In light of the COVID-19 pandemic, critiquing the World Health Organization (WHO) has become somewhat fashionable. Perhaps spotting an appetite for this vein of commentary, António Abrunhosa recently penned an article condemning the WHO’s spending on tobacco control efforts. Through a series of deceptive claims, Abrunhosa attempts to diminish the importance of such efforts—and, ultimately, fails to make his case.
CEO of the International Tobacco Growers Association, Abrunhosa sets out to convince readers that the WHO’s anti-tobacco initiatives are, in short, a waste of money. Yet, the thesis never quite lands. For while COVID-19 remains the world’s most high-profile health threat, most readers have an implicit understanding of tobacco’s deadly consequences. Smoking is responsible for over 8 million deaths annually—a staggering statistic that Abrunhosa conveniently omits.
In his attempt to depict tobacco control as frivolous, Abrunhosa baselessly demeans initiatives and experts in the field. For example, he portrays the hard work of Gro Harlem Brundtland, former director-general of the WHO, as some sort of vanity project. He writes, “her ambition and her connections have led her to spend an increasingly huge amount of WHO money on antitobacco campaigns. That is how tobacco became, in the WHO’s language, a ‘global pandemic.’” In reality, of course, tobacco became a global pandemic when it became the world’s leading cause of preventable deaths.
Contrary to Abrunhosa’s claims, Dr. Brundtland did not fabricate the notion of a tobacco pandemic. She did, however, take important steps combat it—something that I know well, as I was then charged with setting up the Tobacco Free Initiative and working with Member States to develop the Framework Convention on Tobacco Control (FCTC).
Abrunhosa also overstates the cost of WHO tobacco meetings tenfold, suggesting that these events usurped funds from other critical health crises. More specifically, he implies that efforts to tackle tobacco use in Brazil directly led to “hundreds of deaths” from dengue fever in the country. This magical thinking misses a critical point: the WHO can and does address several major health issues concurrently.
At the same time that the WHO was establishing the FCTC, infectious disease teams were revising the International Health Regulations to better prepare for future pandemics. Simultaneously, the nutrition team was amending standards used to support optimal growth in children, the malaria team accelerated work across Africa and Asia to substantially reduce the disease’s impact, and so on. Tobacco control has never undermined other WHO responsibilities.
Charging ahead with his argument, Abrunhosa asserts that the pharmaceutical industry “poured hundreds of millions of dollars” into tobacco control. This, frankly, never happened—much as I wish it had. The WHO was slow to embrace the importance of medicated approaches to smoking cessation and its Member States still underinvest in cessation assistance on the whole. This is a disappointing, as greater focus on cessation and harm reduction could yield a dramatic reduction in premature deaths from tobacco.
The WHO’s mandate includes the development of global norms and standards, including use of international law, to address major health threats. As such, it would be a disgrace if the organization did not address tobacco use. In light of the current pandemic, we should critically evaluate public health priorities, particularly as defined by the WHO. Yet, the pandemic should not be used as an opportunity to minimize the importance of other critical health crises.
On a personal note, I recall first meeting and debating António while at the WHO. He is an effective voice for farmers and, while we disagree on the above points, I believe that his work in support of smallholder tobacco farmers has been crucial. This area of research has, in fact, informed some of the Foundation’s efforts toward agricultural transformation in Malawi.
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