For decades, tobacco control has been framed as a choice between prohibition and aggressive restrictions on one side, and loosely regulated markets on the other. Neither extreme is delivering the fastest possible gains for public health. 

The WHO Framework Convention on Tobacco Control (FCTC) already defines tobacco control as including “harm reduction strategies.” That means not only preventing uptake, but also reducing disease and death among people who continue to use nicotine. Yet in many countries, this harm-reduction pillar remains underused or is actively undermined. 

Why extremes fail public health 

Total bans or nearprohibition of safer nicotine products rarely eliminate demand; they drive it underground. Experience shows that illicit markets flourish, products evade safety standards, and young people still gain access to unregulated goods. At the same time, adult smokers are left with a stark choice: keep smoking, or turn to a black market. 

At the other extreme, poorly regulated markets can expose youth to aggressive marketing and poorly manufactured products, eroding public trust and inviting future crackdowns that again benefit cigarettes. 

In both scenarios, the unintended consequence is the same: cigarettes remain the most available, visible and reliable nicotine product, and smoking prevalence falls more slowly than it could. 

What balanced, riskproportionate regulation looks like 

To design a better approach to risk-proportionate regulation, we’d recommend that regulation be evidence-based and address the following: 

• Sciencebased and riskproportionate: The most harmful products (combustible cigarettes) face the most restrictive rules and highest taxes; lowerrisk, noncombustible products face lighter but robust regulation. 

• Youth protection: Strict age limits, enforcement at point of sale, and penalties for underage supply. 

• Product and manufacturing standards: Clear rules on ingredients, emissions, quality and device safety to minimise avoidable harms. 

• Health information and labelling: Honest, evidencebased communication about risks which neither minimises nor exaggerates them, including the fundamental point that combustion, not nicotine itself, is the primary driver of smokingrelated disease. 

• Accessible pricing for adults: Taxation that maintains a meaningful price gap in favour of lowerrisk products, so switching is both attractive and sustainable for smokers. 

• Responsible marketing controls: Restrictions that prevent youth targeting and misleading claims, while allowing adult smokers to learn about safer alternatives. 

Global lessons from Sweden, New Zealand and the UK 

Countries that have embraced this balanced model are moving fastest. Sweden has combined strict controls on smoking with legal, affordable, safer nicotine products. Its smoking rate is now near 5%, with substantially lower tobaccorelated disease and mortality than the European average. 

New Zealand has followed a similar path, implementing comprehensive smokefree laws, regulated vaping and other alternatives, and launching campaigns that explicitly encourage smokers to switch. Smoking prevalence has more than halved in just over a decade and is heading towards smokefree status. 

England’s health authorities have long recognised that wellregulated vaping can support cessation. Smoking is now at its lowest recorded level, while millions of adults use noncombustible products instead of cigarettes. 

By contrast, Australia has adopted one of the world’s most restrictive models for vaping, relying on prescriptions and import bans. The result has been a large illicit market supplying both adults and young people, persistent smoking, and widespread use of unregulated products, precisely the opposite of what public health intends. 

AsiaPacific’s opportunity 

AsiaPacific bears a high burden of smokingrelated disease but also has an opportunity to lead globally. By moving away from blanket bans and unregulated markets and towards proportionate, sciencebased regulation, governments can: 

• Protect young people from initiation 

• Give adult smokers realistic, lowerrisk alternatives 

• Shrink illicit markets through clear legal pathways 

• Accelerate declines in smoking and tobaccorelated disease 

The choice is not between “tough” policy and harm reduction. The toughest stance on smoking is to make it obsolete by regulating safer alternatives intelligently. 

Policymakers now have ample evidence: balanced, riskproportionate regulation delivers faster public health gains than either prohibition or laissezfaire. The imperative is clear: put evidence before ideology, avoid the extremes, and use harm reduction to save lives at scale.