnson & Johnson, and Novartis.[58] Pfizer was also the primary sponsor of the 2003 World Conference on Tobacco and Health. At the time, Pfizer was the holder of the patent on varenicline, a blockbuster drug that works by reducing the pleasure that users derive from nicotine.[59] As such, varenicline use is incompatible with THR-based solutions that rely on consumers switching to less-harmful nicotine-containing products.

During the World Health Summit in 2022, where the WHO launched the Tobacco Cessation Consortium,[60] WHO Director-General Tedros Adhanom Ghebreyesus shared the stage with executives from a host of strategic partners,[61] including Pfizer, Roche, Sanofi, and Johnson & Johnson Worldwide Chairman for Consumer Health Thibaut Mongon.

The consortium’s literature, more reminiscent of a business-development plan than a health initiative,[62] seeks to engage “multi-sectoral partners” to help “expand the market for cessation services” and to “drive consumer behavior.” It speaks of “easing regulatory barriers to expand markets,” “getting great products and pharmacotherapies into the hands of tobacco users,” and “market shaping of nicotine replacement therapies.” In return, the WHO has promised funding for “[t]he costs of convening of working groups” that help the WHO to deliver “best buy” interventions, and the “delivery of grants to NGOs and governments contributing to these workstreams.”

In fact, some of the WHO’s largest private funders are pharmaceutical companies. This is a clear conflict of interest, considering that many stand to profit considerably if smokers are driven toward an abstinence-only approach and prevented from adopting alternative nicotine-delivery systems, such as e-cigarettes, heat-not-burn products, and nicotine pouches.

It is little wonder then that the stances taken by the WHO and the FCTC secretariat toward safer nicotine alternatives aligns closely with the interests of Big Pharma companies, and heavily against new nicotine-delivery systems that evidence suggests, in some cases,[63] are more effective in helping smokers to quit cigarettes than traditional cessation products.

For example, in 2021,[64] the WHO’s annual World No Tobacco Day (WNTD) campaign moved beyond the use of tobacco products and toward also demonizing nicotine pouches. Likewise, WNTD in 2024[65] included a heavier emphasis on discouraging use of vapes than it did on combustible tobacco.

In 2021, the FCTC secretariat issued a report[66] on “new and emerging” tobacco and nicotine product use that encouraged countries to adopt harsh anti-vaping and anti-harm-reduction positions. The report was funded by the U.S. philanthropist Michael Bloomberg, who is personally opposed to reduced-risk nicotine products such as vapes and heated tobacco. At COP10 in Panama in February 2024, more of the agenda was devoted to discussing “new and emerging” nicotine products than to combustible tobacco, which causes the vast majority of tobacco-related death and disease, and which is the explicit focus of the text of the FCTC treaty.

In December 2023, the WHO issued a press release[67] urging national governments to ban e-cigarettes or, failing that, to only regulate them as medicines, a policy that has failed disastrously in Australia. Also, newly produced WHO guidance[68] calls for widespread use of pharmaceutical-industry products for smoking cessation, while completely ignoring the success of vaping and other nicotine alternatives.

While pharmaceutical products and THR both undoubtedly have a role to play in reducing smoking, it seems fundamentally misconceived to privilege one at the expense of another. In July 2024, the WHO released new guidelines[69] on smoking cessation that conspicuously exclude the use of e-cigarettes, smokeless, and heated tobacco products, despite their significant success in reducing smoking rates in countries where they are allowed to compete with cigarettes. Instead, the new guidance recommends varenicline as a first-line product for cessation practitioners.

Sadly, as Beaglehole and Bonita note: “This opposition [to THR] privileges the most harmful products— cigarettes.”[70]

G. Opaque Funding

The FCTC secretariat is responsible for arranging funding for the treaty’s goals. It does so through a combination of assessed contributions (ACs) paid by countries as a financial commitment to the convention (each party is assessed based on the country’s wealth and population, and dues are calculated accordingly), as well as extrabudgetary contributions (ECs), which are voluntary donations to finance activities adopted at Conference of the Parties meetings, such as expert and working groups on various articles of the treaty.

The FCTC’s overall budget for 2024-25 is $19,498,888, but only $8,801,093 of that is covered by ACs.[71] The rest comes from ECs. The ACs are fully transparent and published online.[72] The ECs, by contrast, are kept largely secret.[73]

H. Implications for Future WHO Treaties

This brief history of the FCTC clearly bodes ill for any future WHO treaty. The WHO can be captured by special interests with an agenda that may be not only unhelpful, but actively harmful to the group it allegedly wants to help. The WHO’s Orwellian approach to the FCTC has included deployment of incomplete and even false science; knowingly ignoring data that run counter to its desired positions; and completely ignoring its own conflicts of interests, while decrying all other stakeholders as biased vested interests.

The WHO happily relies on a compliant media that assumes the best of a health agency and continues to distrust anything associated with market-driven personal choice as a method of smoking cessation.

III. WHO, COVID, and the Pandemic Treaty

Unfortunately, the WHO’s behavior during the COVID-19 pandemic reinforces concerns that it is not well-suited to develop and implement a pandemic treaty.

