Means and ENDS – e-cigarettes, the Framework Convention on Tobacco Control, and global health diplomacy in action

Abstract

article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ Licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Additional information: Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. E-cigarettes are a new and disruptive element in global health diplomacy (GHD) and policy-making. This is an ethnographic account of how e-cigarettes and other Electronic Nicotine Delivery Systems (ENDS) were tackled at the 6th Conference of the Parties to the World Health Organization's Framework Convention on Tobacco Control. It demonstrates how uncertainty about ENDS and differences of opinion are currently so great that 'agreeing to disagree' as a consensus position and 'strategic use of time' were the principles that ensured effective GHD in this case. Observers representing accredited non-governmental organisations were active in briefing and lobbying country delegates not to spend too much time debating an issue for which insufficient evidence exists, and for which countries were unlikely to reach a consensus on a specific regulatory approach or universally applicable regulatory measures. Equally, the work of Costa Rica in preparing and re-negotiating the draft decision, and the work of the relevant Committee Chair in managing the discussion, contributed to effectively reining in lengthy statements from Parties and focusing on points of consensus. As well as summarising the debate itself and analysing the issues surrounding it, this account offers an example of GHD working effectively in a situation of epistemic uncertainty. ARTICLE HISTORY

Electronic Cigarettes and Youth in the United States: A Call to Action (at the Local, National and Global Levels)

“…Others ban e-liquids, or restrict advertising or tax e-cigarettes. In some countries, including China (where 95% of e-cigarettes are made), there are minimal restrictions in place [98]. At the 2014 meeting of the World Health Organization’s Framework Convention on Tobacco Control (FCTC), no consensus was reached regarding a unified international approach to regulation.…”

“…At the 2014 meeting of the World Health Organization’s Framework Convention on Tobacco Control (FCTC), no consensus was reached regarding a unified international approach to regulation. However, the group did delineate four regulatory objectives: (1) Prevention of e-cigarettes by youth, pregnant women and non-smokers; (2) Minimizing the potential health risks of e-cigarettes; (3) Prohibition of false advertising and promotion; and, (4) Ensuring that tobacco control efforts are not impaired by tobacco companies with interest in the e-cigarette market [98]. This last point is of particular importance, given the role the tobacco industry has historically played in promoting smoking, particularly in developing nations [99].…”

The FCTC dilemma on heated tobacco products

“…As shown above, within 4 years from the introduction of the first HTP models in a few selected countries (2014), the COP was able to find a consensus to adopt a decision on HTPs (2018). Four years can be considered a relatively short time for the COP to reactespecially if compared to the lengthy and rather unfruitful debates that the COP has had on ENDS over the last 10 years [63].…”

Global tobacco prevention and control in relation to a cardiovascular health promotion and disease prevention framework: A narrative review

“…ENDS can thwart tobacco control policies, including smoke-free legislation, advertising and promotion restrictions, and taxation. At the sixth session of the Conference of the Parties to the FCTC, the Parties “agreed to disagree” in the debate between the treatment benefit versus harm of ENDS by focusing on four regulatory objectives: 1) preventing uptake of ENDS among nonsmokers, 2) minimizing health risks of ENDS, 3) prohibiting false or deceptive promotion of ENDS, and 4) limiting the industry’s involvement in tobacco control efforts (Russell et al, 2016). …”