Category: Featured

  • Wang: Global Trade Tariffs in Vaping

    Wang: Global Trade Tariffs in Vaping

    The vaping industry has always faced its share of challenges—from shifting regulatory landscapes to evolving consumer preferences. However, a few factors significantly threaten the industry’s future, such as the impact of global trade tariffs. With the United States set to increase tariffs on Chinese imports, companies that fail to adapt could face skyrocketing costs, disrupted supply chains, and a diminished ability to compete in one of the world’s largest markets.

    Trade tensions between the U.S. and China have been escalating for several years. The vaping industry, which relies heavily on hardware manufactured in China, is particularly vulnerable to these developments. Currently, vaping products imported from China face a 25% tariff, but there is a high likelihood that this could double or even increase to 100% under future U.S. administrations.

    For vaping companies, such tariff hikes mean the cost of importing devices could skyrocket. A 100% tariff would effectively double the cost of hardware produced in China, driving up retail prices for all such products in the U.S. market. This scenario threatens the financial viability of vaping companies and the availability of affordable, high-quality products for consumers.

    The Strategic Decision to Move Manufacturing to Malaysia

    Recognizing the potential for increasing tariffs and broader geopolitical challenges, some vaping manufacturers began shifting their operations from China to other countries. Such decisions were never made lightly. China has long been a global leader in manufacturing efficiency with a robust infrastructure and supply-chain network,, and moving away from such an established infrastructure posed significant logistical and operational challenges.

    Malaysia offered several key advantages to manufacturers. Firstly, Malaysia enjoys favorable trade agreements with the United States, the United Kingdom, and the European Union. For instance, starting in December 2024, a new free trade agreement between Malaysia and the U.K. took effect, eliminating tariffs on products moving between the two countries. Similar agreements are in place or in development with other major markets.

    Secondly, Malaysia’s robust manufacturing ecosystem and skilled workforce make it an ideal location for high-quality production. By establishing operations in Malaysia, companies can continue to deliver reliable, innovative hardware without the added burden of excessive tariffs.

    The Broader Impact on the Global Supply Chain

    The shift to Malaysia reflects a broader trend in global manufacturing. As trade barriers between the U.S. and China grow, a widespread redistribution of manufacturing operations is underway. Companies across industries—not just vaping—are reevaluating their supply chains to reduce dependence on any single country.

    This global redistribution of resources presents both challenges and opportunities. For manufacturers, the challenge lies in building new infrastructure, securing reliable suppliers, and maintaining quality control in unfamiliar territories. However, companies that successfully navigate these changes benefit from more resilient supply chains, reduced geopolitical risk, and greater flexibility in responding to market shifts.

    Maintaining Compliance and Quality Standards

    Shifting manufacturing bases also brings new compliance considerations. Regulatory bodies like the U.S. Food and Drug Administration (FDA) require Premarket Tobacco Product Applications (PMTAs) for vaping devices. These applications are tied to specific manufacturing facilities, meaning that changing production locations requires amendments to existing PMTAs or new submissions.

    Manufacturers must ensure that new facilities meet the highest quality and compliance standards. Proactively managing these regulatory requirements ensures that products remain market-ready even as production locations change.

    The Future of the Vaping Industry Amid Trade Challenges

    Looking ahead, it’s clear that trade tariffs and global manufacturing shifts are not short-term challenges. Regardless of who occupies the White House, protectionist trade policies are likely to persist or even intensify. The vaping industry must be prepared for this new reality.

    Companies that fail to diversify their manufacturing operations face mounting costs and increasing vulnerability to trade disruptions. On the other hand, those who invest in flexible, resilient supply chains will be well-positioned to thrive.

    The vaping industry is at a crossroads. Global trade tariffs pose a significant threat, but they also offer an opportunity for companies to rethink their supply chains and build more resilient operations. For manufacturers, shifting production from China to countries like Malaysia is not just a reactive measure—it’s a strategic move to secure long-term growth and competitiveness.

    As the industry moves forward, companies that adapt to these challenges will be the ones that lead the way. The ability to anticipate trade disruptions, embrace innovation and maintain rigorous quality standards will determine who succeeds in this ever-evolving market.