A. Failure to Identify and Share Accurate Information in a Timely Manner

The WHO’s first and arguably deadliest misstep during COVID was its delayed response to identifying and sharing information about the existence of a novel pathogen that might pose a global threat. This is acknowledged in the WHO’s own review.[74]

The WHO has acknowledged that health misinformation can cost lives. Yet during COVID, it inhibited the free flow of information and contributed to the dissemination of misinformation. Taiwan first alerted the WHO[75] to the threat coming out of Wuhan, yet the WHO backed Beijing’s claims[76] that it could contain the virus. In this case, the problem resulted from the fact that Taiwan is not a member of the United Nations or any of its agencies, including the WHO. The WHO therefore does not recognize its statements, due to the UN’s “One China” policy. The unfortunate result was that the WHO provided misinformation. Unless the WHO becomes more inclusive, it cannot be trusted to function as an information coordinator in a pandemic.

Worryingly, the WHO remains remarkably incurious regarding the source of the COVID pandemic, which is rather disconcerting given that early identification of the source of any new pathogen is likely to be important in reducing its spread.[77]

B. Inappropriate Application of One-Size-Fits All Approach

The WHO has failed to acknowledge valid approaches taken by jurisdictions that did not follow its advice. A good example is Sweden, which never “locked down,” allowed schools and business to stay open, relied on the good sense of the Swedish people to socially distance and quarantine where required.[78] Since Sweden has had among the lowest mortality rates in the world over the past four years, perhaps it has lessons for the rest of us.

If the WHO wants to play the role of information coordinator in a future pandemic, it should be more open to evidence of effectiveness—not only from Sweden, but from other countries that took heterodox approaches during COVID. Evidence from Taiwan, Germany, Iceland, and South Korea, also show that there is no single rulebook for effectiveness.[79] Rather, the most effective approach is contingent on many factors, some of which are geographically and culturally specific.

The divergent paths taken by these countries demonstrate that pandemic policies are not “one size fits all,” that mandates rarely work, and that the tradeoffs in shuttering schools and business might ultimately cause more harm than good. When mandates are under consideration, nations should, at a bare minimum, assess whether their costs outweigh their benefits. The WHO should acknowledge this reality and use its position to provide a comprehensive picture of the various ways that countries responded successfully to the exigencies of the pandemic.

C. Arrogance Compounds Ignorance and Is Anti-Scientific

WHO officials seem rather too certain of the best ways to combat a future pandemic, which are essentially a repeat of its COVID playbook: lockdowns, mask mandates, testing mandates, and vaccine mandates. Yet according to a recent analysis by the Cochrane Review—the gold standard for evaluating health interventions—mask mandates are simply ineffective.[80] And according to a comprehensive meta-analysis, while lockdowns may have prevented deaths from COVID (at least, in the initial phase of the pandemic), they increased deaths from other diseases and imposed enormous social and economic costs.[81]

The WHO says we should “follow the science.” But science is a process, not an outcome. Science requires the kind of robust debate that the WHO sought to shut down. During the early phases of the pandemic, public-health officials assessed the infection fatality rate (IFR, or how many people die when infected) by using data from hospitalizations. But these data inaccurately biased the IFR upward, as most of the infected were either asymptomatic or not severe enough to need a hospital. The falsely high IFR led to even greater calls for lockdowns.

D. Decentralized Approaches to the Identification of Treatments Are More Successful

Around the world, physicians tried many drugs to combat COVID-19 infections and associated symptoms. Rapid identification and sharing of information regarding successes and failures saved countless lives. For example, an off-patent corticosteroid (dexamethasone) proved so effective in a UK trial that the trial was halted, and dexamethasone’s use was recommended for severe cases.[82] But the WHO played essentially no role in this process. Indeed, the WHO’s highly centralized approach is directly contrary to the decentralized discovery processes that were so important to the several successful massively distributed trials.

For example, the UK-based Platform Randomised Trial of Interventions Against COVID-19 in Older People (PRINCIPLE) was a highly effective decentralized system for evaluating potential therapies in community settings that helped to identify one highly effective treatment, one moderately effective treatment, and four ineffective treatments.[83] Another notable and prize-winning trial process—the Platform Adaptive Trial of Novel Antivirals for Early Treatment of COVID-19 in the Community (PANORAMIC)—identified the following five lessons for future pandemic response:

1. Prioritise Primary Care Studies: Future pandemic research should position primary care at the forefront, enabling earlier intervention to prevent symptom worsening and reduce hospital admissions.

2. Adopt Platform Study Models: The success of PANORAMIC’s platform study approach suggests this should be the blueprint for future pandemic research in primary care.

3. Enhance Care Home Participation: Efforts should be made to increase recruitment from care homes, addressing barriers such as complex contracting requirements.

4. Improve Medicine Delivery: Further evaluation of methods to deliver medicine directly to participants at home is recommended.

5. Build Community Trust: Prioritise relationships with community leaders to enhance research inclusivity and reach underserved populations.[84]

E. Resist the Rise of the Pandemic-Industrial Complex

The success of vaccine development during COVID is testament to the effectiveness of the private-sector drug-discovery process and of incentives created by government procurement. Arguably, the most successful such program was the U.S. government’s Operation Warp Speed, which used taxpayer funds to support research, development, and production of COVID vaccines so that they could be distributed free to users around the nation and oversees.[85] Companies such as Pfizer and Moderna were paid billions of taxpayer dollars to deliver these potentially lifesaving COVID vaccines.

