Overview of Global Policy Landscape
Worldwide research shows that although more than 70% of smokers want to quit, only 4-7% succeed. Governments that have adopted THR policies are seeing the smoking rates drop thanks to nicotine alternatives.
The UK has the most advanced THR regulation in the world and is a leading case study for how nicotine products can be used to reduce smoking rates. In the UK, four major hospitals are now giving out free starter packs to smokers. Vaping helps 50,000-70,000 smokers quit in the UK every year. (Addiction) Public Health England: “Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders.”
Snus has been used in Sweden and other Scandinavian countries for more than 200 years. Nicotine pouches have helped Sweden achieve the lowest smoking rates in Europe and the lowest rate of tobacco-related mortality, (Royal College of Physicians). 700,000 smokers have quit thanks to vaping in France, (European Journal of Public Health).
Tobacco Harm Reduction in APAC
Millions of smokers worldwide are quitting by using tobacco harm reduction products. Now it’s countries in Asia Pacific and the Middle East’s turn.
Heated tobacco products are gaining popularity globally, especially in Japan and South Korea. South Korean sales of heated tobacco products were 79 million packs in 2017. This increased to 332 million packs in 2018, with sales expected to increase by 21% annually.
Japan has 90% of the global market for heated tobacco products. Smoking rates have dropped dramatically after the introduction of heat-not-burn alternative nicotine products. Japan has seen cigarette sales drop by 47.5% since 2016 (Filter).
In New Zealand the smoking rate decreased dramatically as the vaping rate increased, and the country’s health authorities have publicly acknowledged the role vaping plays in reaching smoke-free targets.
Phillipines
The Philippines legalized vaping through the 2022 Vape Regulation Law, setting age restrictions, registration, and marketing rules. Despite enforcement, youth use is rising (14.1% among students) and smuggling remains rampant. Stronger regulation and oversight are needed to balance adult harm reduction benefits with protecting young people.
India
India banned e-cigarettes in 2019, prohibiting all manufacture, sale, and distribution. Yet illicit markets thrive, with youth and educated groups still accessing devices. Over 60% of youth report susceptibility to trying vaping. The ban limits safer alternatives, risks poor-quality products, and continues high reliance on combustible tobacco.
Indonesia
Indonesia faces one of the world’s highest smoking rates—36.7% of adults (71% of men), causing 300,000 premature deaths annually. E-cigarette use is slowly rising (≈3% of adults), while smoking prevalence may reach 37.5% by 2025. Emerging regulations raise smoking age and restrict sales, but enforcement gaps remain.
Malaysia/ Thailand
Malaysia recently legalized and regulates vaping under the 2024 Control of Smoking Products Act, though state bans persist and youth uptake worries grow. In contrast, Thailand maintains a strict national ban with harsh penalties, yet illicit markets flourish. Diverging approaches highlight the risks of prohibition versus controlled regulation.
Tobacco Control Strategies
- To provide strong incentives not to start smoking.
- To motivate and help people to quit smoking.
- To reduce harm to those who continue to use nicotine.
- To reduce harm to non-smokers arising from exposure to toxins in second hand smoke.
A well-established package of tobacco control measures aims to change the demand for tobacco products by implementing the first three elements of tobacco control discussed above. The WHO and other organisations occasionally use the acronym MPOWER to describe this package. MPOWER has six components:
- Monitor tobacco use and prevention policies.
- Protect people from tobacco smoke.
- Offer help to quit tobacco use.
- Warn about the dangers of tobacco.
- Enforce bans on tobacco advertising, promotion and sponsorship.
- Raise taxes on tobacco.
These measures have contributed to a decline in smoking from very high levels in developed countries in the 1950s-1980s. They also form the basis of the WHO’s Framework Convention on Tobacco Control, which aims to develop these measures more robustly in developing countries.
Addressing Concerns
Harm reduction must acknowledge and manage risks to build credibility. Youth access can be curbed through strict age checks, plain packaging, and penalties for violators.
Product safety requires registration, testing, and traceability to shut out unsafe or illicit goods. Misinformation – especially confusion about nicotine, should be countered with clear public campaigns and evidence-based guidance for healthcare providers.
Finally, balanced regulation is key: apply the toughest rules to cigarettes while ensuring reduced-risk products remain accessible. Regional cooperation can harmonize standards and curb smuggling. Responsible, science-driven policies protect youth, ensure safety, and empower smokers to switch to less harmful alternatives.
Core Messages for Policymakers
Bans backfire
Regulation protects youth and adults
Science shows combustion, not nicotine, causes disease
Alternatives save lives
Equity and Access
Allowing smokers access to lower risk alternative products is not only a health issue, it is also a matter of equity and social justice. Smoking prevalence is often highest in lower-income communities, where people face greater exposure to tobacco marketing, limited access to cessation services, and higher vulnerability to tobacco-related disease.
Why Equity Matters
- Disproportionate burden: Lower-income populations spend a larger share of household income on cigarettes, worsening poverty cycles.
- Health inequalities: Tobacco-related illnesses strike earlier and more severely in disadvantaged groups, limiting life expectancy and productivity.
- Access gaps: In many low-resource settings, nicotine replacement therapies (NRTs) are either unavailable or unaffordable.
How THR Can Help
- Affordable alternatives: Risk-proportionate taxation can make safer products cheaper than cigarettes, incentivising switching.
- Wider reach: Smoke-free products can be distributed through public clinics and pharmacies, extending access to populations underserved by cessation programmes.
- Reducing health disparities: By targeting the highest-burden groups, THR policies can help narrow life expectancy gaps between rich and poor.
- Economic relief: Lower-cost alternatives reduce household spending on tobacco while cutting healthcare costs for governments.
Policy Implications
Embedding equity into THR strategies ensures that reduced-risk products are not limited to affluent populations but are accessible, affordable, and acceptable to the people who need them most. This makes harm reduction a driver of both better health outcomes and fairer societies.