    As co-CEO of Ispire Technology Inc., Michael Wang is a leader in the development and commercialization of vaping technology and precision dosing. Previously, he served in executive roles at The Pharm/Sunday Goods, Onestop Commerce, Zazzle, and Honeywell.

  • GSTHR Report Finds Vapes Help Smokers Quit

    GSTHR Report Finds Vapes Help Smokers Quit

    The latest Briefing Paper from the Global State of Tobacco Harm Reduction (GSTHR), a project from public health agency Knowledge·Action·Change (KAC), focuses on Aotearoa New Zealand’s remarkable journey towards “smokefree” status.

    Pro-consumer laws and an endorsement for vaping: why smoking is disappearing in Aotearoa New Zealand” tells the story of the country’s rapid and growing embrace of vaping, which overtook smoking in 2022, and provides another vital case study showcasing the potential of tobacco harm reduction through the adoption of safer nicotine products (SNP), following recent GSTHR Briefing Papers on Japan and the United Kingdom. This country profile also features in The Global State of Tobacco Harm Reduction 2024: A Situation Report published last month.

    While Aotearoa, New Zealand, had been experiencing falling smoking rates for the last 50 years, this decline gathered pace following the widespread adoption and, in 2018, the legalization of nicotine vaping products. Thanks to the Government’s step change in vaping policy, Aotearoa New Zealand now has a considerable chance of reaching its “Smokefree 2025” goal, a designation indicating that smoking prevalence has been reduced to below 5%.

    David MacKintosh, a director for KAC, said the Briefing Paper explores the rapid trajectory of Aotearoa New Zealand’s progress in reducing smoking, the approaches that have underpinned this, and the lessons that can be learned.

    “By embracing vaping as a tool for smoking cessation, policymakers are accelerating the transition away from cigarettes and their associated harms,” he said. “More needs to be done in addressing high smoking rates in some groups, notably among Māori communities, which contributes significantly to health disparities in the country. However, the experiences and success of Aotearoa New Zealand provide food for thought for many other countries seeking to tackle smoking.”

    This would be a remarkable achievement given the smoking rate in 1976 was 40% for men and 32% for women. This has now fallen to the point where only 8.3% of adults smoked in 2023. In the same year 11.9% of adults vaped in the country, up from 1.4% in 2016. But while the overall smoking figures are low, they mask much higher rates within some communities. Daily smoking prevalence for Maori, who make up 16% of the country’s population, was 17.1% in 2022/2023, which is in stark contrast to the 6.1% rate for people of European descent.

    Alongside regulatory oversight of vaping products to ensure quality and safety, a key factor has been the proactive encouragement of vaping as a tool for smoking cessation by the Government. The Ministry of Health has provided official resources for people looking to stop smoking with the help of vaping. Smokefree New Zealand, a smoking cessation resource run by the country’s publicly funded healthcare service Health New Zealand, has stated that “using vaping products is a legitimate option for those people who are trying to quit smoking”.

    Through the Vaping Facts website, the Ministry of Health of New Zealand and Health New Zealand have also emphasized the Cochrane Review’s position that vaping is significantly safer than smoking.

    Aotearoa New Zealand’s attitude to vaping is in direct contrast to its neighbor Australia, which has heavily restricted the availability of SNP by making nicotine available only in pharmacies. Australia has sought to reduce significantly the availability of safer nicotine products, which has led to the proliferation of a thriving black market in the absence of a legal market. Meanwhile, with its broadly supportive public health messaging, Aotearoa New Zealand has enabled consumers to make positive changes in their own volition, enabling them to switch from smoking to safer products.

    These differences in approach have resulted in a marked difference in smoking rates between the two countries, with Australia’s smoking prevalence plateaued in recent years after many years of steady decline. Indeed, the current smoking prevalence for Australians aged 14 and over has only fallen slightly in the last five years, from 12.8% in 2018 to 11.8% in 2023.

    It should be noted that Aotearoa New Zealand’s attitude towards vaping is not mirrored for all SNP. While heated tobacco products are also legal, the sale of both snus and nicotine pouches is banned. Still, as this Briefing Paper shows, Government and public health organizations in Aotearoa, New Zealand, working with consumers, have highlighted the crucial role that vaping can play in reducing smoking.