But there is a grave danger that the mechanisms established to produce the COVID vaccines could be abused if they were to become a perpetual feature of pandemic response. In his January 1961 farewell address, President Dwight Eisenhower made a powerful plea for caution against the rise of the military-industrial complex:

A vital element in keeping the peace is our military establishment. Our arms must be mighty, ready for instant action, so that no potential aggressor may be tempted to risk his own destruction. . .  American makers of plowshares could, with time and as required, make swords as well. But now we can no longer risk emergency improvisation of national defense; we have been compelled to create a permanent armaments industry of vast proportions. . . This conjunction of an immense military establishment and a large arms industry is new in the American experience. . . Yet we must not fail to comprehend its grave implications. . .  In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.[86]

Just as keeping the peace may justify military expenditure, so too may prevention of pandemics justify pandemic expenditure. But despite Eisenhower’s warning, the military-industrial complex has resulted in misplaced power, leading to excessive spending on military hardware and unjust enrichment of the shareholders of a small number of well-connected companies, not to mention the manufacturing of conflicts that have resulted in the loss of millions of lives. We are now at risk of repeating the same mistakes with the creation of a pandemic-industrial complex.

David Bell, a former WHO scientist, notes that pharmaceutical companies and their investors “have profited greatly from the COVID-19 response and are strongly aligned with the WHO’s current pandemic preparation and response proposals.”[87] These include not only the vaccine makers, but also the scientists and science managers at U.S. National Institutes of Health (NIH) and elsewhere who benefit financially from vaccine sales because they own intellectual property in aspects of vaccine development. It also includes the industries involved in vaccine distribution and other related health interventions, the health authorities who get to decide on mandates and dictate policy, and the media machine that promotes vaccines and suppresses “misinformation” on potential vaccine risks. No doubt there are others, but the tens of thousands of players who would benefit financially from a new pandemic seem happy to push for mass-vaccine schemes for the latest risk, as we are already seeing with monkeypox.[88]

F. How a WHO Pandemic Treaty Would Reinforce the Pandemic-Industrial Complex

Under a WHO pandemic treaty, the WHO and its allies would undertake “surveillance” that is effectively guaranteed to find new virus variants (e.g., bat research in caves in rural China). They would then claim that these variants could cause “Disease X” that has “the potential” to strike in a manner similar to COVID. The media, already primed, would amplify this message, especially once a target is identified.

Members of the OECD and G20 have demonstrated support for mandatory lockdowns and border closures in response to announcements of a significant threat. They are, after all, blame-avoiding bureaucrats who might lose their job if they were to permit another COVID. And once a vaccine is ready, they could mandate that, too. Pharma companies have production lines open and are ready to profit from the market a new scare would create.

The WHO, various health authorities, and pharmaceutical companies would sponsor disease modelers, who are encouraged to provide worst-case scenarios like those invented by Imperial College London’s Neil Ferguson.[89] The WHO would then advise member nations to impose lockdowns and demand vaccinations, lest citizens lose the ability to work or travel. Governments not only purchase the vaccines, but also derisk their manufacture by removing liability for harm to users, despite abbreviated trials. Finally, governments squash any inconvenient facts and dissenting opinions as “misinformation.”

As David Bell puts it: “It amounts to perhaps the most infallible wealth concentration scheme in history. The general model proved itself during Covid-19, orchestrating the largest wealth transfer on a global scale, from poor to rich, the world has seen.”[90] It is ironic that the political left, which offers copious critiques of imperialism past, are rarely heard today on the subject of the Western-led mandate imperialism. Indeed, left-leaning academics and media appear happy with WHO-driven demands, epitomized by the proposed pandemic treaty.

G. What Is in the Proposed Pandemic Treaty?

The aim of the proposed treaty is to improve political leadership and coordination across nations, with the WHO at the center. It calls for significant increases in funding for the WHO; for perpetuating financing mechanisms to fund global disease surveillance; and for strengthening international health regulations, which could include limits on travel and demands for mechanisms like vaccine passports.

A large portion of the treaty seeks to address inequities and how to combat them. What is really at stake is more funding for the WHO “to act as the directing and coordinating authority on international health.” None of this is binding on member nations. And experts pushing the treaty even cite “national sovereignty” as a limitation on the treaty.[91]

Of all the proposals, the most worrying are the plans to strengthen “approaches to and capacities for information and infodemic management… in order to build public trust in data, scientific evidence and public health measures and to counter inaccurate information and unsubstantiated rumours.”[92] As explained above, the danger is that the WHO was a major purveyor of misinformation. Allowing it to control and censor information is a problem.

H. How the FCTC and WHO’s History Is Relevant to a Pandemic Treaty

Given the WHO’s history, its contributors, their aims, and consequent WHO budget allocations, the way WHO has run the FCTC, and its actions over the course of the COVID-19 pandemic, lead us to conclude that the WHO is not capable of promulgating a pandemic treaty fairly, usefully, or to the benefit of public health.

