Update 29 September 2025: The draft resolution failed to secure a consensus: UN Declaration on Noncommunicable Diseases Fails to Win Approval After US Foils Consensus
There are now multiple instances of tobacco control activists, government officials and academics redefining the primary tobacco control problem as nicotine (not smoke or serious disease) and moving their goal towards nicotine eradication. This is also linked to defining the tobacco and nicotine industries as always and everywhere the problem: the vector of harm as defined by anti-nicotine activism.
But the war on nicotine is, in reality, an ideological barrier to driving down rates of smoking-related disease.
The latest example is the most depressing so far: the Fourth High-Level Meeting of the UN General Assembly on Non-Communicable Diseases, which will take place on 25th September 2025 during the UN General Assembly.
In an article on NCDs, Health Policy Watch has published the final draft of the political declaration expected at that meeting.
This is the text: Political declaration of the fourth high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being. This is the fourth declaration, following the third in 2018.
This is supposed to be a statement about NCDs (i.e. cancer, cardiovascular disease, COPD, etc) finalised after a lengthy deliberative process. It is intended to focus on UN SDG Target 3.4, which aims to reduce mortality in adults aged 30-70 from major NCDs by one-third by 2030. The target that is likely to be missed by some distance. Yet, the text refers throughout to “tobacco and nicotine control” even though the primary driver of NCDs is not tobacco per se or nicotine, but smoke, including tobacco smoke.
If we cannot articulate the problem clearly, how will we ever find effective solutions? But defining nicotine as part of the problem will make finding solutions harder and progress slower.
Here are some examples from the text:
41. Fast-track efforts to accelerate progress on noncommunicable diseases and mental health and well-being over the next five years, focusing on tobacco and nicotine control, preventing and scaling up effective treatment of cardiovascular risk factors, such as hypertension, and improving mental health care, with the aim to reduce by one third premature mortality from noncommunicable diseases and achieve the following global targets by 2030: 150 million fewer people are using tobacco, 150 million more people have hypertension under control, and 150 million more people have access to mental health care;
44. Encourage within national and, where relevant, regional contexts, as appropriate, legislation and regulation, policies and actions to: (a) significantly reduce tobacco and nicotine use by: (i) implementing health warnings on all tobacco and nicotine packages; (ii) restricting tobacco and nicotine advertising, promotion and sponsorship, including cross-border, as appropriate; (iii) comprehensively reducing exposure to second-hand tobacco smoke in indoor and outdoor workplaces, public places, and public transport; and (iv) promoting safe and evidence-based quitting programs; (b) regulate, as appropriate, electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS), heated tobacco products (HTPs) and nicotine delivery products; (c) accelerate implementation among Parties to the World Health Organization Framework Convention on Tobacco Control and its Protocol to Eliminate Illicit Trade in Tobacco Products, without any tobacco industry interference; 48. Increase health literacy and implement science and evidence-based, sustained best practice information, and age appropriate communication programmes, across the entire population and life course, to: (i) educate the public about the harms of tobacco and nicotine use, the harmful use of alcohol, and air pollution;
Why is this so bad?
Some of this may seem reasonable at first sight. However, this declaration is terrible for at least three reasons.
- The evasion of the main relevant driver of NCDs – inhalation of tobacco smoke, not tobacco itself, and not nicotine. It is the products of combustion that create the severe toxicity. If you want to reduce NCDs, then deal with the smoke. But one of the most effective ways to do is to switch from high-risk nicotine use (smoking) to low-risk (smoke-free) nicotine use. This declaration simply ignores this option, potentially distracting millions from life-saving, disease-avoiding behaviour change.
- The casual conflation of tobacco and nicotine, implying that nicotine use (of which tobacco use is a subset) is now the primary goal, indicates a shift to a war-on-drugs mindset. Yet no one appears willing to learn from the multiple failures of the war on drugs. This drug is unlikely to be eradicated – people use it for its psychoactive effects (as with most drugs), and it will be supplied in the ways people want, either legally or illegally. The goal of eradicating smoking is, however, much more realistic if it is achieved without requiring people to become nicotine-abstinent.
- This statement is terrible, mostly for what is missing. If reducing NCDs is the point of this meeting, then how on earth did the combined brain-power, time and money of public health, governments, academics, and NGOs that went into this manage to completely ignore the option of shifting nicotine use from nicotine with smoke to nicotine without smoke? It is not as if there is no evidence. Yet, this idea is entirely absent from the text, even though it is one of the biggest and most tractable new opportunities to change the story on smoking and disease. That is how this sort of ideological posturing ends up killing millions.
Aren’t these reasonable proposals?
Some might argue that nicotine is not benign; these are reasonable measures, and fortunately, someone has managed to contain the zealotry here. Yet this final draft is a radical deterioration from the “zero draft“, the starting point for negotiations, published in May 2025. There was only one asinine reference to nicotine in that draft:
27.(b) restrict and regulate electronic nicotine delivery systems (ENDS) and electronic nonnicotine delivery systems (ENNDS);
The earlier draft did at least come closer to recognising the problem, with one reference to smoking:
Increase health literacy and implement sustained best practice information and age appropriate communication programmes across the entire population to: (i) educate the public about the harms of smoking/tobacco use; …
And mainly focused its language on tobacco. But it has actually gone backwards on that if you see taxation as a key lever in changing behaviour:
Zero draft version: …we will […] 26. Increase taxation on tobacco, alcohol and sugar-sweetened beverages bearing in mind the World Health Organization recommendations;
Final draft version: Consider introducing or increasing taxes on tobacco and alcohol to support health objectives, in line with national circumstances;
Who is doing this?
This nicotine-focused language is not the result of accidental or poor drafting; it was deliberately introduced during the course of negotiations since May 2025. It is there because it matters to the people who put it there.
And they are now the problem.
The aims of health policy and healthcare are simple enough: to improve the quality and quantity of life. Yet international policy on tobacco and smoking has drifted from these simple aims into an obsession with tobacco and nicotine eradication including destruction of (traded) tobacco companies. In the process, commitments to base policy on evidence, the protection of human rights and choosing the most cost effective interventions have disappeared. Tobacco control has increasingly adopted the characteristics of the tobacco industry when it was at its worst. Nevertheless, the replacement of combustible cigarettes by safer, smoke-free nicotine products produced mainly by tobacco companies is proceeding rapidly and appears unstoppable.
For the last 30 years I’ve looked at the accusations made against the tobacco industry by anti-smokers and find the charges to be deceptive and slanderous. For example, the well known “Merchants of Doubt” quotation, taken out of context from an industry document, leaves out the need to point out accurate weaknesses in the anti smoking thesis that the public has been misled about (by anti-smokers).