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Brownstone Institute

The Naked Absurdity of Global Public Health

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15 minute read

BY DAVID BELL

“Those Who Can Make You Believe Absurdities, Can Make You Commit Atrocities.” ~ Voltaire.

Something is fundamentally wrong with global public health. More accurately, something is fundamentally wrong with the mindset of global health professionals, particularly those in positions of leadership. It has become normal to speak, repeat, and defend complete absurdity, as if illusions and fantasies are real. There are no sanctions for operating in this way – indeed it is proving highly successful. Statements of demonstrable stupidity are becoming prerequisites for career advancement and the approval of peers. It is like living within a fantasy, except those it kills are real.

The world at large struggles to understand that they could be fed falsehoods on this level. Most people still consider the experts quoted in the media to be credible, serious people. They believe that those leading the health professions would not habitually lie. For professionals to act like this, they would have to be deeply troubled, insecure people, or they would have to be quite malevolent. This does not fit the popular image of global health experts.

Beyond individuals, we now have entire institutions mocking reality. They lie to each other and the public, repeat these lies, and applaud each other for doing so. They can state obvious stupidity with impunity as a once critical media now sees its role as backing them unquestioningly, disseminating their pronouncements and suppressing any information to the contrary for a perceived public good. The emperor’s obvious nakedness has become proof that he is clothed. Acknowledging the evidence of one’s eyes as he parades his wares is tantamount to the crime of Galileo and must be treated accordingly.

The opportunity of COVID-19

Over the last two years, the world’s premier health institutions pretended that humans were unlikely to develop effective clinical immunity in response to coronavirus infections, despite experience with the four common seasonal coronaviruses and the SARS-1 confirming that we do. Despite established understanding of mucosal immunity and T-cell function, the public were asked to believe that antibody titers against a single highly-variable pharmaceutically-induced protein were the only valid measure of effective immunity. The leaders and staff within these health organizations knew this was frankly silly, and that the evidence on COVID-19 was showing otherwise.

All these institutions knew that, in time, the relative effectiveness of post-infection immunity would become obvious to all. But this did not stop them from stating that vaccines were ‘the only way out of the pandemic,’ as if established fact, denigrating those who thought differently and ignoring the natural resolution of prior pandemics. Despite accumulating evidence that the obvious is indeed obvious, this position of fallacy still drives the COVAX global vaccination program. Current evidence that post-infection immunity is more effective than vaccination is of no value– truth simply does not matter to these people anymore.

In 2019, the term ‘genetic medicines’ referred to pharmaceuticals based on introduction of genetic material into a body for therapeutic purposes. It is standard industry terminology for mRNA formulations such as those that induce SARS-CoV-2 (COVID-19) spike protein production. In 2020, institutions that previously used this term for COVID-19 vaccines decided that continuing to do so would equate to promoting a ‘conspiracy theory’ – a particularly severe transgression. These mRNA medicines work by inserting synthetic genes into a person’s cells, using the host’s intracellular machinery to translate the genetic sequence into a foreign protein that is expressed by the cell. These cells are then recognized as foreign by the host’s immune system and killed. While this change to the definition of vaccine can be justified by the end result (an immune response), mRNA vaccines are indeed, as the pharmaceutical industry notes, genetic medicines.

It was considered necessary that the public consider such medicines to be indistinguishable from conventional vaccines that present proteins or other antigens to the immune system through an entirely different mechanism. The fallacy was formed to support the claim that if one type of vaccine was safe and effective, then the other must be.

The entire pharmaceutical industry knows this is an absurdity; mRNA injections may well be safe and effective, or they may not, but they are no more like injecting a protein or attenuated virus than riding a bicycle is to riding a train. If the department of transport told us that railways prove that bicycles are safe and effective, we would laugh. Except we wouldn’t anymore.

We would, apparently, signal our agreement because to identify differences between bicycles and trains would be evidence of incorrect thinking (misinformation, or a conspiracy theory). Similarly ‘incorrect’ thinking regarding COVID-19 has been characterized in the Journal of the American Medical Association, with a nod to Nazism, as a neurodegenerative disorder.

Tedros perfects the art

Tedros Adhanom Ghebreyesus and the World Health Organization (WHO) he leads have perfected the art of mainstreaming the ridiculous through COVAX. With a budget several times higher than any prior international health program, it aims to vaccinate billions of already-immune people in age groups barely affected by COVID-19. WHO is aware that the vaccines do not significantly reduce spread, that post-infection immunity is effective, and that vaccinating people with post-infection immunity will provide minimal additional clinical benefit.

