The Limits of Relying on Science to Regulate Global Risks

Thank you very much for giving me the floor and I'm sorry to take from Professor Negri's very interesting discussion on COVID-19 and those of you who may have dialed in to follow discussions on global health may be disappointed but I give you two reasons to keep following and the first one is that the WHO is actually a small world and at least my work on the WHO has allowed me to understand many things also about the COVID-19 epidemic because at least in my work the WHO really has a type of working method, a type of mentality that replicates in all areas of work and the second one is that although non-communicable diseases which are often called silent pandemics although obviously they also cause a lot of deaths but what is even more important is that even in the case of a pandemic such as the one we are witnessing actually non-communicable diseases are an increased risk factor and that's quite evident but it's not we don't have concrete studies yet but this still has seemed to emerge when you look at the newspapers that report that there is a very much higher percentage of people from minorities disadvantaged populations that are affected by the virus. That being said now I'll go into my my presentation on the Framework Convention on Tobacco Control. So I'm very sorry. So just three parts. First I want to introduce you a bit to the Framework Convention on Tobacco Control. Second I want to, I will explain a bit what is the first part of my research and my thesis about how the Framework Convention on Tobacco Control has been to what I call a strategy and evidence and then in the third part and concluding part I will discuss how then this strategy and evidence is played out in the second the new life of the Framework Convention on Tobacco Control which is the life has taken place since the convention entered into force. So very briefly the Framework Convention on Tobacco Control is actually called the first treaty negotiated and adopted under article 19 of the WHO constitution and as many of you may have realized now also from Professor Snegri's presentation the WHO is usually reluctant for the legal instruments especially hard law legal instruments so that's actually was actually quite a remarkable event like for you it may seem just just another treaty but it was actually a very remarkable important event in the history of the WHO and the FCTC establishes very basically some common obligations for parties for the tobacco control measures and it is what I've shown you here very simplistic terms of passing from the picture you can see in your left to the one to your right so we have passed actually if you reflect upon this if you have ever done it we have passed in a few decades from having you know advertisement that actively promoted smoking to now having plain packaging and you know very horrible pictures on cigarette packages I've actually chosen one that is not too horrible but I'm sure all of you the very horrible ones that are around and this is all part of course it will be simplistic to say this is only due to the Framework Convention on Tobacco Control but the Framework Convention on Tobacco Control has been has been an important part of this change. I think it's also very important for the purpose of what I'm going to analyze today to discuss a bit the historical background of the FCTC team. So the FCTC was negotiated an important historical moment of open war to the tobacco industry like the so-called cigarette papers had just been discovered in which all the lies and all the misfacts of the tobacco industry had been unveiled and so there was there was it was a clear historical moment in which states felt you know they could go against the interest of the tobacco industry. It's also very important and this is again another common characteristic that I will show that the treaty has been very much pushed yes by civil society but by a civil society that at least I find in my thesis is very much medical in nature so not only doctors but also generally health care workers or people with a scientific background and this already I think can start giving you an impression of why science is so important but then obviously also like the science is only part of course it was also possible by the strong commitment of the WHO secretary general. So now we go a bit into the history and what would I call this strategy on evidence. So I dubbed it strategy on evidence because in trying to understand how this treaty was built I found that actually many of course not all but many of the framing and strategies put in place by the advocates that I refer to as a tobacco control network were actually very much based on evidence. So these people were using evidence to push for stronger and stricter tobacco measures and I have many speeches by Dr Brandtland but also by other people which say we have the evidence this is proved by evidence of course you know we we have to do it because this is proved by evidence and of course this was possible because by the time we are now around the year 2000 of course there was like very solid body of evidence not only on the risks posed by tobacco smoking but also on how like tobacco control could be done so all these advertising bans and health warnings that you have seen in the Marine and of course why also why strategy on evidence was important because it was exactly one of the grounds on which the tobacco industry played so one of the very long-standing tactics of the tobacco industry have been very scientific you know to try to always say that there was not enough evidence like to higher up the threshold