The 11th Conference of the Parties (COP11) of the WHO Framework Convention on Tobacco Control (FCTC) transcended its usual role as a routine gathering, becoming a pivotal moment of awakening, resistance, and reassertion of sovereignty. This shift was particularly evident among African nations, which, instead of remaining at the margins of global health policy, spoke with unprecedented clarity, confidence, and unity. They delivered numerous statements, engaged meaningfully in debates, and directly challenged long-standing FCTC practices that had consistently failed to acknowledge regional diversity or scientific nuance. The overarching message from Africa was unambiguous: the continent will no longer passively accept imported policies and demands genuine representation, evidence-based approaches, and respect for its unique realities.

A central point of contention at COP11 was the deeply opaque selection process and functioning of the FCTC’s small, exclusive expert groups. The lack of transparency regarding their composition, selection criteria, and internal mechanisms raised significant concerns among many Parties. Despite this obscurity, these groups are responsible for formulating broad, often highly prescriptive recommendations intended for over 180 countries, each with distinct cultural, economic, and health landscapes. African delegates repeatedly questioned the legitimacy of a handful of experts from a limited number of countries making decisions that profoundly impact the entire world. This palpable frustration led to calls for working groups that truly represent all regions, are composed of independent experts, and are committed to developing practical, evidence-based solutions that reflect diverse market realities, rather than imposing generic bans or punitive measures conceived in Geneva.

A troubling pattern observed at COP11 was the systemic suppression of discussions around harm reduction. Delegates who advocated for safer nicotine alternatives, not on behalf of the tobacco industry but in the interest of their citizens, were frequently interrupted, challenged, or accused of promoting industry interests. A striking example involved the delegate from St Kitts and Nevis, a medical doctor with extensive expertise in harm reduction, who attempted to explain the health benefits of risk-reduced products. Instead of engaging with his evidence, he was baselessly accused of reading a script provided by the tobacco industry. Offended, he forcefully read out his professional credentials, underscoring that harm reduction is a legitimate scientific discipline, not merely a corporate slogan. His powerful message resonated: harm reduction is a public health imperative that belongs to the people whose lives it can save, not the tobacco industry. These accusations highlighted a deeper systemic issue: the FCTC's intense focus on combating the industry appears to have overshadowed its equally crucial mandate of saving lives.

Despite clear scientific evidence demonstrating that safer nicotine products—such as e-cigarettes, heated tobacco products, and oral smokeless alternatives—are significantly less harmful than combustible cigarettes, this evidence was largely dismissed at COP11. Public Health England, for instance, estimates vaping to be at least 95% less harmful than smoking. Sweden has achieved the lowest smoking rate in Europe, at 5%, largely due to the cultural integration of snus, resulting in a significantly lower incidence of cancer. Japan has witnessed a remarkable 40% reduction in cigarette sales since the introduction of heated tobacco products. These are not industry propaganda but measured public health outcomes verified and published by independent authorities. Nevertheless, repeated calls for risk-proportionate regulation, thorough scientific evaluation, and the establishment of independent testing facilities were met with staunch resistance. Rather than embracing evidence-based pathways, the FCTC advanced dozens of extreme proposals—many drafted by the same closed expert groups—that many Parties are already struggling to implement. Several countries pleaded for a sense of realism, stating: “We support ending smoking. But we cannot abandon the people who are still smoking today.”

One of the most significant interventions at COP11 was the firm insistence that harm reduction is fundamentally a public health strategy, not a concept owned by the tobacco industry, despite the WHO’s persistent assertion that any mention of it implies industry interference. Harm reduction is a universal principle applied across various public health domains: it’s seen in HIV/AIDS prevention through condom distribution, in drug policy via methadone therapy and needle exchange programs, in nutrition through sugar substitutes, in cosmetics with the regulation of skin-lightening products, and in alcohol control with light beers and alcohol-free alternatives. No one suggests the sugar industry “owns” sweeteners or that condom use is a corporate scheme. Yet, when the same logical framework is applied to smoking—the single largest preventable cause of death—harm reduction becomes inexplicably taboo. This profound contradiction undermines public health efforts and inadvertently cedes control of a vital narrative to the tobacco industry, a narrative that should rightly belong to governments, scientists, and citizens. African countries articulated this point sharply: by refusing to discuss harm reduction, the FCTC effectively hands the industry ownership over a concept that is central to the public health mandate of saving smokers' lives.

Many Parties, particularly from Africa, the Caribbean, and parts of Asia, demanded clarity on Articles 9 and 10, which govern the regulation of new nicotine products. They called for robust, independent scientific assessments, rejecting ideologically driven bans. Their demands included: every country establishing its own testing facility, working groups composed of independent experts, risk classification based strictly on scientific evidence, and guidance that is adaptable rather than mandatory. Crucially, they also insisted that future decisions must be implementable, highlighting the impracticality of the FCTC issuing 16 new forward-looking measures when many countries lack the resources to implement existing ones. The adjustment to Article 19, which changed proposals from “mandatory” to “optional,” represented one of the few instances of genuine consensus, signaling that flexibility fosters unity, whereas rigidity provokes resistance.

The FCTC’s continued use of the infamous ‘Dirty Ashtray Award,’ intended to publicly shame countries deemed obstructive, was widely condemned at COP11. Delegates argued that public humiliation is neither a diplomatic nor an effective tactic. Many observed that the award has increasingly been directed at countries that simply advocate for evidence-based approaches and have demonstrated real progress in saving lives through tobacco harm reduction. Far from enhancing the WHO’s credibility, such practices were seen as undermining it.

COP11 thus unveiled a significant shift in global health diplomacy, ushering in a new era for the Global South. African countries, historically patronized in international forums, powerfully asserted their right to shape policies that directly impact their citizens. They unequivocally demanded autonomy free from interference, evidence unburdened by ideology, and collaboration devoid of condescension. Their message was clear and resolute: the goal is to end smoking, but the lives of current smokers matter, and they refuse to abandon them. Harm reduction is not an industry agenda, nor a Western conspiracy, nor a compromise; it is a lifeline that African nations are now ready to claim and integrate into their public health strategies.