Rani and colleagues should be commended for investigating barriers to implementing tobacco control measures—specifically Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC).(1) Yet, deeper concerns deserve mention. First, it must be acknowledged that the FCTC has largely failed to accelerate progress. Between 1980 and 2004—the year of the Convention—the annual decline in daily smoking prevalence reached 2%, but it subsequently plateaued. More recently, the GBD 2019 Tobacco Collaborators reported a significant increase in smoking prevalence since 2005 in 111 countries. Second, Rani et al. correctly identify “conflicts of interest involving government officials, lobbying by the tobacco industry, resource constraints, and weak regulatory frameworks.” Public officials who choose to protect a lethal industry over their citizens’ health are not victims of lobbying—they are, at times, its active accomplices. In my opinion, the WHO FCTC has become a smokescreen: a) The WHO has remained blind and silent in the face of inertia and open breaches of the Convention by signatory countries, rendering it little more than a symbolic document. b) The WHO has shown little willingness to defend states that act. c) The WHO has failed to promote nicotine reduction d) Finally, the WHO has not updated the Convention to address electronic nicotine delivery systems (ENDS)
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