The World Health Organization risks credibility with inaccurate attacks on vaping

May 31 marks World No Tobacco Day (WNTD), an annual event created by the World Health Organization (WHO) in 1987 to raise awareness about the harms of tobacco products. What was once a simple exercise in public health communication is now igniting discussion about whether the WHO itself is promoting incorrect or misleading information about the relative risks of different tobacco products.

The main point of contention surrounds the WHO’s position on e-cigarettes. In the weeks before this year’s WNTD, WHO released a report titled “Hooking the next generation: How the tobacco industry captures young customers.” The document contains recommendations and calls to action that would strike most people as unobjectionable, such as ensuring tobacco products aren’t sold or marketed to kids. 

But the report also frames e-cigarettes, nicotine pouches, and heated tobacco products as threats to public health without any recognition that they are safer than smoking or that they have helped tens of millions of smokers across the world kick cigarettes for good. The report compares claims that e-cigarettes are less harmful than combustible cigarettes with the tobacco industry’s past messaging about low-tar cigarettes being less dangerous and says that there’s insufficient evidence to conclude these alternatives are effective in helping smokers quit.

Shortly after the report’s publication, Dr. Sarah Jackson, the principal research fellow for the Tobacco and Alcohol Research Group at University College London, challenged WHO’s negative take on e-cigarettes. “Large evidence reviews, conducted independent of industry, consistently conclude that while vaping is not risk-free, it poses only a small fraction of the risks of smoking tobacco,” Jackson told the Science Media Research Center. Jackson also referenced the Cochrane Review, which concluded that vaping is more effective than nicotine replacement therapies, such as gums or patches, for smoking cessation.

WHO’s report is of a piece with its wider messaging on safer nicotine alternatives. WHO’s explainer on e-cigarettes erroneously links nicotine vapes to incidents of lung damage and death that were found to be caused by tainted illicit marijuana cartridges. The most basic question of whether e-cigarettes are safer than cigarettes is not answered on WHO’s website. WHO also claims e-cigarettes haven’t been shown to be effective for smoking cessation at the population level and that there is “alarming evidence” on the negative health effects of vaping.

For policy recommendations, if e-cigarettes aren’t banned outright, WHO recommends banning all flavors other than tobacco, raising taxes, and “limiting the concentration and quality of nicotine.” In a series of articles published at Medium, veteran journalist Marc Gunther highlighted brazen examples of misinformation from the WHO. In April 2024, the WHO tweeted that vaping increases your risk of seizures, typically within 24 hours. The study was based on a small sample of self-reports with no evidence of causality. Neal Benowitz, a professor of medicine at the University of California, San Francisco, who specializes in nicotine, wrote in 2020 that the study shouldn’t discourage smokers from switching to vaping.

Another WHO tweet in March 2024 claimed it’s a myth that e-cigarettes and heated tobacco products are safer alternatives to cigarettes. Even regulators that have been hostile to e-cigarettes, such as the U.S. Food and Drug Administration, concede that the basic science demonstrates e-cigarettes to be safer than cigarettes.

Referring to WHO’s social media messaging and website content, Gunther told the YouTube show RegulatorWatch, “They have both spread unwarranted fear about the risks of e-cigarettes, and they discourage people from using e-cigarettes as a way of quitting smoking even though there’s really strong independent evidence that for many, many people e-cigarettes have become the best way to quit smoking.”

Gunther fears the WHO’s messaging will have the biggest impact on low- and middle-income countries that lack a well-developed public infrastructure and rely on the WHO for accurate information and sound policy recommendations. His fears are not without cause. In 2021, Dr. Harsh Vardhan, India’s health and welfare minister at the time, was awarded the WHO Director-General’s Special Recognition Award for driving forward legislation banning all e-cigarettes and heated tobacco products in India.

“Fundamentally, in the advice they give to other countries, they’re terrible on e-cigarettes,” Gunther said “Then, in their public communications, they’ve consistently spread fear and minimized the benefits of e-cigarettes.” According to polling from Ipsos conducted for the We Are Innovation think tank, three-quarters of smokers globally incorrectly believe vaping is just as harmful or more harmful than smoking.

If the WHO continues to promote messaging that is out of sync with the best scientific evidence and guidance, it should be discounted as a credible source of information for governments trying to give their citizens the best options to improve their health.

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