    The country has demonstrated its ability to enact pro-consumer legislation effectively, and its consistent endorsement of some safer nicotine products has been a key component of its stop-smoking strategy. Central to this has been consumers, who have established a demand for safer products and proven to the Government that these products can and will exist despite initial legislative opposition.

  • Vietnam Continues to Reject ENDS Products

    Vietnam Continues to Reject ENDS Products

    Image generated with Adobe Firefly

    Vietnam’s Ministry of Health rejected claims that next-generation nicotine products are less harmful than traditional cigarettes during a seminar held on Oct. 3, reports VietnamNet.

    Nguyen Trong Khoa, deputy director of the ministry’s Department of Medical Examination and Treatment, insisted that there is no scientific evidence suggesting that e-cigarettes or heated tobacco products reduce harm or aid in quitting smoking.

    Khoa emphasized that e-cigarettes and heated tobacco products contain high levels of addictive nicotine and contain hazardous chemicals that can cause cancer.

    He dismissed Public Health England’s finding that e-cigarettes are 95 less harmful than traditional cigarettes as a “tobacco-funded study that lacks scientific credibility.”

    The smoking rate among adolescents aged 13-17 in Vietnam decreased from 5.36 percent in 2013 to 2.78 percent in 2019. For those aged 13-15, the rate of cigarette use dropped from 2.5 percent in 2014 to 1.9 percent in 2022.

    However, the use of new-generation tobacco products has surged recently. A survey found that vaping among students aged 13-15 rose from 3.5 percent in 2022 to 8 percent in 2023.

  • Ispire Launches New Vape Filling Machine

    Ispire Launches New Vape Filling Machine

    Image: Luluraschi

    Ispire Technology is launching a new vapor device filling machine. Scheduled to be unveiled at the Benzinga Cannabis Capital Conference in Chicago Oct. 8–9, the I-80 can fill and seal 4,000 0.5 mL vapor devices per hour.

    According to Ispire, the machine is 10 times faster than traditional manual methods and twice as fast as current automated systems. It is also cost-effective, saving $1,000 for every 10,000 units produced, the manufacturer wrote in a press release.

    Ispire says its self-sealing devices remove the need for separate capping, boosting overall workflow efficiency by 1,000 percent over manual methods and 100 percent over other automated systems.

    “The I-80 isn’t just a machine; it’s a game-changing solution to the capacity challenges that have hindered cannabis operators for years,” said Ispire Co-CEO Michael Wang.

    “We’re not just improving productivity—we’re leading a paradigm shift in cannabis production efficiency. This innovation aligns with our mission to push the boundaries of technology for the benefit of our customers and the adult consumers they serve.”

  • New Zealand Cracks Down on Illegal Nicotine Sales

    New Zealand Cracks Down on Illegal Nicotine Sales

    Image: mehaniq41

    New Zealand has started sentencing for repeat violators of its cigarette and vape laws, according to the ministry of health.

    Christchurch tobacco retailer Canteros received a fine of NZD28,000 for eight breaches of the Smoke-free Environments and Regulated Products Act. The violations related to the selling, labeling and advertising of cigars.

    The owner and an employee of Discount Specialist were fined a total of NZD8,000 for repeatedly selling single cigarettes and allowing tobacco products to be visible to the public inside the store.

    While infringement notices with fees of NZD500 are routinely issued for sales of regulated products to minors, this chain of prosecutions is among the strongest action to be taken against illegal vape and cigarette sales to date.

    In August, a Christchurch dairy owner was fined NZD56,000 under the act.

    “A significant majority of retailers comply with the law and do not sell restricted products to young people, though it’s disappointing to see some retailers fail to abide by the law and sell cigarettes or vapes to children and young people,” said Jo Pugh, compliance manager at the national public health service.

    “This compliance work is a high priority for the health agencies. We will continue to monitor and identify retailers who are not complying with the law.”

  • Spain Urged to Keep Vape Flavors Legal

    Spain Urged to Keep Vape Flavors Legal

    Photo: nyker

    The Independent European Vape Alliance (IEVA) has asked Spain to refrain from banning flavored vapes.

    According to the group, the proposed measure presents several risks.

