My Times column is on the World Health Organisation’s odd priorities: its early complacency about ebola, while it attacks a new technology that saves the lives of smokers by getting them off tobacco, and obsesses about climate change:
Is there a connection between ebola and e-cigarettes?I don’t mean to imply that vaping has caused the epidemic in west Africa. But the World Health Organisation (WHO) now has serious questions to answer about its months of complacency over ebola. WHO’s director-general, Margaret Chan, made a speech only two weeks ago implying that tobacco control and the fight against e-cigarettes is a more important issue.
On October 13 Dr Chan gave her apologies for not being able to attend a conference on ebola and made a speech instead at a WHO summit in Moscow on tobacco. This is what she said there: “Some people speculated that I would not attend this meeting because I am so busy with so many other outbreaks of communicable diseases [ebola was third on her list, after flu and Mers coronavirus].No. No. No. I will not cancel my attendance at this meeting because it is too important . . . Tobacco control unquestionably is our biggest, surest and best opportunity to save some millions of lives . . .The next challenge is that the tobacco industry is increasing its dominance over the market for electronic cigarettes.”
The $20 million Moscow meeting happened behind closed doors, with even accredited journalists excluded. High on the agenda was vaping. WHO has long been trying to define e-cigarettes as tobacco products, though they are not, so as to bring them under the aegis of its tobacco “framework convention”.
The outcome of the Moscow meeting was the suggestion that more countries should ban e-cigarettes, despite the lack of scientific evidence that they do harm and ignoring the growing evidence that they save lives. Such bans would be convenient for pharmaceutical companies, with which WHO has close links, whose sales of nicotine gum and patches have been in free fall because of e-cigarettes.
WHO is not wrong to fight tobacco; but in fighting e-cigarettes, it is protecting tobacco and doing real harm. Louise Ross, of the NHS Stop Smoking Service in Leicester, reports a drop in interest in vaping as a method of quitting cigarettes at the time the WHO report came out. Urban myths say e-cigarettes are no better than cigarettes. People tell Ms Ross: “I’ve seen it on telly, it’s safer to carry on smoking.”
Yet Philip Morris reports that countries that are liberal about vaping, such as Poland, have seen tobacco sales fall by more than 10 per cent in the past year alone. Countries that discourage vaping, such as Italy and Spain, have seen falls of less than 2 per cent. A French government survey of 13,000 Parisian schoolchildren has found a startling 45 per cent reduction in tobacco smoking among young teenagers in three years, since e-cigarettes have rebranded tobacco as “dirty and nerdy”. This technology is a breakthrough in the fight against smoking. Yet WHO’s director-general regards fighting it as a priority.
Meanwhile, WHO’s sluggish response to ebola has infuriated many health experts. In April Médecins Sans Frontières issued a stark warning that the outbreak was out of control and was contradicted by a WHO spokesman. In June Dr Chan was warned that WHO was hindering the fight against the virus, but little changed till August.
A leaked report says that WHO’s “failure to see that conditions for explosive spread were present right at the start” was a big mistake. In April public health measures would have stopped the disease; now it could be too late and we may have to wait many months for vaccines instead. Big international agencies have unique responsibilities: if the WHO was reassuring, why would anybody else react with urgency?
Vaping was not the only thing on Dr Chan’s mind this autumn. In September, when the world had at last woken up to what is going on in west Africa, she was keen to comment on another great crisis, almost as important as tobacco: climate change.
Writing on The Huffington Post website, she called climate change the “defining issue of the 21st century” and even seemed to imply it was more important than ebola, because “it cannot be contained by doctors in hazmat suits, patients in isolation wards, or hopes that a vaccine or cure is somewhere on the horizon.” The article was so hysterical about climate change it would have embarrassed a green pressure group. It claimed inaccurately that “records for extreme weather events are being broken a record number of times” and it abandoned the current scientific consensus by suggesting that worsening malaria will result from climate change. This is out of date. Scientists now agree that efforts to combat malaria are likely to progress despite any small changes in the range of mosquitoes as a result of climate change.
The article was especially naughty in citing the figure of seven million people dying each year from air pollution. More than half of these die from indoor air pollution because they cook over (renewable) wood and dung fires, the phasing out of which is being delayed worldwide by the increasing reluctance of western governments to fund fossil-fuel energy, lest it contribute to climate change. So some of these dying people are the victims of climate change policy, rather than climate change itself. WHO’s own figures suggest indoor smoke kills 30-150 times as many people as global warming does.
Dr Chan rightly says that the ebola epidemic underscores the need for better public health infrastructure in poor countries. But the lack of these in Sierra Leone and Liberia is a symptom of poverty, not climate change (let alone nicotine). That lack should have alerted WHO to the risk of an ebola epidemic much earlier.
Lest you think I am unfairly selecting Dr Chan’s pronouncements, go on WHO’s home page and look under “director-general” where on Sunday only two recent speeches were listed: the Moscow one, and another delivered in Tunis eight days ago. On that occasion, ebola, though discussed, was still given third billing in the causes of shocks humanity is facing: “whether caused by extreme weather events in a changing climate, armed conflict or civil unrest, or a deadly and dreaded virus spreading out of control.” The delay of the United Nations’ key agency in raising the alarm about ebola appears to have stemmed at least partly from its obsession with other, politically fashionable and scientifically dubious, priorities. Is WHO fit for purpose?