To vape or not to vape is fueling a fierce debate in Geneva, where more than 1,400 delegates have gathered to discuss the World Health Organization’s tobacco control treaty and the global “tobacco epidemic.” E-cigarettes, heated tobacco and nicotine pouches are at the center of a split among scientists, doctors and public health experts.
Harm-reduction proponents argue these products, while not harmless, may be far less dangerous than combustible cigarettes, which kill up to half of long-term users. As a “lesser evil,” e-cigarettes could help current smokers cut down or quit. Opponents counter that the tobacco industry is promoting and profiting from these products, young non-smokers are being drawn in by flavors and packaging, and long-term risks remain unclear.
WHO has taken a firm stance opposing e-cigarettes as a cessation tool. In a recent position paper and in Geneva, WHO leaders have called for strict regulation, warning the industry is “misappropriating” harm-reduction language and “mass marketing harmful products.” WHO Director-General Tedros Adhanom Ghebreyesus says there is no evidence of net public-health benefit and mounting evidence of harm. WHO officials point to rising youth use: recent data estimate 15 million children worldwide are using e-cigarettes, with youth rates far outpacing adults.
Supporters of harm reduction include figures such as Dr. Derek Yach, an architect of WHO’s tobacco treaty who now says the traditional “quit or die” message fails to acknowledge nicotine addiction’s complexity. Yach argues that because e-cigarettes deliver nicotine without burning tobacco—and thus without many combustion-related toxins—they represent a major opportunity to save lives. He led the Foundation for a Smoke-Free World (now Global Action to End Smoking), a group that drew controversy because of earlier funding ties to Philip Morris International; that link has left Yach ostracized by many former colleagues.
The U.K. National Health Service has endorsed e-cigarettes as a quitting aid, and independent researchers such as Mike Cummings of the Medical University of South Carolina advocate debating their role openly. Cummings stresses he does not want non-smokers to use e-cigarettes but believes safer alternatives for current smokers merit consideration. He and other proponents complain of being labeled industry shills and say research into harm-reduction strategies is underfunded and politically fraught.
On the other side, public-health experts warn of serious risks. The International Pediatric Association and authors in Pediatrics have warned e-cigarette use is associated with cardiovascular, metabolic, respiratory, oral disease and cancer, and that dual users (those who use both e-cigarettes and cigarettes) may face greater risks than cigarette-only smokers. Critics say promoting e-cigarettes could reverse decades of progress in tobacco control and create a new generation addicted to nicotine.
Some scientific questions remain unsettled. Concerns have arisen about exposure to metals from heating elements and other product-specific hazards; studies have reported mixed findings, and WHO notes risks will only become clearer over time. Public-health advocates argue products vary widely and generalizing about their safety is irresponsible; many call for regulation at least as strict as that applied to cigarettes.
Skepticism about industry motives runs deep. Critics say tobacco companies have long used tactics—filter claims, “low-tar” marketing—to create a public impression of reduced harm while continuing to sell addictive, deadly products. Former CDC tobacco official Tim McAfee calls past industry safety claims “an unutterable scam” and views today’s harm-reduction push as a possible diversion. Some observers see the current dispute as a strategy to sow division in tobacco control.
Proponents counter that industry involvement does not automatically invalidate the potential public-health role of non-combustible nicotine products and call for evidence-based policy rather than ideological rejection. They urge open scientific debate and further research to weigh benefits and harms, especially for adults trying to quit.
Both sides agree on one thing: getting policy right matters. With roughly 1.2 billion tobacco users worldwide—most in low- and middle-income countries—decisions about regulation, cessation tools and youth protection will shape the future of the tobacco epidemic.
