Aligning With the WHO or Supporting Harm Reduction: Belize’s Next Step

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Key Points:

• New Legislation: Belize’s Cabinet backs first-ever comprehensive tobacco control bill, covering cigarettes, e-cigs, heated tobacco, hookah, and nicotine pouches.

• WHO Alignment: Bill seeks to mirror FCTC policies – restrictions on ads, packaging, and smoke-free laws – though critics warn these approaches often ignore harm reduction.

• Declining Rates: Adult tobacco use already dropped 33.6 percent in 20 years (13.7 percent in 2000 to 9.1 percent in 2020); in 2022, prevalence stood at 8.7 percent. Women’s use fell over 40 percent.

• Youth Use: 8.9 percent of 10–14-year-olds reported tobacco use in 2022 – down from 12.3 percent of teens in 2014.

• Implementation Gaps: Despite ratifying FCTC in 2005, Belize still lacks smoke-free laws, comprehensive ad bans, and regulations for novel products.

• Harm Reduction Evidence: Countries like the UK, Canada, New Zealand, Sweden, Japan, and South Korea show safer alternatives accelerate smoking declines.

• Policy Choice: Belize could lead Latin America toward smoke-free status if it balances regulation with harm reduction instead of punitive bans.

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The Belizean Cabinet has endorsed legislation to regulate tobacco use, advertising, and packaging for the first time in the country’s history. Officials described the move as an effort to reduce tobacco-related harm and “align with international public health standards.” The proposed bill will extend beyond traditional cigarettes to include novel products such as e-cigarettes, heated tobacco, hookah, and nicotine pouches.

While stronger regulation may appear necessary as global markets shift toward new nicotine products, there is concern that the legislation will mirror the World Health Organization’s Framework Convention on Tobacco Control (FCTC). Policies stemming from the FCTC are frequently rigid and punitive, failing to account for harm reduction and often pushing adults who smoke – or who seek to quit – toward illicit markets or continued combustible cigarette use.

The Cabinet has authorized the Ministry of Health and Wellness to present the bill to the House of Representatives, following Belize’s participation in a Pan American Health Organization forum earlier this year that examined regional tobacco control measures. Officials stressed the law would include restrictions on advertising and promotion, packaging requirements, smoke-free protections, and special safeguards for youth and vulnerable groups.

Belize has already experienced a steady decline in smoking rates over the past two decades without comprehensive FCTC-style laws. In 2000, 13.7 percent of adults used tobacco products; by 2020, this had dropped to 9.1 percent, a 33.6 percent decline. Prevalence further decreased to 8.7 percent in 2022.

Gender differences remain stark: in 2022, only 1.9 percent of adult women reported tobacco use compared to 15.5 percent of men. Women also experienced a greater reduction in tobacco use since 2000, with prevalence falling by over 40 percent, compared to a 35 percent decline among men.

Among youth, prevalence is slightly higher than adult averages. In 2022, 8.9 percent of adolescents aged 10 to 14 used tobacco, including 11.5 percent of boys and 6.3 percent of girls. Still, this is a reduction from 2014, when the WHO estimated 12.3 percent of Belizean youth aged 13 to 15 used tobacco products.

Belize ratified the WHO FCTC in 2005, with the treaty entering into force in March 2007. The FCTC obligates Parties to implement the MPOWER strategy, a policy package supported by Bloomberg Philanthropies, which includes tax hikes, indoor smoking bans, strict packaging and labeling standards, and advertising restrictions. Despite nearly 20 years of membership, Belize’s own FCTC implementation report in 2025 revealed significant gaps. The country lacked smoke-free laws, comprehensive advertising bans, packaging regulations, tobacco taxation, and any regulation of novel nicotine products. The pending legislation is being promoted as finally addressing those shortcomings.

Yet while elements of the bill may address clear policy gaps, others risk undermining public health by restricting access to products that are demonstrably less harmful than smoking. The WHO continues to oppose tobacco harm reduction, often mischaracterizing alternatives such as e-cigarettes, heated tobacco products, and nicotine pouches, despite a growing body of evidence affirming their lower risk profiles and their effectiveness as smoking cessation tools.

E-cigarettes, first invented in China in 2003 and introduced there in 2004, reached the UK and US markets by 2007. Since then, regulators such as, Health Canada, Public Health England (now the Office for Health Improvement and Disparities), the UK Royal College of Physicians, the New Zealand Ministry of Health, the US Food and Drug Administration, have all acknowledged their reduced-risk profile. Multiple studies and systematic reviews between 2019 and 2025 have concluded that e-cigarettes are more effective for quitting smoking than traditional nicotine replacement therapies. Their availability has coincided with significant declines in cigarette consumption and smoking prevalence in several markets.

Heated tobacco products have shown similar effects, with notable drops in cigarette sales in Hungary, Japan, and South Korea following their introduction.

Sweden, which has promoted oral nicotine pouches and snus over combustible tobacco, has achieved the lowest rates of smoking-related cancers in Europe and is projected to become the world’s first smoke-free country under the WHO definition of less than 5 percent smoking prevalence. In 2024, only 5.3 percent of Swedes smoked, and among native-born Swedes the rate was just 4.5 percent.

Belize now faces a critical choice. With already low smoking prevalence achieved without FCTC-aligned restrictions, policymakers should be careful not to undermine progress by enacting overly punitive laws that criminalize safer alternatives. Differentiating between combustible tobacco, which causes the overwhelming majority of smoking-related disease, and lower-risk products that can help adults quit is essential. If Belize embraces harm reduction alongside sensible regulation, the country could accelerate its decline in smoking and position itself among the first in Latin America to reach smoke-free status.

Nothing in this analysis is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101.