WHO promotes COVAX under the banner “No one is safe until all are safe.” WHO thus wants the public to believe that vaccinating an individual does not protect them until everyone else is vaccinated, whilst simultaneously believing, as WHO insists, that vaccination against COVID-19 is highly protective for all those who are vaccinated.

The complete incompatibility of these claims, together with the absurdity of claiming that a vaccine that does not stop transmission could protect others and ‘end the pandemic,’ does not matter. The writers and designers of WHO’s speeches and brochures know these opposing claims cannot simultaneously be true. They have found that stating absurdities is rewarded, and that if a young boy points to the emperor’s nakedness he can simply be denigrated and excluded, while the emperor swaggers on.

A pox on us all 

Tedros recently proclaimed monkeypox, a virus that had then killed 5 people globally, to be a public health emergency of international concern. His organization’s last such pronouncement contributed to an increase of about 45,000 added malaria child deaths in 2020, over 200,000 additional dead children in South Asia in the same year, rising tuberculosis, millions of girls forced into child marriage and sexual slavery, and the decimation of global education that will entrench future poverty for billions. Yet this man managed to concentrate the world on monkeypox, an outbreak of such tiny impact that annual mortality from bungee-jumping will likely be higher.

Whole countries followed his lead, global media ran headlines on how many people had this chicken pox-like disease, and the world pretended the emergency was real. Once this man would have been laughed out of office, but the world of 2022 considered this blatant absurdity normal and acceptable. It no longer expects or requires rational discourse from people in authority. Stupidity is expected and its dictates adopted.

The purpose of pointing out the above is not to single out WHO. WHO’s fantasy statements are repeated and supported by its peer health organizations. Gavi (the vaccine alliance), CEPI (Coalition for Epidemic Preparedness Innovations), UNICEF (the UN agency that once concentrated on vaccinating children but now leads mass vaccination against a disease targeting the elderly) all apparently agree that ‘No one is safe until everyone is safe.’

This needs to be understood as an entire industrial culture – global health is a business and its primary role is to support itself. Its members know their pronouncements are false or illogical, but dishonesty has become an important tool to achieve their goals. It fuels income and expansion, and therefore must be good. Many private corporations would act similarly if advertising standards were not enforced. These international health agencies operate outside of national jurisdictions, and so have no enforceable standards. The media, once a check on such malfeasance and misgovernance, has ceased to value truth.

The COVID-19 event has opened the gate to a new era in public health, and the absurdity of the monkeypox ‘emergency’ is an example of what is coming. A pandemic industry that has formed around these agencies, now with the weight of the World Bank behind it, is asking us to believe that pandemics are becoming more frequent, and that the world’s diminishing wildlife poses an ever-increasing threat.

WHO’s own publications may tell us that pandemics have occurred just 5 times in 100 years, with overall reducing mortality, but this is of no consequence. Fantasy, when repeated sufficiently in a matter-of-fact manner, can displace objective reality as a driver of policy. The removal of employment, disruption of supply lines, increase in mass poverty and the economic wreckage of the COVID-19 response is used to justify a call for repetition of the same, more easily and more often, by the same people who orchestrated it.

Killing by killing truth

Most health professionals, given a few minutes to sit down and think this through, can see that something is wrong. However, it is hard to hold onto this reality if the lie opposing it is repeated widely and frequently, echoed by all one’s peers. People who understand infection control can still put on a mask at a restaurant door to remove it at a table just meters away. Humans are fully capable of living a lie, of embracing absurdity in life and work, just to get along. We now have an entire international industry fully reliant on acceptance of such absurdity for its survival. Despite the risks, it works.

COVID-19 showed us how willing many people are to join the harming and denigration of others to defend positions they know are illogical and untrue. To see one’s own profession indulging in such behavior is difficult to reconcile, when that profession is in some ways entrusted with the welfare of others. But we should not be surprised, we are all human and this promotion of global harm will continue as long as it reaps local rewards. People do not easily tire of wrong – they get accustomed to it.

This institutional self-delusion would be of little consequence, even humorous, if it only involved an emperor walking the streets of a children’s tale. But many of the children in this tale are now dead from malaria and malnutrition, millions of girls are enduring nightly rape and tens of millions denied education will spend their lives in poverty. They did not ask these people in Geneva, Washington, or Brussels to remove their food security, education and healthcare to ostensibly protect elderly elsewhere from COVID-19.

They are not asking for a growing pandemic bureaucracy to gorge itself whilst entrenching further inequality. Our response to this level of institutional dishonesty and absurdity must not be one of amusement but rather of disgust, and concern for what could happen next.

Author

  • David Bell, Senior Scholar at Brownstone Institute, is a public health physician and biotech consultant in global health. He is the former Program Head for malaria and febrile diseases at the Foundation for Innovative New Diagnostics (FIND) in Geneva, Switzerland.

