Harnessing tobacco harm reduction

• Published in: The Lancet (British edition) 2024-02, Vol.403 (10426), p.512-514
• Main Authors: Beaglehole, Robert, Bonita, Ruth
• Format: Article
• Language: English
• Subjects: Adults; Cigarette industry; Cigarettes; Electronic cigarettes; Harm reduction; Income; Legislation; Low income groups; Nicotine; No-smoking policies; Outdoor air quality; Public health; Risk; Smoke; Smoking; Tobacco; Tobacco industry; Vaping
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(24)00140-5

WHO FCTC has been influential in encouraging a global response to tobacco control,3,4 but it has been challenging to show a strong and consistent association between the implementation of FCTC measures and smoking prevalence and cigarette consumption outcomes.5,6 The FCTC does not prohibit harm reduction approaches but leaves it up to countries to decide how to regulate e-cigarettes and other novel nicotine products.3 WHO's lack of endorsement of tobacco harm reduction limits healthier choices for the 1·3 billion people globally who smoke and who are at an increased risk of early death.4 There is no scientific justification for WHO's position that e-cigarettes and other novel nicotine products should be treated in the same way as tobacco products.7,8 This position overlooks a risk-proportionate approach. In the same period, and with the support of the government and regulation of vaping,13 the prevalence of adult daily vaping increased from 2·6% to 9·7%.12 New Zealand's recent decline in smoking occurred in the absence of any other major tobacco control policy, apart from the annual cost-of-living price increases.14 The decrease in smoking during this period in New Zealand shows what can be achieved and exceeds the WHO smoking prevalence reduction goals of 30% over 15 years from 2010 to 2025.15 The New Zealand 2022 smoke-free legislation includes a “tobacco-free generation”, a 90% reduction in smoked tobacco retail outlets, and compulsory denicotinisation of retail tobacco.16 The New Zealand Government, elected in November, 2023, is committed to reaching the Smokefree 2025 goal of 5% (or less) smoking prevalence for the adult population, but intends to repeal the 2022 smoke-free legislation.17 However, because of the implementation timelines, fears that this repeal would jeopardise the Smokefree 2025 goal can be allayed; none of the three headline measures would be expected to have an impact before 2025 and might have had negative unintended consequences.18 Based on recent progress, New Zealand's Smokefree 2025 goal looks likely to be reached by consent rather than coercion and by further support for switching to smoke-free nicotine products.19 Other high-income countries have also succeeded in reducing smoking prevalence in association with the use of a range of lower-risk nicotine delivery devices to complement FCTC demand and supply reduction measures. Sweden, with a long tradition of snus use, has the lowest prevalence of adult daily smoking in the wor