As we have seen with the FCTC and during the COVID-19 pandemic, the WHO engages in censorship of those who disagree with its ideological stance.[93] The solution to misinformation is more information and debate, not censorship. Yet the WHO has no interest in views outside its favored policies. Sweden’s response to COVID and UK policies on tobacco harm reduction should provide valuable lessons, yet the WHO shows no interest in such lessons. This alone should disqualify the WHO from a central role in coordinating pandemic response.

The WHO also appear incapable of, and probably uninterested in, standing up to powerful nations like China. After all, the WHO’s COVID policies were watered-down versions of the lockdowns and other mandates that China employed. If another pandemic were to originate in China, we cannot expect the WHO’s response to be any better than before.

The WHO also allows certain NGOs too much power to influence its policies even when overwhelming scientific evidence shows their advice to be incorrect.[94] Despite its claim to “follow the science,” when put to the test with the FCTC and COVID, the WHO has spectacularly failed to do so. Its responses were dogmatic—based on ideology and not science.

The WHO is beholden to its donors, who increasingly are unrepresentative of the global population and who have specific agendas. As David Bell has asserted, there is now something approaching a pandemic-industrial complex, in which drug companies and NGOs support WHO to enact policies (notably vaccine mandates and accompanying research to support mandates) that benefit the very groups that provide WHO with support. In essence, NGOs are buying the WHO’s image for enhancing global public health to achieve their private aims.

That the WHO has allowed its brand to be used in this manner is yet another reason it should be disqualified from taking the lead on pandemic responses. NGO efforts to discredit THR and promote virus research will probably worsen public health. Refusing to debate a wide variety of public-health responses in favor of a one-size-fits-all approach is dangerous for public health, especially when their one approach is so often wrong. After all, the WHO is supposed to provide technical assistance to poorer nations; if its advice is incorrect, it will worsen public health.

Virus research and mandates can arguably be effective and important, and public discussion of those topics makes sense. But the WHO operates a blind top-down approach that fails to seek crucial input from those most affected by its policies. Without debate, poor policies will sustain. In the end, the WHO refuses to recognize when it is failing and to change its approach accordingly.

IV. Conclusion

For 30 years, the WHO operated successful programs to combat infectious diseases. But after the Alma Ata Declaration, it attempted unsuccessfully to help nations develop their own health systems. Donor fatigue set in, and the WHO shifted both its operations and funding toward “special programs.” Some of these were successful and, when Director-General Brundtland sought to apply the model to tobacco, there was considerable enthusiasm.

Unfortunately, the WHO in general and the FCTC in particular has succumbed to ideological positions that deny the best science and policies. The organization’s attack on vaping and other forms of THR have stalled efforts to lower smoking, the greatest preventable threat to health. The WHO’s response to COVID was likewise weak, also not based in science, and highly political. Its advice is often contradictory and counterproductive.

The WHO is today once again pushing to establish and govern a pandemic treaty. But given the experience of COVID and the FCTC, it would be unwise to entrust WHO with such an endeavor.[95] Should there be any role for WHO in pandemic preparedness? Perhaps, but giving it more power to direct responses without significant changes in the way it operates would be premature.

Oversight of UN bodies, including the WHO, is very weak, and the only real constraint is the threat to withhold funds. With a growing share of WHO funds coming from private actors like the Gates Foundation to fund specific projects, however, governmental threats of withholding general funds are becoming weaker. As such, the U.S. government should only agree to grant the WHO new powers when it is sure the WHO is the correct body to have those powers, and equally sure it can execute said powers fairly and effectively. At the moment, neither of those conditions has been satisfied.

It is tempting to just move on from COVID, and even to assume that a WHO treaty could help to prevent a future pandemic. But doing so would invite a new pandemic and could lead to even more draconian policies, which will once again harm our economy, our health, and our children’s education.

* This foreword is written by Derek Yach (MBChB MPH), who has spent four decades addressing tobacco control and actions to end the health toll caused by tobacco. He started this work in South Africa, where he led development of the epidemiological and economic base for regulatory action; continued this work at the World Health Organization, where he played a major role in the conceptualization, development, and adoption of the WHO Framework Convention on Tobacco Control; before leading global health at Yale University and then the Rockefeller Foundation, PepsiCo, and Vitality. He has striven for the past decade striven to promote the development of the science base to support tobacco harm reduction as the fastest way to end adult smoking. This includes the formation and leadership of the Foundation for a Smoke Free World for five years and, since then, deep engagement with private, public, and philanthropic groups seeking to strengthen their research in ways that could end tobacco use. He lives in Connecticut and is a keen open-water swimmer.

* Martin Cullip is an international fellow at the Taxpayers Protection Alliance’s Consumer Center, based in South London, England. Roger Bate is a nonresident scholar with the International Center for Law & Economics (ICLE). ICLE has received financial support from numerous foundations, individuals, and companies, including firms with interests both supportive of and in opposition to the ideas expressed in this and other ICLE-supported works. Unless otherwise noted, all ICLE support is in the form of unrestricted, general support. The ideas expressed here are the authors’ own and do not necessarily reflect the views of ICLE’s advisors, affiliates, or supporters.

[1]  See Roger Bate, Curing the International Health System, Am. Enter. Inst. (Sep. 1, 2009), https://www.aei.org/articles/curing-the-international-health-system.

