The World Health Organization (WHO) has shown its ability to act quickly and effectively with SARS, an illness that has so far claimed about 500 lives, but is facing failure in its attempts to reach agreement over controlling tobacco, a health hazard that killed more than 4 million people last year.
After four years of steady and protracted negotiations to agree internationally on protections that are now considered standard in the developed world, the US and Germany are trying to wreck a treaty due to be signed next week in Geneva that would save millions of lives, by providing developing countries with the basic tools for enacting comprehensive tobacco-control legislation.
Tobacco, with a known mortality rate of 50 percent compared to the 20 percent estimated for SARS, will soon become the leading single cause of death across the world.
If current trends persist, about 500 million people alive today will eventually be killed by tobacco, half of them in their middle years, losing 20 to 25 years of life. There have been more than 70,000 scientific articles since 1950 which leave no room for doubt that prolonged smoking is a major cause of premature death and disability worldwide.
Until recently, this epidemic mainly affected rich countries, but this is changing as patterns of consumption change. One in four of all smokers now live in China, where smoking rates are well over 50 percent.
By comparison, in the US, the proportion of men who smoke fell from 55 percent in the 1950s to 28 percent in the 1990s. If these trends continue, by the late 2020s seven out of 10 victims of tobacco will be from the poorer nations of Asia, Africa, Latin America and Eastern Europe.
The treaty, if signed, could curtail the growing global tobacco epidemic. Once ratified by 40 countries it would become the first legally binding international treaty on tobacco control. It includes compulsory minimum-size health warning labels on tobacco, banning of ads and sponsorship, banning of sales to children and protection for non-smokers in public and work places. It also provides for more effective control of smuggling and for increasing taxation to reduce tobacco consumption.
US President George W. Bush has publicly stated that tobacco use is the greatest health issue facing America, so you'd think the US would be happy to sign. But last week the Bush administration wrote to all the other 191 WHO member states, threatening to pull out unless an opt-out clause is included in the treaty, enabling countries to pick and choose which parts of it they implement.
Now the entire treaty threatens to unravel as others follow America's lead. In particular Germany, less publicly, is lobbying for changes, and threatens not only to withdraw from the treaty itself, but to take with it the 15 other current EU members, and 10 new members, since the EU signs as a group.
Behind the scenes negotiations are going on to get Germany to fall in line so that the EU can sign, but the word is that the political opposition comes from the very top, the offices of Gerhard Schroeder, the German chancellor.
So why are the US and Germany so keen to sink the treaty? Unfortunately, governments and politicians suffer from their own brand of nicotine addiction -- finance ministries and political parties reap the benefit of tobacco sales-related tax revenues and campaign donations respectively.