The Controversy Surrounding
Tobacco Harm Reduction
Harm reduction is a long-established public-health strategy underpinning interventions such as needle and syringe programmes, opioid substitution therapy, condom distribution, and more recently the use of GLP-1 medicines (e.g., semaglutide, tirzepatide) to reduce the cardiometabolic risks associated with obesity.
Yet despite strong evidence of effectiveness, harm-reduction policies have always been controversial. Understanding these general controversies helps explain why tobacco harm reduction provokes particularly intense debate — including within the World Health Organization (WHO).
1. Harm Reduction and the Right to Health
The preamble to the WHO Constitution states:
“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…”
In HIV and drug policy, this rights-based approach is applied explicitly to harm reduction. The International Guidelines on Human Rights and Drug Policy (developed with WHO as a technical partner) state that:
“The right to health as applied to drug policy includes access, on a voluntary basis, to harm reduction services.”
This approach is recommended by UN technical agencies such as WHO, UNAIDS, and the UN Office on Drugs and Crime.
“Harm reduction measures have been recognised as essential for people who use drugs- by the General Assembly of the United Nations, the Human Rights Council, the World Health Organisation, UNAIDS, and multiple human rights Treaty Bodies and Special Rapporteurs.”
Michelle Bachelet, UN High Commissioner for Human Rights, Harm Reduction International Conference 2019 - 28th April 2019
2. General Controversies Around Harm Reduction
Despite strong support from WHO, harm-reduction policies often trigger opposition. Common sources of resistance include:
- Moral or ideological objections: providing clean needles or condoms is sometimes seen as “enabling” undesirable behaviors
- Fear of risk compensation: concern that people may engage in riskier behavior (“If you give out clean needles, people will inject more drugs or start injecting when they otherwise wouldn’t,” or “making condoms available will encourage earlier sexual activity among adolescents”)
- Concerns about medicalisation or “shortcuts”: e.g., GLP-1 medicines have been criticized as a shortcut that might normalize long-term pharmaceutical use and distract from broader social and dietary determinants of health
- Distrust of actors involved: especially where behaviors are criminalized, stigmatized, or commercial interests are involved
These general dynamics provide the backdrop for debates around tobacco harm reduction.
3. Why Tobacco Harm Reduction Is Especially Controversial
These dynamics form the backdrop against which tobacco harm reduction is debated. The WHO’s Framework Convention on Tobacco Control (FCTC), which entered into force in 2005 and has been ratified by over 180 Parties worldwide, explicitly builds harm reduction into its definition of tobacco control.
“'Tobacco control' 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.”
Article 1(d) of the WHO Framework Convention on Tobacco Control
However, WHO’s recent messaging is much more sceptical. A 2025 WHO position paper warns that “tobacco and nicotine companies are misappropriating the public health concept of harm reduction while mass marketing harmful products like e-cigarettes and nicotine pouches to the public at large”.
To the WHO, this is “part of a profit-driven strategy to grow and sustain tobacco company businesses by expanding their customer base or market share”.
The tobacco control movement has become highly political, and harm reduction sceptics have come to dominate the WHO’s tobacco control division. That might be rooted in a justifiable historical mistrust of the tobacco industry, but our view is that the WHO’s position has not caught up with the new reality in terms of the new products which are now available, the science backing up claims that these really are significantly less harmful, and the reality that a very large number of consumers are choosing to use THR products – over 140m now globally according to one estimate.
Unfortunately this attitude has led to many countries, particularly those in lower and middle-income regions, introducing bans for reduced harm tobacco and nicotine products. In places like India, Brazil, Vietnam and Singapore consumer are denied access to the new products at the same time as cigarettes are freely available. A May 2025 report put the number of countries where e-cigarettes are banned outright at 46.
That is likely to have significant unintended consequences, including increased cigarette use and an illicit market in e-cigarettes and other THR products so that consumers are denied appropriate regulation of the products they wish to use.
4. Global Implications
The controversy surrounding THR is not just academic; it has real-world consequences. Denying access to reduced-harm products may undermine public health efforts, increase smoking rates, and leave consumers without safe, regulated options.
Further reading:
WHO Constitution, World Health Organization
Framework Convention on Tobacco Control, United Nations Treaty Collection.
WHO Position on Tobacco Control and Harm Reduction, World Health Organization, 2025
The Global State of Tobacco Harm Reduction 2024, Knowledge-Action-Change
Next article: Engagement vs. Divestment in the Tobacco Sector
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