    “The effective ban of e-liquids in the Spanish market will lead to a boom in black market activities with dangerous, non–compliant products,” the IEVA wrote in a statement.

    In addition, the group warned, it will cause a rise in smoking rates and put at risk more than 3,000 jobs in the Spanish vaping industry, leading to a reduction in government revenues by reducing tax collection.

    The IEVA shared its concerns in a contribution to the public consultation that is currently underway.

  • WHO: Vape Surpasses Smoking Among European Youth

    WHO: Vape Surpasses Smoking Among European Youth

    Photo: Maksym Yemelyanov

    Vaping has surpassed smoking among adolescents in Europe, according to a new report by the World Health Organization.

    The global health body found that among 15-year-olds, 32 percent had used an e-cigarette and 20 percent consumed vaping products in the past 30 days.

    “The widespread use of harmful substances among children in many countries across the European region—and beyond—is a serious public health threat,” said Hans Henri P. Kluge, WHO regional director for Europe. “Considering that the brain continues to develop well into a person’s mid-20s, adolescents need to be protected from the effects of toxic and dangerous products. Unfortunately, children today are constantly exposed to targeted online marketing of harmful products.”

    Historically, there has been a difference between boys and girls, with more boys smoking than girls. With e-cigarettes, girls reach the same level of use by 15 as boys and even outpace them after 15.

    While acknowledging that some health authorities view e-cigarettes as a positive alternative to smoking for adults, the WHO expressed concern about aggressive targeting by manufacturers of a younger market, which has contributed to a particularly sharp rise in consumption between the ages of 13 and 15, according to the organization.

    The WHO report calls for e-cigarettes to be incorporated into smoke-free policies, with similar measures to restrict marketing, reduce toxicity, remove flavors and increase taxation.

    The health body has already called for e-cigarettes to be made available only to those who are trying to quit smoking, where other proven cessation strategies have been exhausted. It has also called for e-cigarettes to be regulated like medicines rather than being sold as consumer products.

  • COP10 Postponed Until 2024, No Date Announced

    COP10 Postponed Until 2024, No Date Announced

    Photo: Maksym Yemelyanov

    The Tenth session of the Conference of the Parties (COP10) to the WHO Framework Convention on Tobacco Control (FCTC) and the Third session of the Meeting of the Parties (MOP3) to the Protocol to Eliminate Illicit Trade in Tobacco Products have been postponed to 2024.

    “Following communication received from Panama, the host country of the Tenth session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control  and the Third session of the Meeting of the Parties to the Protocol to Eliminate Illicit Trade in Tobacco Products, it is no longer possible to conduct COP10 and MOP3 in November 2023, as scheduled,” the FCTC wrote on its website.

    The sessions are expected to be held in Panama, as early as possible in 2024, at dates to be confirmed.

    The postponement of COP10 and MOP3 is due to the current security situation in Panama, which has been shaken by mass protests about a government contract that allows a Canadian company to expand its copper mining operations there.

    The Convention Secretariat said it will communicate further details in relation to COP10 and MOP3, as soon as available.

  • Public Hearings Ahead of COP10

    Public Hearings Ahead of COP10

    Image: Tobacco Reporter archive

    The Subcommittee for the Defense of the Tobacco Supply Chain, linked to the Committee on Agriculture, Livestock, Fisheries and Cooperatives of the Rio Grande do Sul State Assembly, promoted the first of 10 meetings to be held in the interior of Rio Grande do Sul with the aim to debate and see to the future and to the economic and social importance of the sector as well as for collecting data and evidences to formulate and forward the positioning of Rio Grande do Sul with regard to the provisions of the 10th Conference of the Parties (COP10) to the World Health Organization Framework Convention on Tobacco Control.

    The working meeting brought together approximately 300 people at the City Council Hall in Santa Cruz do Sul, including representatives of the supply chain, authorities, politicians and entrepreneurial leaderships. The premise was presented by deputy Marcus Vinicius de Almeida, coordinator of the subcommittee.

    “We want to give voice to those who frequently are judged without right to their defense. We cannot afford to allow people who do not know the reality of the farmers to dictate the future of our municipalities,” he said. According to the deputy, the committee will hold meetings in 10 municipalities, listening to farmers and companies.

