Dr. Ziauddin Islam and Lindsey Stroud
Last year The World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) celebrated the 20th anniversary of the world’s first public health treaty. Ratified in 2005, the FCTC now includes 183 countries and the European Union and was designed to reduce tobacco use. However, over time, it has evolved into a vehicle for Michael R. Bloomberg’s prohibitionist agenda, implemented under the banner of philanthropy. The FCTC relies heavily on the MPOWER strategy, a WHO initiative pushed and funded by Bloomberg Philanthropies. It emphasizes taxation, advertising bans, and smoking restrictions, while disregarding tobacco harm reduction and consumer-driven innovations – such as e-cigarettes, heated tobacco products (HTPs), and nicotine pouches – that have led to notable smoking declines in several countries but face growing restrictions elsewhere.
Since 2005, Bloomberg Philanthropies has poured over $1.58 billion into global tobacco control, funding organizations like the Campaign for Tobacco-Free Kids (CTFK) the International Union Against Tuberculosis and Lung Disease, which currently work as Vital Strategies. These groups champion MPOWER strategies and aggressively oppose harm-reduction alternatives that help smokers transition away from combustible tobacco.
This stance reveals a troubling inconsistency. While Vital Strategies promotes harm reduction in drug policy – investing in naloxone, safe consumption sites, and drug-checking tools – it lobbies to ban harm-reduction tools for tobacco. For example, in India, Bloomberg-backed groups helped secure a 2019 e-cigarette ban, ignoring evidence from places like the UK and Japan where such products contributed to dramatic declines in smoking. Notably, Vital’s own annual report acknowledges its role in supporting vape and HTP restrictions in India, indicating that the Indian government’s stance was influenced by its interventions.
This double standard undermines the credibility of public health advocacy. It embraces harm reduction for drug policy while rejecting it for tobacco—a contradiction driven more by ideology and donor influence than by science. Evidence from countries like Sweden and Japanshows that harm reduction works. Sweden’s widespread use of snus has helped drive smoking rates below 5 percent. In Japan, HTPs have contributed to a 40 percent decline in cigarette sales. In the U.S., increased e-cigarette use has paralleled steep declines in smoking, yet Bloomberg-funded groups continue to push for flavor bans, ignoring CDC data showing youth vaping rates are at historic lows.
The impact of Bloomberg’s policies is especially harmful in low- and middle-income countries (LMICs), where smoking rates are high, and enforcement resources are limited. In Pakistan, Bloomberg-funded advocates pushed for a 154 percent tobacco tax hike in 2023. Rather than curbing smoking, it fueled a 44 percent increase in illicit trade, costing the government revenue while legal cigarette sales plummeted and smoking rates stayed largely the same. Even a Bloomberg-funded study confirmed the surge in illicit trade. In Bangladesh, concerns have also been raised about the extent of external influence, including instances such as Vital Strategies’ involvement in running Ministry of Health (MoH) website and infrastructure.
Inconsistencies also mark Bloomberg-backed efforts around HTPs and vaping. CTFK, through its partner SPARC, challenged Pakistan’s regulatory approach to HTPs in court – mirroring their efforts to ban vaping in India – only to withdraw the case in 2025 without scientific explanation. In Pakistan, the flip-flop reflected more of an ideological shift than a thoughtful policy recalibration, raising broader concerns around transparency and alleged instances of corruption in Pakistan and the Philippines linked to Bloomberg-backed initiatives.
In South Asia, Bloomberg-funded groups often overlook local tobacco use patterns, such as smokeless tobacco (SLT) and bidis. In India, while advocating for cigarette tax hikes, they largely ignored SLT, which comprises a major share of tobacco consumption. India’s 2019 e-cigarette ban – supported by Bloomberg groups – drove many users back to cigarettes or the illicit market. High taxation, another MPOWER pillar, has produced similar results in Bangladesh and India, where tobacco use remains persistently high, at 34.6 percent and 19.1 percent, respectively.
Bloomberg’s policies fail to account for informal economies, poverty, and weak enforcement. In Pakistan, a previously tiered tax system helped keep legal tobacco somewhat affordable. The abrupt hike disrupted this balance, driving consumers to illicit products—a pattern seen globally where high taxes aren’t matched by anti-smuggling efforts.
Even high-income countries have suffered unintended consequences from Bloomberg’s policies. In 2020, Massachusetts banned flavored tobacco and vapor products, leading to a 22 percent drop in cigarette tax revenue and a 73 percent increase in spending to combat illegal sales. San Francisco’s flavor ban contributed to an uptick in youth smoking – a stark contrast to its intended outcome.
While reducing tobacco use is essential, Bloomberg-backed strategies often fail to consider local contexts, neglect harm reduction, and exacerbate illicit trade. Moving forward, the FCTC and Bloomberg-affiliated organizations must prioritize balanced, science-based policies. These should include support for harm-reduction alternatives, pragmatic tax structures, and culturally and economically informed local strategies.
Global tobacco control must be adaptable, evidence-driven, and realistic. To regain its credibility, the FCTC must stop forcing Parties to bow to Bloomberg’s dogma.
Dr. Ziauddin Islam, the former National Focal Person for the FCTC from Pakistan, is a renowned tobacco control expert who advocates for evidence-based harm reduction strategies. Lindsey Stroud is tobacco harm reduction advocate based in Florida, and creator and manager of Tobacco Harm Reduction 101. Originally published at The Opinion Pages.