for the good evidence and this is once again very this is a very nice book merchants of doubt that has been very widely documented. No speculations but actually they are all documents. So just you know very briefly what I've shown so my thesis how this strategy on evidence was used well first of all they mobilized evidence so the WHO had accumulated a very solid body of evidence but also they started cooperating with other actors and one of the most important actors was certainly the World Bank which was kind of asked by the WHO that the nature of this relationship is a bit unclear but they were kind of asked to publish a report in which they proved how with economic methods how tobacco control could work and could make countries richer in the long term and also there were also a lot of other strategies like for example I spend a lot of time in my thesis talking about why this framework convention is both an evidence-based which I think it was also part of all these framing strategies and the strategy on evidence more generally. Now going to the third part of my presentation so what happened after the treaty was concluded because the treaty was concluded in 2003 entered into force in 2005 but it was supposed to be I call it even a regime but in any case it's the kind of that was modeled after many environmental agreements people are familiar with so it has secretariat and it has a COP, a conference of the parties every two years and it was so supposed to keep the treaty alive it's not a treaty that you know you include the text and you decide but it's a treaty where you want countries to keep discussing and to keep negotiating and to keep advancing in a way. So what has happened after the countries have very much continued to discuss but what I found is that at least in the about first 10 years since the FCTC entered into force much of the energies of the FCTC parties and I know the secretariat as well has been developed to develop some evidence-based guidelines for the implementation of the FCTC. So to provide the idea was to provide evidence-based guidance so whereas the text can tell you like you should add health warnings at least it has at least 30 percent in the text of the treaty then the guidance going to depth explaining how they should be done how they how this text should be added you know even the font sometimes they can become quite difficult like they provide some kind of tech even technical guidance to a certain extent. But the problem that has arose in this in this context and that I highlight in my thesis that this way of acting of the whole tobacco control network which can encompass not only civil society but also to a certain extent the secretariat of the FCTC all this insisting on the evidence-based we have to do what is evidence-based right evidence-based guidance and I'm sure if you have connected to a few of the WHO press conferences that have these days on COVID-19 you also hear continuously this evidence-based language and so what I found in my thesis is that whereas this strategy on evidence has worked very well for concluding the treaties relatively well then of course we could open a whole discussion but it has worked relatively well for helping countries concluding the treaties actually in the long term it has also started having some negative consequences most importantly I'm sure you've all heard that there have been some new products developed so like e-cigarettes, vaping products and even icos which is not properly an e-cigarette because it actually contains tobacco and these new products have actually started causing a lot of doubts that have divided in a way the scientific community and people are very much divided whether you know the risks that they pose are more or less so that the risk that they could help address so whether you know like yes we could we could encourage vaping but the problem is that vaping still poses some risks so is it worth to have the risk of having new people vaping when in fact to just lower the risks of those who smoke traditional cigarettes and have them switch to vaping so this is a bit you know in a very very very very in a nutshell the debate that is going on and it's the problem is that that what I've found is that lacking totally any kind of evidence on what are the long-term effects the public health community including the NGOs and for certain extent you can see even the secretariat is completely is not able to provide guidance to say so whenever you ask but why don't you have taken any more courageous decisions about these products the typical answer is like oh we don't have the evidence and so this has actually made the conflict unpassed and whereas you know so why I'm saying this and I just really go to the conclusion is that of course evidence can be a powerful negotiation but it also has can have we should be we should be very careful not to overly deny on evidence and what is really important to highlight here is that whereas this may seem obvious for example when people are doing international environmental law because that has been because for a long time in the field the problem has always been that there was no so they have developed other principles like the proportionality principles in other ways so of course in other fields it may seem very obvious but the problem is that in an institution like the WHO and the FCC which is at least part of the WHO this is totally new they're really not able to deal with situations of uncertainty and of course this causes some problems and I'll stay here and conclude on tobacco but I think it's also impacting the COVID-19 and thank you all very much for the attention.