[2] Constitution of the World Health Organization, World Health Organ. (1946), available at https://treaties.un.org/doc/Treaties/1948/04/19480407%2010-51%20PM/Ch_IX_01p.pdf.

[3] See Brett D. Schaefer, ConUNdrum: The Limits of the United Nations and the Search for Alternatives (2009), at 297-300.

[4] Michael T Mbizvo et al., 40 Years of Innovation in Sexual and Reproductive Health, 380(9843) The Lancet 705-706 (2012).

[5] Public Health Milestones Through the Years, World Health Organ., https://www.who.int/campaigns/75-years-of-improving-public-health/milestones#year-1946 (last visited Nov. 11, 2024).

[6] Donald Henderson, Principles and Lessons From the Smallpox Eradication Programme, 65(4) Bull. World Health Organ. 535-546 (1987), at 539.

[7] Global Programme on AIDS 1987-1995: Final Report, World Health Organ. (1997).

[8] Who We Are, Polio Glob. Eradication Initiative, https://polioeradication.org/who-we-are (last visited Nov. 10, 2024).

[9] Contributors, World Health Organ., https://open.who.int/2022-23/contributors/contributor (last visited Nov. 6, 2024).

[10] Id. at 10.

[11] David Bell, Pandemics: A Business Opportunity, Brownstone Inst. (Apr. 2, 2024), https://brownstone.org/articles/pandemics-a-business-opportunity.

[12] See Giulia Carbonaro, How Is the World Health Organization Funded, and Why Does It Rely So Much on Bill Gates?, Eur. News (Mar. 2, 2023), https://www.euronews.com/health/2023/02/03/how-is-the-world-health-organization-funded-and-why-does-it-rely-so-much-on-bill-gates.

[13] Speech to the Fifty-first Health Assembly Geneva, World Health Organ. (May 13, 1998), A.51(4), available at https://apps.who.int/gb/ebwha/pdf_files/WHA51/eadiv6.pdf (Brundtland announced the establishment of the Roll Back Malaria partnership during her acceptance speech to the World Health Assembly).

[14] See WHA Res. 28.85, Off. Rec. WHO No. 226, Twenty-Eighth World Health Assembly, World Health Organ. (1975), available at https://iris.who.int/bitstream/handle/10665/86022/Official_record226_eng.pdf (Resolution WHA28.85 from the 1975 World Health Assembly called for international collaboration on research into cancer.)

[15] See WHO Tech. Rep. Ser. No. 568, Smoking and its Effects on Health: Report of a WHO Expert Committee World Health Organ. (1975), available at https://iris.who.int/bitstream/handle/10665/41157/WHO_TRS_568_eng.pdf.

[16] See WHO Tech. Rep. Ser. No. 636, Controlling the Smoking Epidemic, World Health Organ. (1979), available at https://iris.who.int/bitstream/handle/10665/41351/WHO_TRS_636.pdf.

[17] See WHA Res. 56.1, WHO Framework Convention on Tobacco Control, World Health Organ. (2003), available at https://apps.who.int/gb/archive/pdf_files/WHA56/ea56r1.pdf (last visited Nov. 6, 2024).

[18] Framework Convention on Tobacco Control., World Health Organ., https://www.who.int/europe/teams/tobacco/who-framework-convention-on-tobacco-control-(who-fctc) (last visited Nov. 10, 2024).

[19] World Health Organ., supra note 17, Art 3.

[20] Id. at 19 Art 1(d).

[21] Bureau of the COP, World Health Organ. Framework Convention on Tobacco Control, https://fctc.who.int/who-fctc/governance/bureau-of-the-cop (last visited Nov. 6, 2024), (The bureau’s role is to make proposals that are then circulated to regional coordinators and distributed to member governments).

[22] Full List of Signatories and Parties to the WHO Framework Convention on Tobacco Control, World Health Org. Framework Convention on Tobacco Control, https://web.archive.org/web/20090113054050/http:/www.who.int/fctc/signatories_parties/en (archived Jan. 13, 2009).

[23] Treaty Status of the Convention on the Prevention and Punishment of the Crime of Genocide, United Nations (May 21, 2003), https://treaties.un.org/pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IX-4&chapter=9&clang=_en.

[24] See Janet Chung-Hall et al., Impact of the WHO FCTC Over the First Decade: A Global Evidence Review Prepared for the Impact Assessment Expert Group, Tobacco Control (2019), https://tobaccocontrol.bmj.com/content/28/Suppl_2/s119.

[25] WHO Global Report on Trends in Prevalence of Tobacco Use 2000-2030, World Health Organ. (2024), https://www.who.int/publications/i/item/9789240088283.

[26] Steven J Hoffman et al., Impact of the WHO Framework Convention on Tobacco Control on Global Cigarette Consumption: Quasi-Experimental Evaluations Using Interrupted Time Series Analysis and In-Sample Forecast Event Modelling, 365 BMJ I2287 (2019), https://www.bmj.com/content/365/bmj.l2287.

[27] Robert Beaglehole & Ruth Bonita, Tobacco Control: Getting to the Finish Line, The Lancet (May 14, 2022), https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00835-2/fulltext.