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Brownstone Institute

Bizarre Decisions about Nicotine Pouches Lead to the Wrong Products on Shelves

Published on

From the Brownstone Institute

  Roger Bate  

A walk through a dozen convenience stores in Montgomery County, Pennsylvania, says a lot about how US nicotine policy actually works. Only about one in eight nicotine-pouch products for sale is legal. The rest are unauthorized—but they’re not all the same. Some are brightly branded, with uncertain ingredients, not approved by any Western regulator, and clearly aimed at impulse buyers. Others—like Sweden’s NOAT—are the opposite: muted, well-made, adult-oriented, and already approved for sale in Europe.

Yet in the United States, NOAT has been told to stop selling. In September 2025, the Food and Drug Administration (FDA) issued the company a warning letter for offering nicotine pouches without marketing authorization. That might make sense if the products were dangerous, but they appear to be among the safest on the market: mild flavors, low nicotine levels, and recyclable paper packaging. In Europe, regulators consider them acceptable. In America, they’re banned. The decision looks, at best, strange—and possibly arbitrary.

What the Market Shows

My October 2025 audit was straightforward. I visited twelve stores and recorded every distinct pouch product visible for sale at the counter. If the item matched one of the twenty ZYN products that the FDA authorized in January, it was counted as legal. Everything else was counted as illegal.

Two of the stores told me they had recently received FDA letters and had already removed most illegal stock. The other ten stores were still dominated by unauthorized products—more than 93 percent of what was on display. Across all twelve locations, about 12 percent of products were legal ZYN, and about 88 percent were not.

The illegal share wasn’t uniform. Many of the unauthorized products were clearly high-nicotine imports with flashy names like Loop, Velo, and Zimo. These products may be fine, but some are probably high in contaminants, and a few often with very high nicotine levels. Others were subdued, plainly meant for adult users. NOAT was a good example of that second group: simple packaging, oat-based filler, restrained flavoring, and branding that makes no effort to look “cool.” It’s the kind of product any regulator serious about harm reduction would welcome.

Enforcement Works

To the FDA’s credit, enforcement does make a difference. The two stores that received official letters quickly pulled their illegal stock. That mirrors the agency’s broader efforts this year: new import alerts to detain unauthorized tobacco products at the border (see also Import Alert 98-06), and hundreds of warning letters to retailers, importers, and distributors.

But effective enforcement can’t solve a supply problem. The list of legal nicotine-pouch products is still extremely short—only a narrow range of ZYN items. Adults who want more variety, or stores that want to meet that demand, inevitably turn to gray-market suppliers. The more limited the legal catalog, the more the illegal market thrives.

Why the NOAT Decision Appears Bizarre

The FDA’s own actions make the situation hard to explain. In January 2025, it authorized twenty ZYN products after finding that they contained far fewer harmful chemicals than cigarettes and could help adult smokers switch. That was progress. But nine months later, the FDA has approved nothing else—while sending a warning letter to NOAT, arguably the least youth-oriented pouch line in the world.

The outcome is bad for legal sellers and public health. ZYN is legal; a handful of clearly risky, high-nicotine imports continue to circulate; and a mild, adult-market brand that meets European safety and labeling rules is banned. Officially, NOAT’s problem is procedural—it lacks a marketing order. But in practical terms, the FDA is punishing the very design choices it claims to value: simplicity, low appeal to minors, and clean ingredients.

This approach also ignores the differences in actual risk. Studies consistently show that nicotine pouches have far fewer toxins than cigarettes and far less variability than many vapes. The biggest pouch concerns are uneven nicotine levels and occasional traces of tobacco-specific nitrosamines, depending on manufacturing quality. The serious contamination issues—heavy metals and inconsistent dosage—belong mostly to disposable vapes, particularly the flood of unregulated imports from China. Treating all “unauthorized” products as equally bad blurs those distinctions and undermines proportional enforcement.

My small Montgomery County survey suggests a simple formula for improvement.

First, keep enforcement targeted and focused on suppliers, not just clerks. Warning letters clearly change behavior at the store level, but the biggest impact will come from auditing distributors and importers, and stopping bad shipments before they reach retail shelves.

Second, make compliance easy. A single-page list of authorized nicotine-pouch products—currently the twenty approved ZYN items—should be posted in every store and attached to distributor invoices. Point-of-sale systems can block barcodes for anything not on the list, and retailers could affirm, once a year, that they stock only approved items.

Third, widen the legal lane. The FDA launched a pilot program in September 2025 to speed review of new pouch applications. That program should spell out exactly what evidence is needed—chemical data, toxicology, nicotine release rates, and behavioral studies—and make timely decisions. If products like NOAT meet those standards, they should be authorized quickly. Legal competition among adult-oriented brands will crowd out the sketchy imports far faster than enforcement alone.

