By Providence Ayanfeoluwa

When the world’s health leaders gather for COP11 of the World Health Organisation’s Framework Convention on Tobacco Control (WHO FCTC) later this month, they will face a choice that could define the future of global tobacco policy: whether to continue down the path of prohibition and exclusion – or to open the door to dialogue, evidence and respect for humanity.

For someone like Samuel Ndlovu, a 52-year-old father of three from Bulawayo, that decision could mean the difference between life and death. Samuel has smoked for over thirty years. He has tried to quit, cold turkey, using nicotine patches and gum — all to no avail. A friend recently told him about nicotine pouches, but in Zimbabwe, the sale and promotion of such products are restricted. “I just want to stop smoking,” he says, “but no one wants to tell us how.”

Samuel’s story is painfully common. Across Africa and beyond, millions like him are caught in the crossfire of a policy war that too often favours ideology over impact. The result is a tobacco control framework that risks losing touch with the people it’s supposed to serve in favour of donor ideals.

Ideals Without Inclusion
The WHO FCTC, adopted in 2003, was a landmark treaty in global health – a moral and legal instrument designed to combat the devastating toll of tobacco, which kills over 8 million people worldwide each year. Its intent was noble, but over time, the movement it inspired has hardened into orthodoxy and forgotten that the priority of its conception is to save lives.

The conversation has become closed, guarded and resistant to challenge. At COP11, delegates will once again meet behind closed doors with limited participation from independent scientists, consumer advocates, journalists or even smokers themselves. Industry voices are, by design, excluded, but in practice, so are many public health experts and risk reduction advocates who do not toe the ideological line.

This exclusion may have begun as protection from industry interference, but it has since evolved into intellectual isolation — a space where dissent is treated as danger and where science that complicates the narrative is sidelined. No matter how vital it is to saving lives.

The result? A policy ecosystem that struggles to reflect real-world complexity and fulfil its purpose.

The Case for Inclusion

Effective public health is not built on purity; it’s built on participation and collaboration. Every major health breakthrough in history, from HIV prevention to vaccine uptake, has required dialogue between scientists, policymakers, civil society and the public. Tobacco control should be no different.

At COP11, Member States have an opportunity to reset this balance by embracing inclusion and realism and bringing in voices that have too often been ignored:

Scientists who can speak to new data on risk differentials between smoking and alternatives.

Journalists who can help demystify science for the public.

Consumers whose lived experiences reveal what actually works beyond the policy papers.

Industry innovators under strict transparency rules, who can offer technological insights without steering regulation.

This is not about weakening tobacco control; it’s about strengthening it through reality.

Science and Pragmatism: A Proven Partnership

The world already has examples of what pragmatic inclusion looks like. In the United Kingdom, regulators and scientists worked together to evaluate vaping, ultimately concluding that e-cigarettes are at least 95% less harmful than smoking. Rather than banning them, the UK integrated vaping into its public health strategy, even distributing free vape kits through the NHS’s “Swap to Stop” program launched in 2023. Smoking rates are now at their lowest on record offering real relief to the public health budget for managing Non-communicable disease. In Sweden, policymakers chose to tolerate and regulate snus, a smokeless tobacco product. As a result, Sweden has achieved a smoking rate below 5%, effectively becoming the first smoke-free nation in the world. In Japan, heated tobacco products – regulated but not banned – have contributed to a 40% drop in cigarette sales since 2014.

These are not stories of compromise. They are stories of courage and of nations choosing evidence over ideology.

The Cost of Exclusion

In contrast, the global conversation at the WHO FCTC level remains largely static. While some low- and middle-income countries, including many in Africa, struggle with high smoking rates, they are being urged to adopt blanket bans on alternative nicotine products rather than risk-based regulation.

This approach risks perpetuating harm rather than reducing it. Denying adult smokers access to less harmful alternatives does not eliminate nicotine use; it simply ensures that cigarettes remain the dominant and deadliest option.

As one African health economist recently noted, “The most dangerous product on the market continues to be the only one that is widely available.”

Furthermore, exclusion of scientists and journalists from COP discussions undermines transparency and public trust. Decisions made behind closed doors, without scrutiny or debate, invite skepticism even when well-intentioned.

If the aim is to save lives, then information, innovation, and inclusion must be tools of the mission and not casualties of it.

Realism Over Rhetoric

Realism acknowledges that nicotine use is not disappearing anytime soon. It asks how to reduce harm, not just how to declare war. It recognises that public health is not only about prohibition, but also about compassion, science, and choice.

COP11 offers a rare opportunity to redefine what “control’ really means. It could mean control through education, regulation, and quality assurance — or control through silence, bans, and punitive policies. One empowers citizens and the other severely hinders them.

Pragmatism is not moral weakness; it is moral intelligence. It says: we cannot wish smokers away or abandon them, but we can give them safer paths. We cannot undo history, but we can learn from it and save lives.

If the WHO FCTC wants to remain relevant in a rapidly changing world, it must embrace this spirit of pragmatic inclusion.

A Call for a More Open COP

The next chapter of global tobacco control must not be written in isolation, but in conversation and representative consultation. COP11 should not fear transparency; it should model it if they would like to be effective and sustainable.

It should allow scientists to present data, even if it challenges orthodoxy, let journalists ask questions, even if they are uncomfortable, let consumers share their lived experiences, even if they complicate the narrative, and let innovation be scrutinised — not shunned.

Inclusion is not an invitation for interference; it is a safeguard against irrelevance.

For people like Samuel Ndlovu — and for millions of smokers worldwide — the stakes are not political. They are profoundly human. They deserve a system that listens as much as it lectures, that adapts as much as it aspires and provides solutions for the human condition.

The call from the global South, from Africa especially, is clear: be pragmatic, be inclusive and be real.

COP11 can either continue to echo the same moral slogans or it can finally speak the language of progress.