Asia-Pacific is the world’s largest cigarette market by volume, and the market where tobacco harm reduction can have the largest real-world impact. Tobacco harm reduction is a public health strategy that aims to reduce the health risks associated with tobacco use.
With more than 600 million people across the region classifying themselves as smokers, the need for alternative solutions is pressing.
Tobacco Harm Reduction in action
Across countries that have started to bring in safer alternatives to smoking, we’ve seen a significant decrease in the number of smokers, and smoking-related diseases.
Japan introduced heated tobacco products in 2014-15 which marked the beginning of the fastest decline in smoking in the country’s history. Smoking prevalence dropped from 21% in 2015, to 16% in 2023. Now, 12.4% of adults use HTPs, reflecting a substantial consumer shift away from cigarettes with sales dropping 52% from 182 billion sticks sold in 2015 to 88 billion in 2023.
New Zealand has similarly halved its smoking rate from 13.3% in 2018 to 6.9% in 2024, a number which has directly coincided with the government legally recognising and promoting vaping as a less harmful alternative. Almost four in five (78%) of daily vapers are ex-smokers, demonstrating vaping’s strong role as a quitting aid. Further, between 2017 and 2022, chronic obstructive pulmonary disease (COPD)-related hospitalisations for adults aged 45 years and over decreased from 645 per 100,000 to 455 per 100,000, a fall of 29.4%.
Sweden is poised to become the first country in the world to achieve an official “smoke-free” status, with just 5.3% of adults smoking. This has largely been driven by the widespread use of smokeless products (15.7% overall), including growing adoption of nicotine pouches. Over 12 years, smoking rates dropped by 54% with the smoking rate for women declining by 49% after the introduction of nicotine pouches in 2016. The stats speak for themselves — 76.3% of men and 71.6% of women who use snus have quit smoking completely, which has directly translated into 34% fewer cancer deaths in Sweden than the EU average.
Why the Asia Pacific region matters
Lower- and middle-income countries bear the brunt of the global tobacco burden, accounting for 80% of all smoking-related deaths. In several of these countries, conventional quitting tools are scarce or unaffordable, leaving millions with few options beyond traditional tobacco.
For example, in India and Bangladesh, oral tobacco products such as gutka are widely used among low-income and rural populations and remain a major driver of oral cancer.
Substituting these products with regulated, non-combustible alternatives such as oral nicotine pouches could provide a critical path to reducing harm and healthcare costs.
Risk-proportionate approaches are a solution
The Framework Convention on Tobacco Control (FCTC) includes harm reduction as one of its pillars under Article 1(d), yet this provision is routinely overlooked in global policy discussions.
While countries that embrace harm reduction strategies are seeing faster declines in smoking and related disease, the World Health Organization and FCTC guidance has not kept pace with the growing scientific and public health evidence.
The success from countries such as Japan and New Zealand is proof that tobacco harm reduction is a global opportunity that the world, and especially Asia Pacific, cannot afford to ignore.
This is a real-world issue that needs to be solved, not through encouraging smokers to completely give up cigarettes with no support, but through helping smokers move away from smoking to reduced-risk alternatives such as e-cigarettes, heated tobacco products or oral nicotine pouches.
