The debate over e-cigarettes is nothing if not polarising, and the recommendations handed down by the World Health Organization last week, the most influential health body to pass judgement so far, are no exception.

A group of tobacco experts has now published a critique of the WHO guidelines calling them misguided and alarmist, and warning that they could have serious negative health consequences.

Ann McNeill from the National Addiction Centre at King’s College London and her colleagues take issue with a number of the statements made in the report, which made strong recommendations on curbing e-cigarette use. The report is likely to influence countries’ regulation of the devices.

“When I read the report I was shocked and surprised, because I felt it was an inaccurate portrayal of the evidence on e-cigarettes,” says McNeill. She adds that the report draws heavily on another research paper which misrepresents her own work and does not accurately portray the benefits and risks of vaping.


Chief among the criticisms of the report is the idea that e-cigarettes will act as a gateway drug to smoking. Evidence shows that very few people who try e-cigarettes have never smoked. The report is also condemned for suggesting that vaping could hinder a person’s attempts to quit smoking.

Instead, the number of smokers in wealthy countries continues to decline, which suggests that the growth in the e-cigarette market is not stopping people from quitting. Earlier this year, Robert West of University College London found that e-cigarettes helped people to quit more than over-the-counter nicotine replacement therapies such as patches or gum, or going cold turkey. He called the WHO recommendations “ridiculous”. West has calculated that for every million smokers who switch to an e-cigarette, 6000 premature deaths could be avoided in the UK every year – even if those users were to carry on vaping for the rest of their lives.

So just why is one of the world’s largest public health bodies taking such a conservative approach? “One can only speculate as to what the motives are, but my feeling is that there is a kind of puritanical view that everything relating to nicotine is bad and harmful and should be stamped on,” says West. “You can understand why – we don’t want people to be addicted to something that isn’t doing them any good and could be doing them a small amount of harm in the case of nicotine.” He says that what the WHO is doing is comparing the risk of vaping against not smoking at all, whereas what we should be doing is comparing smoking e-cigarettes with real cigarettes.

Journal reference: Addiction, DOI: 10.1111/add.12730