[28] Derek Yach, Scorecard Exposes WHO’s Big Fall in Curbing Tobacco Use, TobaccoHarmReduction.net (Jan. 31, 2024), https://www.tobaccoharmreduction.net/article/scorecard-exposes-whos-big-fail-in-curbing-tobacco-use.

[29] See Jonathan Foulds et al., Effects of Smokeless Tobacco (Snus) on Smoking and Public Health in Sweden, 12 Tobacco Control 349-359 (2003), https://pmc.ncbi.nlm.nih.gov/articles/PMC1747791.

[30] Brad Rodu et al., Evolving Patterns of Tobacco Use in Northern Sweden, 253 J. Intern. Med. 660-665 (2002), available at https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-2796.2002.01057.x.

[31] Foulds, supra note 29.

[32] Id.

[33] Priority HIV and Sexual Health Interventions in the Health Sector for Men Who Have Sex With Men and Transgender People in the Asia-Pacific Region, World Health Organ. (2010), https://iris.who.int/bitstream/handle/10665/205675/B4537.pdf?sequence=1&isAllowed=y.

[34] Tobacco: Deadly in Any Form or Disguise, World Health Organ. (2006), at 27, available at https://www.emro.who.int/images/stories/tfi/documents/wntd-2006/kit.pdf.

[35] See WHO Doc. FCTC/COP5/12, Control and Prevention of Smokeless Tobacco Products, World Health Organ. Framework Convention on Tobacco Control (2012), available at https://apps.who.int/gb/fctc/PDF/cop5/FCTC_COP5_12-en.pdf.

[36] Id. at 37–38.

[37] @WHO, Twitter (Jul. 9, 2013, 6:14 am) https://x.com/WHO/status/354559151889842176?lang=ar-x-fm.

[38] Ann McNeill et al., E-cigarettes: An Evidence Update A Report Commissioned by Public Health England, Pub. Health Eng. (2015).

[39] PHE’s successor, the Office for Health Improvement and Disparities (OHID), published an eighth and final report in September 2022 (It was the final report because the authors felt they had reviewed all possible evidence and there was nothing left to study). Running 1,468 pages and studying all potential health risks of vaping, it concluded that “[b]ased on the reviewed evidence, we believe that the ‘at least 95% less harmful’ estimate remains broadly accurate.”

[40] Tobacco: E-Cigarettes, World Health Organ. (2024), https://www.who.int/news-room/questions-and-answers/item/tobacco-e-cigarettes.

[41] Id. at 39.

[42] See EB Doc. EB153/10, Matters for Information: Report on Meetings of Expert Committees and Study Groups, World Health Organ. (2023), available at https://apps.who.int/gb/ebwha/pdf_files/EB153/B153_10-en.pdf.

[43] See Kerry Cullinan, E-Cigarettes Are a ‘Trap’ to Recruit Children Not Harm Reduction – Tedros, Health Pol’y Watch Indep. Glob. Health Reporting (Feb. 6, 2023), https://healthpolicy-watch.news/e-cigarettes-are-a-trap-to-recruit-children-not-harm-reduction-tedros.

[44] See Press Release, Dr Harsh Vardhan Conferred WHO Award for Leadership in Tobacco Control, World Health Organ. (Jun. 2, 2021), https://www.who.int/india/news/detail/02-06-2021-dr-harsh-vardhan-conferred-who-award-for-leadership-in-tobacco-control.

[45] Id. at 41

[46] Press Release, Urgent Action Needed to Protect Children and Prevent the Uptake of E-cigarettes, World Health Organ. (Dec. 14, 2023), https://www.who.int/news/item/14-12-2023-urgent-action-needed-to-protect-children-and-prevent-the-uptake-of-e-cigarettes.

[47] Technical Note on the Call to Action on Electronic Cigarettes, World Health Organ. (Dec. 14, 2023), https://www.who.int/publications/m/item/technical-note-on-call-to-action-on-electronic-cigarettes.

[48] Press Release, Latest Cochrane Review Finds High Certainty Evidence that Nicotine E-cigarettes Are More Effective than Traditional Nicotine-Replacement Therapy (NRT) in Helping People Quit Smoking, Cochrane (Nov. 17, 2022), https://www.cochrane.org/news/latest-cochrane-review-finds-high-certainty-evidence-nicotine-e-cigarettes-are-more-effective.

[49] @WHO, Twitter (Jun. 11, 2024, 12:20 pm), https://x.com/WHO/status/1800563699255529698.

[50] @WHO, Twitter (Jan. 21, 2020, 8:49 am), https://x.com/WHO/status/1219618083645595650.

 

[51] Derek Yach, The Origins, Development, Effects, and Future of the WHO Framework Convention on Tobacco Control: a Personal Perspective, The Lancet (May 17, 2014), https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62155-8/fulltext.

[52] See Drew Johnson, Johnson: The UN’s Health Agency Works on a Global Tobacco Tax in Secret, The Wash. Times (Oct. 13, 2014), https://www.washingtontimes.com/news/2014/oct/13/johnson-uns-health-agency-works-global-tobacco-tax.

[53] See Driving Addiction: A Race for Future Generations, STOP: A Global Tobacco Industry Watchdog, https://exposetobacco.org (last visited Nov. 11, 2024).

