For the millions of adult smokers across the Asia-Pacific region, deciding to quit cigarettes is often the most important health choice they will ever make. It is also one of the hardest. While some can quit cold turkey or with traditional nicotine replacement therapies, many cannot. For these individuals, the difference between continuing to smoke and successfully quitting often comes down to one factor: choice.
It is critical that regulatory frameworks acknowledge the need for adult smokers to have informed access to regulated, reduced-harm products. Alternatives such as vaping devices, heated tobacco products, and nicotine pouches provide a pathway away from combustible cigarettes. Denying access to these tools ignores the scientific reality of tobacco harm reduction and leaves smokers with few viable options.
The science of combustion
The primary danger of smoking lies in the process of combustion. When a cigarette is lit, the tobacco burns at temperatures of up to 950 degrees Celsius. This process releases more than 7,500 chemicals, of which around 150 are known toxicants. It is these chemicals, produced by burning tobacco, that cause most smoking-related diseases, not the nicotine itself.
Smoke-free alternatives work by delivering nicotine without burning tobacco. Heated products, for example, heat tobacco to temperatures below 300 degrees Celsius, while vaping products heat a liquid. This fundamental difference can substantially reduce toxic exposure. Scientific assessments show that these products emit far fewer toxicants at significantly lower levels compared to cigarette smoke. By switching to non-combustible products, smokers can lower their disease risk and improve their quality of life without the challenges of total abstinence.
Evidence from around the world
The impact of policy on public health is evident when comparing countries that embrace choice with those that restrict it.
Countries that allow regulated alternatives are seeing rapid declines in smoking rates. Japan has seen domestic cigarette sales drop by approximately 33 per cent between 2018 and 2023 as heated tobacco products gained market share. Sweden is on the verge of becoming the first “smoke-free” country in Europe, with a smoking rate of just 5.6 per cent. This is largely due to the widespread acceptance of snus and nicotine pouches. Consequently, Sweden has the lowest rate of tobacco-related disease in the EU.
In contrast, countries that enforce blanket bans or severe restrictions such as India, Thailand, and Australia struggle with stagnating smoking rates and booming black markets. In Australia, despite strict prescription-only models for vaping, the smoking rate decline has slowed, and a significant illicit market has emerged. The data suggests that prohibition does not reduce demand; it merely drives it underground.
Debunking the myths
Despite the evidence, myths regarding safety and effectiveness persist. Critics often argue that these products do not help smokers quit. However, a 2024 review by the Cochrane Collaboration, a gold standard in evidence-based medicine, concluded with high certainty that nicotine e-cigarettes are more effective than traditional nicotine replacement therapy for quitting smoking.
Concerns about safety often conflate the risks of burning tobacco with the much lower risks of non-combustible nicotine. While no product is entirely risk-free, public health authorities in the UK have stated that vaping is at least 95 per cent less harmful than smoking.
A call for proportionate regulation
Policymakers in the Asia-Pacific region have an opportunity to save lives by adopting risk-proportionate regulation. This approach protects youth through strict age verification and marketing guidelines, ensures product safety through manufacturing standards, and safeguards adults’ right to choose safer alternatives.
We must move beyond ideology and examine the evidence. Providing adult smokers with a range of safer choices is not just good policy. It is a public health necessity.
