The WHO’s Stance on THR
When it comes to tobacco harm reduction (THR), the WHO Framework Convention on Tobacco Control (Article 1) (FCTC) explicitly endorses harm reduction strategies in tobacco control: (d) “Tobacco control” means a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke” (emphasis added).
This means reducing harm to people who continue to use nicotine or tobacco. Despite this endorsement in the FCTC text, this tobacco harm reduction approach has not yet been expanded in the Convention. It has also not been widely developed as a tobacco control strategy other than by chance.
Core Message for Policymakers
Rather than criminalising safer nicotine alternatives, the primary goal of advocacy of member states across the region should be to move away from prohibitive bans and instead adopt regulatory frameworks that are guided by science and harm reduction principles.
This approach serves to protect youth while expanding access to proven, reduced-risk products for adult smokers, ultimately advancing public health.
The scientific consensus is clear: the harm from smoking is caused by the thousands of chemicals released during combustion, not by nicotine itself. Therefore, non-combustible alternatives provide a reduced-risk alternative for adult smokers.
Data shows that these alternatives are highly effective. For example, Vapour Products double the likelihood of switching completely from smoking compared to traditional Nicotine Replacement Therapies (NRTs), a success that has been demonstrated in Indonesia and other high-burden countries. This approach is also consistent with global health frameworks, as the WHO FCTC does not exclude Tobacco Harm Reduction; in fact, relevant articles within it support regulation and strategies aligned with harm reduction.
Experience has shown that outright bans tend to backfire, often driving products underground and sacrificing public health gains. A more pragmatic and effective alternative is risk-proportionate regulation coupled with public education.
Principles for Evidence-
Based Regulation
Adopt a Regulatory Framework
Instead of counterproductive bans, it is crucial to implement clear regulatory systems that manage, rather than eliminate, smokeless products.
Enforce Strict Safeguards
Legislation should ensure adult-only access to all Smokeless Products and establish robust standards for product safety and manufacturing.
Invest in Clear Communication
Public education campaigns should be funded to provide accurate, evidence-based information. This must include clarifying that nicotine, while addictive, is not the primary cause of smoking-related disease; combustion is.
Promote Regional Collaboration
Regional cooperation is needed to harmonise policies, share data, and reduce the disparities in access to reduced-risk alternatives for citizens across the region.
The priority should be lives over ideology. Member states have the opportunity to accelerate toward a Smokeless world through compassionate, evidence-based, and harm-reduction-aligned regulations—not bans.
Expert Voices
“The first and foremost obstacle to Tobacco Harm Reduction in [India] is the lack of political will in articulating it in national policy and realizing its potential in a country like India with almost 300 million tobacco users. Followed by other challenges like the lack of awareness about Tobacco Harm Reduction.”
Sree Sucharita
Medical Professor, Tagore Medical College & Hospital in Chennai
“From a public health standpoint, it is important to minimize risk…by advising on less harmful alternatives. For instance, use of injectable drugs bears the risk of HIV transmission, and to prevent HIV infection among people who inject drugs and their partners, the WHO, UNAIDS and other UN entities created a package of interventions including needle and syringe programmes, opioid substitution therapy, condom programmes, etc. The same concept can be extrapolated to a number of other ‘risky’ behaviours like tobacco smoking.”
Dr. Girish Tyagi
President, Delhi Medical Association
“Many Asian countries remain very sceptical about tobacco harm reduction, and some have even banned alternative nicotine products. Regulators need to see that tobacco harm reduction is potentially the most effective solution to solving the smoking epidemic in Asia, and can complement existing tobacco control measures.”
Ron Christian Sison
Lead Convenor, Harm Reduction Alliance of the Philippines
“The ‘quit or die’ approach in Indonesia does not work for some smokers. Therefore, it is time to consider the ‘quit or try’ approach; that is, try alternative nicotine products. We need to actively inform policymakers about tobacco harm reduction and the potential benefit of alternative nicotine products to public health.”
Dr. Drg. Amaliya
Co–Founder, Indonesian Public Health Observer Foundation
“We should adopt the harm reduction approach and actively prepare to research and regulate less-harmful tobacco products that can reduce the harm due to smoking.”
Professor Moon Ok-rin
Seoul National University