Inside the WHO FCTC Conference of the Parties: Global Tobacco Governance in Action

Every two years, in a conference center in Geneva or a rotating host city, several thousand delegates from over 180 countries gather for the Conference of the Parties (COP) to the WHO Framework Convention on Tobacco Control. For a week, they negotiate decisions that shape global tobacco policy: whether to classify novel nicotine products as tobacco products, how to interpret Article 5.3's industry-exclusion provisions, what guidance to issue on flavor regulation and cross-border advertising. The COP is simultaneously the most important and least visible institution in global tobacco governance. Its decisions influence national legislation, shape the WHO's technical assistance to member states, and set the normative framework within which the global tobacco control community operates. But its proceedings are largely inaccessible to the public, its decision-making processes are opaque, and its outcomes reflect the constraints of consensus-based diplomacy in an institution where industry influence—despite being formally excluded—permeates the proceedings through national delegations and the structural power of tobacco-dependent economies.

The COP's most consequential recent debates have concerned novel nicotine products—e-cigarettes, heated tobacco, nicotine pouches—and the FCTC's position on harm reduction. The debate is structured by the treaty's foundational premise: all tobacco products are harmful, the tobacco industry is an irreconcilable adversary, and the appropriate policy response is to discourage all use. This framing, which made eminent sense when cigarettes were the only meaningful product category, has become increasingly strained as the product landscape has diversified. The COP's response has been to double down on the precautionary framing: novel products should be regulated as strictly as cigarettes, harm-reduction claims should be treated as industry propaganda, and member states should be discouraged from integrating reduced-risk products into their tobacco control strategies. The UK, New Zealand, and Canada—countries that have adopted harm-reduction policies—have found themselves in the minority at COP sessions, their evidence and arguments outvoted by a coalition of countries following the WHO's precautionary line.

The COP's treatment of harm reduction reflects a deeper institutional dynamic: the capture of the FCTC process by what might be called the 'precautionary coalition'—a group of member states, WHO officials, and civil society organizations that share a commitment to the abstinence-oriented, industry-exclusionary framework. This coalition's influence is reinforced by the COP's procedural rules: decisions are made by consensus or majority vote of member states, most of which are LMICs with limited capacity for independent evidence assessment and a strong reliance on WHO technical guidance. The WHO Secretariat, which prepares the technical documents that frame COP debates, has consistently presented the evidence on harm reduction in ways that emphasize uncertainty and risk while minimizing the evidence of reduced toxicant exposure and smoking cessation effectiveness. The result is a self-reinforcing cycle: the Secretariat produces precautionary guidance, member states adopt it, the COP endorses it, and the guidance becomes the basis for the next round of technical documents. Dissenting evidence—including from the UK's highly regarded public health agencies—is acknowledged but not integrated into the framework.

The industry's role at the COP is formally excluded by Article 5.3 but practically pervasive. Industry representatives are not permitted to attend COP sessions as observers (unlike at most UN meetings, where industry observers are common), and delegates are required to disclose conflicts of interest. But the industry influences the COP indirectly through multiple channels: through national delegations from tobacco-dependent countries whose economic interests align with industry positions, through trade and finance ministries that prioritize economic considerations over health, through third-party allies (farmers' organizations, retailers' associations, libertarian think tanks) that echo industry arguments without being formally linked to the industry, and through the structural power of an industry that can threaten investment, employment, and tax revenue if policies are adopted that threaten its interests. The COP's Article 5.3 provisions are designed to exclude the tobacco industry from tobacco control policymaking. In practice, they exclude the industry's representatives from the room while leaving its influence largely intact.

The civil society dimension of the COP is both a strength and a weakness of the process. The Framework Convention Alliance, a coalition of hundreds of NGOs from over 100 countries, plays a formal role in the COP as an observer and advocate. Its presence ensures that the public health perspective is represented, that LMIC delegations receive technical support, and that the COP's decisions are subject to external scrutiny. But the FCA, like the COP itself, is dominated by organizations that share the precautionary, abstinence-oriented framework. Harm-reduction organizations have been excluded from FCA membership or marginalized within it, and the civil society voice at the COP is overwhelmingly aligned with the precautionary coalition. The result is that the COP's civil society engagement reinforces the institutional consensus rather than challenging it—exactly the opposite of the function that civil society is supposed to serve in international governance.

The COP's relationship with science is complex and contested. The COP relies on the WHO's technical documents and on evidence reviews commissioned by the Secretariat, but it does not have an independent scientific advisory body comparable to the IPCC for climate change or the SAGE for immunization. The absence of a formal scientific advisory mechanism means that the COP's interpretation of evidence is mediated by the institutional perspectives of the Secretariat and the political dynamics of the member-state negotiations. Proposals to establish an independent scientific advisory body for the FCTC have been advanced by harm-reduction advocates and some member states but have been resisted by the precautionary coalition, which views independent scientific advice as a potential vehicle for industry-influenced evidence. The result is that the COP's evidence base is narrower and more institutionally mediated than that of comparable international governance bodies—a significant limitation for an institution whose decisions affect the health of billions.

The COP is not a failed institution, but it's an institution in crisis—confronted with a product landscape it wasn't designed for, an evidence base it can't fully engage with, and a political dynamic that systematically excludes perspectives that challenge the institutional consensus. Reforming the COP would require multiple changes: establishing an independent scientific advisory mechanism, reforming the procedures for developing technical documents to ensure diverse perspectives are represented, creating space for harm-reduction evidence and arguments within the formal proceedings, and strengthening the capacity of LMIC delegations to evaluate evidence independently rather than relying exclusively on WHO guidance. These reforms are politically difficult—the precautionary coalition has no incentive to adopt them—but they're essential if the COP is to remain relevant to the rapidly evolving nicotine landscape. The COP was designed for a world of combustible cigarettes. The world has changed. The COP hasn't.