[54] Press Release, Philippines Given International Award For Excluding National Tobacco Administration From COP Delegation, Health Justice (Nov. 13, 2012), https://healthjustice.ph/philippines-given-international-award-for-excluding-national-tobacco-administration-from-cop-delegation.

[55] COP10 Bulletin Day 6, Glob. All. for Tobacco Control (Feb. 10, 2024), https://gatc-cop10-bulletin.my.canva.site/day6.

[56] See Sabrina Jonas, WHO Refuses to Accept Quebec’s Medicago COVID-19 Vaccine Over Company’s Tobacco Ties, Can. Broad. Corp. (Mar. 25, 2022), https://www.cbc.ca/news/canada/montreal/who-rejects-medicago-covid-vaccine-1.6397153.

[57] Beaglehole & Bonita, supra note 27.

[58] Setting the EU Tobacco Control Agenda and Celebrating the ‘Pledge’, Smoke Free Partnership (May 31, 2010), https://www.smokefreepartnership.eu/our-policy-work/events/setting-the-eu-tobacco-control-agenda-and-celebrating-the-pledge.

[59] Chloe J. Jordan & Zheng-Xiong Xi, Discovery and Development of Varenicline for Smoking Cessation, 13(7) Expert Opin. Drug Discov. 671–683 (2018).

[60] Press Release, Pharma, Tech and Social Media Companies Join Forces with WHO to Launch the Tobacco Cessation Consortium During World Health Summit in Berlin, Germany, World Health Organ. (2022), https://www.who.int/news/item/20-10-2022-pharma–tech-and-social-media-companies-join-forces-with-who-to-launch-the-tobacco-cessation-consortium-during-world-health-summit-in-berlin–germany.

[61] World Health Summit 2022, October 16-18 Berlin, Germany & Digital, World Health Summit,  https://www.worldhealthsummit.org/whs-2022/partners.html (last visited Nov. 9, 2024).

[62] Tobacco Cessation Consortium: The Latest Innovation in Tobacco Control, World Health Organ., https://www.who.int/initiatives/tobacco-cessation-consortium (last visited Nov. 9, 2024).

[63] Can Electronic Cigarettes Help People Stop Smoking, and Do They Have Any Unwanted Effects When Used for this Purpose?, Cochrane (Jan. 8, 2024), https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used.

[64] See Tiziana Cauli, Nicotine Pouches Don’t Escape WHO’s World No Tobacco Day Campaign Debate, Tobacco Intelligence (Jun. 3, 2022), https://tobaccointelligence.com/nicotine-pouches-dont-escape-whos-world-no-tobacco-day-campaign-debate.

[65] World No Tobacco Day 2024, World Health Organ., https://www.who.int/campaigns/world-no-tobacco-day/2024 (last visited Nov. 9, 2024).

[66] WHO Report on the Global Tobacco Epidemic 2021: Addressing New and Emerging Products, World Health Organ. (2021), https://www.who.int/teams/health-promotion/tobacco-control/global-tobacco-report-2021.

[67] Urgent Action Needed to Protect Children and Prevent the Uptake of E-cigarettes, World Health Organ. (2023), https://www.who.int/news/item/14-12-2023-urgent-action-needed-to-protect-children-and-prevent-the-uptake-of-e-cigarettes.

[68] WHO Clinical Treatment Guideline for Tobacco Cessation in Adults, World Health Organ. (2024), https://www.who.int/publications/i/item/9789240096431.

[69] Id. at 67

[70] Glob. All. for Tobacco Control, supra note 55.

[71] FCTC/COP10(25) Workplan and Budget for the Financial Period 2024–2025, World Health Organ. Framework Convention on Tobacco Control (2023), https://fctc.who.int/news-and-resources/publications/i/item/fctc-cop10(25)-workplan-and-budget-for-the-financial-period-2024-2025.

[72] Status of Payments of Assessed Contributions (VAC) as of 30 September 2024, World Health Organ. Framework Convention on Tobacco Control, https://fctc.who.int/news-and-resources/publications/m/item/status-of-payments-of-assessed-contributions-(vac)-as-of-4-february-2024 (last visited Nov. 9, 2024).

[73] Donors and Partners, World Health Organ. Framework Convention on Tobacco Control, https://fctc.who.int/secretariat/donors-and-partners (last visited Nov. 6, 2024). The FCTC website does list the names of the parties and some other organizations that have provided additional funds on top of their obligations as FCTC signatories (including the UK, European Commission, Germany, Russian Federation, and the U.S. Centers for Disease Control) but it does not state categorically that these are the only sources of additional support, nor does it say how much they support they provided.

[74] COVID-19: Make It the Last Pandemic, The Independent Panel for Pandemic Preparedness & Response (2021), available at https://theindependentpanel.org/wp-content/uploads/2021/05/COVID-19-Make-it-the-Last-Pandemic_final.pdf.

[75] Yimou Lee & Ben Blanchard, Taiwan Says WHO Ignored Its Coronavirus Questions at Start of Outbreak, Reuters (Mar. 24, 2020), https://www.reuters.com/article/us-health-coronavirus-taiwan/taiwan-says-who-ignored-its-coronavirus-questions-at-start-of-outbreak-idUSKBN21B160.

