Smoking was ‘alive and well’ but the ever-expanding market in safer nicotine products gave hope that many more people would choose them over combustibles, concludes the latest Global State of Tobacco Harm Reduction (GSTHR) report from Knowledge-Action-Change.
The period from January 2025 to early 2026 showed that as well as a developing market – and accompanying regulations – there was also a step-up in opposition to THR, ‘prompting the need for a timely, authoritative synthesis in a fast-moving public health environment’. One billion people currently smoked tobacco according to the World Health Organization (WHO) – a market of nearly a trillion dollars a year for major tobacco companies.
Since nicotine vapes became available to buy 20 years ago, further developments had included heated tobacco products (HTPs), a resurgence of snus, and the launch of oral nicotine pouches. For high-income countries this meant a rapid decline in smoking – but progress had been much slower in many low- and middle-income countries. Among the countries that had embraced harm reduction, the choice of dominant substitution product varied and was influenced by tradition, with education level and career occupation also playing a significant part. Insights relating to young people contradicted the familiar narrative around the assumed transition from teenage vaping to adult smoking.
A key message of the report was that combustible cigarettes remained legally available everywhere, including in countries that had banned safer alternatives. ‘Global tobacco control is paradoxical: the most harmful product is universally legal, less harmful alternatives are not,’ it says. Yet the health benefits of switching from smoking to vaping or HTPs were robustly evidenced.
A main focus still lay in challenging institutional opposition, including from WHO, which ‘continues to resist evidence of the public health benefits’ of substituting combustibles by safer nicotine products – an ‘irrational but deeply ingrained refusal of harm reduction of tobacco’. Many other prominent institutions had taken an anti-THR position and continued to ignore independent clinical evidence, says the report. In the UK, misconceptions had grown from misinformation, including media reports of an academic study that had not yet been peer-reviewed.
Decision-makers needed to listen to people who had quit smoking by switching and ‘treat them as stakeholders with expertise to share’, says the report. ‘Policy is out of step with reality.’