The Bottom Line

Enforcement matters, and the data show it works—where it happens. But the legal market is too narrow to protect consumers or encourage innovation. The current regime leaves a few ZYN products as lonely legal islands in a sea of gray-market pouches that range from sensible to reckless.

The FDA’s treatment of NOAT stands out as a case study in inconsistency: a quiet, adult-focused brand approved in Europe yet effectively banned in the US, while flashier and riskier options continue to slip through. That’s not a public-health victory; it’s a missed opportunity.

If the goal is to help adult smokers move to lower-risk products while keeping youth use low, the path forward is clear: enforce smartly, make compliance easy, and give good products a fair shot. Right now, we’re doing the first part well—but failing at the second and third. It’s time to fix that.

Author

Roger Bate

Roger Bate is a Brownstone Fellow, Senior Fellow at the International Center for Law and Economics (Jan 2023-present), Board member of Africa Fighting Malaria (September 2000-present), and Fellow at the Institute of Economic Affairs (January 2000-present).

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Addictions

The War on Commonsense Nicotine Regulation

Published on

From the Brownstone Institute

Roger Bate  Roger Bate 

Cigarettes kill nearly half a million Americans each year. Everyone knows it, including the Food and Drug Administration. Yet while the most lethal nicotine product remains on sale in every gas station, the FDA continues to block or delay far safer alternatives.

Nicotine pouches—small, smokeless packets tucked under the lip—deliver nicotine without burning tobacco. They eliminate the tar, carbon monoxide, and carcinogens that make cigarettes so deadly. The logic of harm reduction couldn’t be clearer: if smokers can get nicotine without smoke, millions of lives could be saved.

Sweden has already proven the point. Through widespread use of snus and nicotine pouches, the country has cut daily smoking to about 5 percent, the lowest rate in Europe. Lung-cancer deaths are less than half the continental average. This “Swedish Experience” shows that when adults are given safer options, they switch voluntarily—no prohibition required.

In the United States, however, the FDA’s tobacco division has turned this logic on its head. Since Congress gave it sweeping authority in 2009, the agency has demanded that every new product undergo a Premarket Tobacco Product Application, or PMTA, proving it is “appropriate for the protection of public health.” That sounds reasonable until you see how the process works.

Manufacturers must spend millions on speculative modeling about how their products might affect every segment of society—smokers, nonsmokers, youth, and future generations—before they can even reach the market. Unsurprisingly, almost all PMTAs have been denied or shelved. Reduced-risk products sit in limbo while Marlboros and Newports remain untouched.

Only this January did the agency relent slightly, authorizing 20 ZYN nicotine-pouch products made by Swedish Match, now owned by Philip Morris. The FDA admitted the obvious: “The data show that these specific products are appropriate for the protection of public health.” The toxic-chemical levels were far lower than in cigarettes, and adult smokers were more likely to switch than teens were to start.

The decision should have been a turning point. Instead, it exposed the double standard. Other pouch makers—especially smaller firms from Sweden and the US, such as NOAT—remain locked out of the legal market even when their products meet the same technical standards.

The FDA’s inaction has created a black market dominated by unregulated imports, many from China. According to my own research, roughly 85 percent of pouches now sold in convenience stores are technically illegal.

The agency claims that this heavy-handed approach protects kids. But youth pouch use in the US remains very low—about 1.5 percent of high-school students according to the latest National Youth Tobacco Survey—while nearly 30 million American adults still smoke. Denying safer products to millions of addicted adults because a tiny fraction of teens might experiment is the opposite of public-health logic.

There’s a better path. The FDA should base its decisions on science, not fear. If a product dramatically reduces exposure to harmful chemicals, meets strict packaging and marketing standards, and enforces Tobacco 21 age verification, it should be allowed on the market. Population-level effects can be monitored afterward through real-world data on switching and youth use. That’s how drug and vaccine regulation already works.

Sweden’s evidence shows the results of a pragmatic approach: a near-smoke-free society achieved through consumer choice, not coercion. The FDA’s own approval of ZYN proves that such products can meet its legal standard for protecting public health. The next step is consistency—apply the same rules to everyone.

Combustion, not nicotine, is the killer. Until the FDA acts on that simple truth, it will keep protecting the cigarette industry it was supposed to regulate.

Author

Roger Bate

Roger Bate is a Brownstone Fellow, Senior Fellow at the International Center for Law and Economics (Jan 2023-present), Board member of Africa Fighting Malaria (September 2000-present), and Fellow at the Institute of Economic Affairs (January 2000-present).

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