    State Deputy Elton Weber presided over the meeting and prompted the debates. “We know that the federal government will have a seat at the COP, and it is our intention to define, in unified fashion, with all entities linked to the sector, our firm stance. It is an attempt to prevent ideological positions, but positions in accordance with what the sector produces and related to the everyday activities of the sector,” Weber said. The deputy mentioned that the ministries had been invited to participate and regretted the absence of their representatives.

    Interstate Tobacco Industry Union (SindiTabaco) President Iro Schuenke spoke about his expectation for the upcoming months. “We have plenty of work ahead of us; what we have witnessed in other editions is that the supply chain is simply ignored. Brazil, due to its global leadership position, should be an advocate of the supply chain. Unfortunately, it is not what we have seen while the measures of the Framework Convention are always immediately applied in our country. This is the speed that our subcommittee now needs. We need to work quickly to finish the report before August so that we are effective in our provisions sent to Brasilia. Support from all is necessary, but in Brasilia. Political pressure is the only manner for us to move forward,” Schuenke concluded.

    “The Framework Convention on Tobacco Control is the worst dictatorship I know, where the real interested parties are not allowed to take part in the debates,” said Schuenke at a public hearing requested by federal deputy Alceu Moreira on June 15 at the House of Representatives in Brasilia. “The [ideas] we normally hear, and there are many of them, especially in the area of health, have to be rebutted with facts. It is the case of the pitiable campaign we saw on May 31, where a child is sitting in front of a dinner plate full of cigarette ash. It is an aggression to the child and to the tobacco sector, which produces a licit crop that generates income and jobs for millions of Brazilians and is a protagonist in sustainable production, the so-called ESG. My intervention is to discover what stance the Brazilian delegation will adopt at the upcoming COP10 meeting and warn about the consequences from a poorly conducted positioning at the COP.”

    The public hearing was attended by representatives of the Ministry of Foreign Affairs, the Ministry of Agriculture and Livestock and the Ministry of Agrarian Development and Family Farming. The Ministry of Health did not attend the public hearing but sent a note, which stated that the ministry declined the invitation because the World Health Organization has not yet disclosed the agenda for the COP10, which is supposed to occur in August in Panama, thus making it “unnecessary” for the ministry to take part in the debates.

  • Doctor’s Orders

    Doctor’s Orders

    Photo: Minerva Studio

    Medical licensing of e-cigarettes and nicotine pouches should be an urgent priority.

    By Derek Yach

    The alarm about the risks of products to health is usually first sounded by physicians. That was certainly the case with tobacco and health. The 1962 Royal College of Physicians (RCP) Report on Smoking as well as the 1964 Surgeon General’s (SG) Report on the same topic were led by physicians and drew upon the best epidemiological evidence available. The reports’ statement that “smoking kills” led to rapid changes in physicians’ smoking behavior well before regulators took up the challenge. The world had to wait eight years before the World Health Organization passed its first modest resolution on smoking. Only then did modest public health policies emerge.

    Internationally, the evidence is clear: No country experiences a serious decline in their smoking rates before it declines among physicians. And it takes about a decade before the population benefits start appearing. Globally, smoking rates among men approach 40 percent to 50 percent in countries as diverse as China, Bulgaria, Jordan and Bangladesh—or 50 years behind where the U.K. is today. Smoking rates among the physicians in these countries are about the same. There are few examples of physician-led reports like those of the RCP or SG from middle-income or lower middle-income countries. In such settings, we cannot expect to see substantial progress in ending smoking if we stick with the status quo.

    Physician Leadership Is Crucial for the Introduction of Innovative Interventions

    Innovations in healthcare are usually led by physicians armed with solid epidemiological and clinical data showing the benefits of new interventions for patients and the population. Physician leadership gives credibility to new products. The opposite is also true. Products that are not endorsed or approved by physicians rarely achieve population benefits and may face stiff regulatory approval.

