‘There is no single route away from cigarettes’ and progress can stall, says the latest situation report from the Global State of Tobacco Harm Reduction (GSTHR). Instead, price, availability, culture and consumer preference will determine which products are the most widely used.
Smoking rates can fall even without formal tobacco harm strategies being in place, says the report, which looks at the progress of three countries – Estonia, Ireland and South Korea – that show ‘emerging but different’ shifts away from cigarettes and a concurrent rise in the use of safer nicotine products. In Estonia smoking rates fell from 26 per cent in 2020 to less than 20 per cent in 2024, while vaping rates have more than tripled to 13.5 per cent. Although none of these countries had formal tobacco harm reduction strategies a shift away from cigarettes still took place, the report points out, with many consumers in South Korea now using several safer nicotine products alongside cigarettes.
Poorly designed policy, however, risks halting or reversing progress, the document warns. ‘Protecting young people and adult harm reduction should be pursued jointly – without making safer alternatives less appealing, less affordable and less accessible to adults who smoke,’ it says, while widespread misconceptions about the safety of alternative products are still a major barrier to switching. Polling commissioned by ASH last year found that more than half of UK adults wrongly believe that vaping is as – or more – harmful than smoking. The proportion in Ireland, however, rises to almost three quarters, GSTHR warns. Governments and public health organisations need to be sharing accurate harm reduction information aimed at all adults who smoke, it urges.
‘Ultimately, success should not be measured by uptake of safer nicotine products alone, but by how quickly and equitably cigarette smoking declines, how many people switch completely, and whether those changes are sustained,’ says the report. ‘A policy environment that makes the safer choice easier rather than harder is essential to realising the full potential of tobacco harm reduction.’
‘Evidence from South Korea, Ireland and Estonia shows that, when they can, people who smoke will opt for safer alternatives,’ said GSTHR Economist Giorgi Mzhavanadze. ‘But these transitions are not inevitable and can be easily disrupted or reversed. When considering safer nicotine products, policymakers should always ask: will this make it easier or harder for adults who smoke to make the safer choice?’
A recent Cochrane review that examined 80 randomised control trials involving nearly 30,000 people found ‘high-certainty evidence’ that vaping was the most effective quitting aid for smokers.
The next wave of tobacco harm reduction? Emerging transitions from smoking to safer nicotine products in South Korea, Ireland and Estonia available here