At a time when commitment to the post-war order and international law is shifting, and the negotiation of new treaties has become more difficult, the Framework Convention on Tobacco Control shines as the most successful binding health treaty in history. As the first international treaty negotiated under the auspices of the World Health Organization, it stands out for several reasons. First, the treaty was adopted and ratified with remarkable speed, from its adoption by the World Health Assembly on 21 May 2003 to entering into force on 27 February 2005. Today, the FCTC has global support, adopted by 183 states covering 90% of the world’s population.
Second, with tobacco use killing around 8 million people annually by 2025, the treaty has been a political catalyst for new or stronger national tobacco control legislation worldwide. The FCTC Secretariat was established to advise and guide parties on specific commitments, monitor treaty implementation and facilitate international cooperation.
Third, the FCTC’s success is most evident in the global decline in tobacco use since 2005, from 29.3% to 19.8% in 2025. The treaty is credited with preventing 24 million young people from starting smoking in its first ten years. Total tobacco users decreased globally from nearly 1.4 billion in 2000 to about 1.25 billion in 2024. To date, the FCTC is credited with saving an estimated 37 million lives.
Dealing with pressure
From its inception, the FCTC faced strong and sustained opposition by a powerful tobacco industry and the governments protecting it. Its eventual success was due to the marrying of compelling evidence and sound political strategy to underpin the negotiation process. This began with the establishment of the Tobacco Free Initiative as one of two high-level cabinet priorities by WHO director-general Gro Harlem Brundtland, a physician and seasoned politician. Politically savvy TFI senior officials immediately set to work building a broad coalition of support for tobacco control in each WHO region. Significantly, allies were confirmed far beyond the public health community, including civil society, and formed the Framework Convention Alliance. Recognising that health-based arguments alone failed to secure political commitment to stronger tobacco control for decades, the TFI engaged ministries of finance, customs and excise, environment, and education. Notable was a close collaboration with World Bank economists who generated influential data to dispel the longstanding myth that the tobacco sector generated net economic benefits for societies. A fuller accounting of the costs associated with the global burden of tobacco disease and death, such as health care, lost productivity, tax evasion and housefires, totalling an estimated $1.7 trillion (1.7% of the world economy), reversed the economic argument, turning it in favour of stronger regulation. The WHO estimated that, over a 15-year period, the economic benefits of implementing FCTC policy measures would save $6.2 trillion.
Approach to addiction
Another key shift achieved by the FCTC was changing the portrayal of tobacco use as an individual choice and thus responsibility. Given clear evidence of the health harms from tobacco use, continued smoking was then blamed on lack of education, poor judgement or even weak character. Many within the public health community focused on interventions to reduce ‘risky behaviours’ through health education, advocacy and other behavioural change strategies.
Evidence of the highly addictive nature of nicotine, alongside revelations that the tobacco industry had designed its products to optimise addiction, showed the issue to be one of political will. Internal documents further revealed that the tobacco industry, despite awareness of the deadly nature of its products, intentionally acted to addict children and youth, women and other targeted populations. This significantly shifted public opinion. Tobacco control policies expanded, from prevention and cessation programmes for individuals to stronger regulation and prosecution of the tobacco industry to recover billions of dollars of healthcare costs. As evidence of large-scale complicity in cigarette smuggling emerged, governments also brought legal action to recover tax revenues and impose severe fines. These and many other effective tobacco control measures were made possible by the global cooperation mobilised by the FCTC.
Although the FCTC has galvanised collective action to reduce global tobacco use, hard battles continue to rage. The tobacco industry, as the disease ‘vector’, continues to evolve new strategies and products to circumvent stronger regulation. With half of smokers dying of their habit, the industry globalised in search of new users across Africa, Asia and the Middle East where populations are increasing and regulation is often less stringent. The tobacco industry has also heavily marketed e-cigarettes and vaping to adolescents and young adults, resulting in alarming levels of nicotine consumption and addiction. The industry has portrayed itself as contrite and committed to harm reduction; in practice, it has aligned itself with powerful political and economic interests to coordinate lobbying, create scientific doubt, and weaken public support of the WHO, scientists and the public health community. These challenges require governments – the 183 parties to the FCTC – to adapt their own political strategies by exposing the evolving tactics of the tobacco industry, its ideological and financial links to populism and partisan politics, and the broader role of the commercial determinants of health.
