Case Studies
New Zealand
Sweden has become the gold standard in what a smoke-free future could look like, and New Zealand has successfully mirrored Sweden’s approach to Tobacco Harm Reduction so far.
Historically, New Zealand has had high rates of smoking which have displayed stark inequities through ethnicity, with Māori women at one point having the world’s highest female incidence of lung cancer.
However, in 1990, New Zealand became the first country to pass a comprehensive Smoke-Free Environments Act which included the designation of smoke-free environments and excise tax increases which supported the ongoing gradual reduction in national smoking rates.
Following on from this, in 2015, the New Zealand government began tracking vaping prevalence and assessing the merits of vaping products to support smoking cessation. This led to a campaign called ‘Vape to Quit Strong’ which was aimed at supporting smokers to switch to regulated products that are less harmful than smoking.
Since then, New Zealand has witnessed a remarkable drop in smoking prevalence (from 16.4% to 6.9%) between 2011 and 2024.
By supporting adult smokers, especially those from marginalised groups, to transition to vaping, New Zealand has halved its smoking rate in just five years. Like Sweden, it is on track to becoming one of the first countries with less than 5% of adults smoking, proving that Sweden’s success is not just a one-off, but replicable globally.
Japan
With 127.7 million people living in Japan, almost 160,000 die prematurely every year from combustible tobacco and toxic smokeless tobacco products.
In 2000, the World Health Organisation (WHO) reported that the smoking prevalence in Japan would decrease from 31.7% to 15.5% in 2025. Yet, Japan’s real smoking prevalence as of 2024 was 19.4%.
While combustible cigarettes are by far the most common form of tobacco use in Japan, cigarette sales have started to decline rapidly (over 50% decline) between 2011 and 2023.
Some of this is due in part to the uptake of Heated Tobacco Products (HTPs), which were introduced to the market as harm reduction products and are less harmful than combustible cigarettes, but still pose risks for nicotine dependence.
It’s critical to note that the sale of e-cigarettes containing nicotine is prohibited in Japan unless they are approved as medicinal products, a status which no e-cigarette has achieved yet.
Expert analysis shows that over 2.04 million lives could be saved by 2060 in Japan if THR products were made accessible, affordable and acceptable for adult smokers.
Indonesia
Indonesia has the highest male (64.7%) smoking prevalence on Earth. With 64.5 million smokers out a total of 283 million people living in Indonesia, 300,000 people die prematurely every year due to using tobacco products.
As one of the world’s largest markets for smoking tobacco, Indonesia is significantly affected by smoking-related illness and worldwide, Indonesia is one of the last countries with a large population in the world where smoking is still increasing. Tobacco deaths account for 25% of all male deaths and 7% of female deaths.
Science-backed government policy is needed to reduce the number of smokers in Indonesia which would thereby reduce the health problem of smoking-related illness in the future.
In addition, there is a significant economic cost of smoking-attributable disease in Indonesia with reports showing that direct and indirect economic costs far exceed tax revenue on cigarettes.
Expert analysis shows that over 4.6 million lives could be saved through the combined impact of embracing THR, better cessation services and improved lung cancer in Indonesia.
Smoking-related disease, disability, premature death and its burden on the economy sets Indonesia apart as a public health emergency. Moreover, smoking prevalence trends are worsening. Combined with suboptimal national tobacco control, the slow progress of THR introduction and ongoing misperceptions of THR and nicotine, urgent action across Indonesia is required.
Sri Lanka
As a country of 23.2 million, almost 12,000 people die prematurely in Sri Lanka every year due to using combustible and smokeless tobacco products.
Despite this high smoking prevalence, use of THR products is currently restricted in Sri Lanka. Vaping products and heated tobacco products are essentially banned, while there are no specific regulations for oral nicotine pouches and snus.
Nicotine replacement therapy (NRTs) are available in pharmacies, but marketing of NRTs is banned.
Therefore, the expanded use by those who smoke and cannot or do not want to quit, remains low. Health gains across the country would be greatly increased if smoke free nicotine alternative products were to be made more accessible, affordable and acceptable.
If Sri Lanka embraces THR, better cessation services and improved lung cancer treatment, over 85,000 lives could be saved by 2060 through these interventions.
Malaysia
With the World Health Organisation projecting that the smoking prevalence in Malaysia will increase from 29.7% in 2020 to 30% in 2025, much needs to be done to support the country lower its smoking rate.
The stats speak for themselves with 39% of COPD deaths in Malaysia attributable to smoking, and 54% of lung cancer attributable to smoking.
There remain significant gaps in research in Malaysia, as most studies are small, cross-sectional and related to youth uptake rather than smoking cessation interventions.
However, expert analysis projects that 416,000 lives could be saved by 2060 if tobacco harm reduction products were made more widely available, alongside better cessation services in Malaysia.
This represents a major opportunity for Malaysia to improve the health of its population.
Bangladesh
Bangladesh is in the grip of a smoking crisis with more than one in every three adult males smoking, and smoking-related illnesses claiming more than 130,000 lives each year. Smoking rates among men are reaching an alarming 34.1%. Millions more use smokeless tobacco products such as zarda and gul, which are linked to health risk such as oral cancer, heart disease and stroke.
The cost of this crisis is staggering, with tobacco-related diseases responsible for 21.9% of deaths in the country.
Despite implementing conventional tobacco control measures such as high taxes, graphic health warnings and smoking bans in public places, progress in reducing smoking rates has been slow with overall smoking prevalence dropping from 23% in 2015 to 17% in 2022.
According to international health experts, integrating harm reduction strategies alongside existing tobacco control measures could save over 900,000 lives in Bangladesh by 2060.
However, instead of embracing harm reduction, activists and policymakers are pushing for bans on alternatives such as vaping and nicotine pouches. This approach risks worsening the country’s tobacco crisis, leaving millions with no alternative but to continue smoking or using dangerous smoking tobacco products.