E-cigarettes are leading a new global trend in tobacco control and helping to transform public health
Traditional tobacco still dominates, policy resistance to be addressed
Despite the positive trends, the report also reveals serious challenges. Despite the legalization of low-risk nicotine products in nearly 130 countries worldwide, reaching more than two-thirds of the population, cigarettes remain ubiquitous. The World Health Organization (WHO) continues to oppose strategies to reduce the harms of tobacco and has pursued stringent regulatory policies that often limit access to safer products and, in some countries, have even imposed bans, resulting in cigarettes being the only easily accessible option.
GSTHR 2024 empirically reveals the substitution effect of low-risk nicotine products for traditional cigarettes. Countries such as the United Kingdom, the United States, New Zealand and Sweden have seen smoking prevalence decline much faster than the historical effectiveness of traditional tobacco control measures. In Hungary and South Korea, declines in cigarette sales have been strongly associated with an increase in the popularity of heated tobacco products, confirming the role of substitution programs in driving the cessation transition.
Experts call for policy shift
Harm reduction experts who participated in the report emphasized the urgent need for supportive regulatory frameworks to build on existing gains, with Gerry Stinson, co-founder of the GSTHR project, noting, “Cigarettes are a highly hazardous way of ingesting nicotine, and the smoke produced by their combustion sickens, maims and even kills millions of people every year. Today, by turning to safer alternatives such as e-cigarettes, heated tobacco, snus and nicotine pouches, people can completely circumvent these risks.”
Harry Shapiro, the report's editor-in-chief, further warns, “Opposition to tobacco harm reduction is essentially an enemy of people, not products.” He argues that restricting low-risk products only serves to maintain the smoking status quo in disguise, ultimately preserving tobacco industry profits at the expense of public health.
A Historic Opportunity Awaits
The discovery of GSTHR 2024 marks a critical stage in global tobacco control initiatives. As the health benefits of low-risk nicotine products become more validated, governments are being called upon to develop risk-rated regulatory policies. By increasing the accessibility and affordability of alternative products, a historic decline in global smoking rates is expected, which may become one of the most significant public health achievements of this century.
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