[76] See Matt Ridley & Alina Chan, The Search for the Origin of Covid-19 (2022).

[77] Id. at 75; Katie Bo Williams et al., Exclusive: Intel Agencies Scour Reams of Genetic Data from Wuhan Lab in Covid Origins Hunt, CNN Pol. (Aug. 5, 2021), https://www.cnn.com/2021/08/05/politics/covid-origins-genetic-data-wuhan-lab/index.html; Ross Pomeroy, Why Do New Disease Outbreaks Always Seem to Start in China?, RealClear Sci (Feb. 18, 2020), https://www.realclearscience.com/blog/2020/02/18/why_do_new_disease_outbreaks_always_seem_to_start_in_china.html; Patrick Berche, Gain-of-Function and Origin of Covid19, 52 Nat’l Libr. of Med. (2023), https://pmc.ncbi.nlm.nih.gov/articles/PMC10234839; Matt Ridley, There Is Now Very Little Doubt that Covid Leaked from a Lab, Spiked (Sep. 10, 2024), https://www.spiked-online.com/2024/09/10/there-is-now-no-doubt-that-covid-leaked-from-a-lab.

[78] Witness Statement of Professor Anders Tegnell, UK COVID-19 Inquiry (Oct. 2, 2023), https://covid19.public-inquiry.uk/wp-content/uploads/2023/12/18145343/INQ000283502.pdf.

[79] See Julian Morris & Marc Joffe, COVID-19 Lessons from the Past and Other Jurisdictions, Reason Found. (2020), available at https://reason.org/wp-content/uploads/coronavirus-response-2-lessons-from-jurisdictions.pdf

[80] See Tom Jefferson et al., Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses, Cochrane (Jan. 30, 2023), https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full.  

[81] See Jonas Herby et al., Did Lockdowns Work? The Verdict on COVID Restrictions, Inst. of Econ. Affs. (Jun. 5, 2023), https://iea.org.uk/publications/did-lockdowns-work-the-verdict-on-covid-restrictions.

[82] Press Release, Dexamethasone Reduces Death in Hospitalised Patients with Severe Respiratory Complications of Covid-19, U. of Oxford (Jun. 16, 2020), https://www.ox.ac.uk/news/2020-06-16-dexamethasone-reduces-death-hospitalised-patients-severe-respiratory-complications.

[83] Favipiravir, Principle, https://www.principletrial.org/results, (last visited Nov. 6, 2024).

[84] See PANORAMIC Trial Learnings: Shaping Future Pandemic Research, Nuffield Dept. of Primary Care Health Scis. Med. Scis. Div., Aug. 8, 2024, https://www.phc.ox.ac.uk/news/nihr-report-panoramic-trial-primary-care-pandemic-research-learnings.

[85] Operation Warp Speed: Accelerated COVID-19 Vaccine Development Status and Efforts to Address Manufacturing Challenges, U.S. Gov’t Accountability Off. (Feb. 11, 2021), https://www.gao.gov/products/gao-21-319.

[86] President Dwight D. Eisenhower’s Farewell Address, Nat’l Archives (Jan. 17, 1961), https://www.archives.gov/milestone-documents/president-dwight-d-eisenhowers-farewell-address.

[87] Bell, supra note 11.

[88] See David Bell, What’s Really Happening with Mpox, Brownstone Inst. (Aug. 18, 2024), https://brownstone.org/articles/whats-really-happening-with-mpox.

[89] See Phil Magness, The Failure of Imperial College Modeling Is Far Worse than We Knew, The Daily Econ. (Apr. 22, 2021), https://thedailyeconomy.org/article/the-failure-of-imperial-college-modeling-is-far-worse-than-we-knew.

[90] See David Bell & Thi Thuy Van Dinh, The WHO Pandemic Agreement: A Guide, Brownstone Inst. (Mar. 22, 2024), https://brownstone.org/articles/the-who-pandemic-agreement-a-guide.

[91] What to Know About an International Pandemic Agreement, Found. for the Nat’l Inst. of Health (Jan. 30, 2021), available at https://fnih.org/sites/default/files/2021-11/What%20to%20Know%20About%20an%20International%20Pandemic%20Agreement%2011.30.21.pdf.

[92] A Potential Framework Convention for Pandemic Preparedness and Response: Member States Briefing, World Health Organ. (Mar. 18, 2021), https://apps.who.int/gb/COVID-19/pdf_files/2021/18_03/Item2.pdf.

[93] See Kevin Bardosh, Why Is the WHO Calling Critics ‘Conspiracy Theorists’?, Collateral Glob. (Jan. 26, 2024), https://collateralglobal.org/article/why-is-the-who-calling-critics-conspiracy-theorists.

[94] E-Cigarettes, Bloomberg Philanthropies, https://www.bloomberg.org/public-health/reducing-tobacco-use/e-cigarettes (last visited Nov. 11, 2024).

[95] Priti Patnaik, Renewed Push for a December Deadline to Conclude the Pandemic Agreement, Geneva Health Files (Oct. 24, 2024), https://genevahealthfiles.substack.com/p/renewed-push-for-december-deadline-pandemic-agreement-world-health-organization-inb-geneva-2024-tedros-africa-group-pabs-ip-tech-transfer-world-health-assembky-special-session.