    Sluggish Progress on Improving Cessation Outcomes

    For decades, physicians have followed a “medicalization” path to cessation, so it is not surprising that they have neglected tobacco harm reduction (THR) options. The basic advice given by physicians has changed little. Quit cold turkey, counseling, nicotine-replacement therapies (NRTs) and a few other pharmaceutical and behavioral services remain the mainstay of cessation. None have success rates that exceed 15 percent over the year, and most are associated with repeated relapses. The World Health Organization’s own reports to the World Health Assembly this year pointed to slow progress in addressing cessation. Numerous reports, such as those issued by the Foundation for a Smoke-Free World, have pointed to the failure of the pharmaceutical industry to bring better cessation tools to the market despite advances in behavioral and neuroscience that have led to new therapies for a range of diseases.

    It is long overdue that physicians have access to far more efficacious and effective ways of ending smoking. We now have a full range of feasible options that have been authorized by the U.S. Food and Drug Administration as “appropriate for the protection of public health”: heated-tobacco products, e-cigarettes, snus and most recently nicotine pouches. E-cigarettes and nicotine pouches are well placed to form the basis of a new approach to cessation and harm reduction.

    How Do We Engage Physicians in Scaling up Access to These Lifesaving Products?

    Recent experience shows that physicians have been resistant to these products for several reasons. They fear these are a new tactic by the tobacco industry to keep the next generation addicted. They seek data on long-term benefits. They are bamboozled daily by well-funded nonprofits and WHO messages about the dangers of these products for kids, and the impact of them on cancer or heart disease. The fact that none of this is based on science has not stopped the opposition.

    Could Medically Licensed Products Break Through and Reach Physicians?

    I strongly believe that they could.

    At a recent Keller and Heckman meeting, Ian Fearon, chief scientific officer at McKinney Scientific Advisors, described the “halo” effect of having medically licensed e-cigarettes on the market. To get medically licensed requires proof of quality, safety and efficacy. Once achieved, this could legitimize the category and open the doors to widespread physician acceptance of the products. The same could happen with nicotine pouches.

     This could start to erode distrust of these products by physicians as they use them and advise their patients to use them. The predictable positive outcomes would accelerate adoptions and use.

    Recall that almost 50 percent of male doctors in many low-income and middle-income countries and countries across the Middle East smoke. Helping them to switch first deserves concerted effort. And having a new medically licensed e-cigarette or nicotine pouch could well trigger the desired cascading impacts on their patients and then among the general population.

    The process to obtain a medical license has been well outlined by the FDA’s Center for Drug Evaluation and Research (CDER) and the U.K.’s Medicines and Healthcare products Regulatory Agency (MHRA). Neil Benowitz et al. (see below) and Fearon have stressed that CDER requirements are particularly onerous. The MHRA process is more “encouraging.” According to them, a major benefit of the MHRA is that studies required can be conducted in any country whereas only U.S. studies are accepted by the CDER.

    A unique authoring partnership between people who usually disagree about the value of THR concluded that the CDER should “reach out to companies that may be interested in developing smoking cessation products” and indicated that that could include medically approved vapes. Authors included Benowitz and Ken Warner, known supporters of THR, and Matt Myers and Joanne Cohen, who until now have opposed THR.

    They commented that “the deadliest form of nicotine delivery has been subject to limited oversight whereas products marketed to help people quit face far more regulatory barriers.” The fact that agreement can be reached on the value of THR in the context of medically licensed products should be taken as a signal to how broader acceptance might happen.

    Mitch Zeller, previous head of the FDA’s Center for Tobacco Products, jumped into this field recently and urged action on medical licensing when he announced that he had joined a company aiming to bring a medically licensable vape to market.

    Why Has Industry Not Led the Way?

    There can be little doubt that the pharmaceutical industry and leaders in the tobacco industry have long had the scientific knowledge and technical capabilities to develop medically licensed equivalents to e-cigarettes and nicotine pouches. So why has there been no progress? Are short-term commercial interests taking precedent over health needs? I suspect this is a major factor delaying progress by large companies. But thankfully, smaller entrepreneurial companies are pursuing medical licenses at considerable cost to them.

    In addition to commercial interests, industry leaders and analysts have mentioned three other issues as hampering to progress:

    1. Concern that the WHO and anti-harm reduction activists would mount campaigns against them.
    2. Tobacco companies fear that a medically licensed product would reach a small part of the market—people with early symptoms of disease or those deeply concerned about their health. That might turn off other smokers seeking to use safer products for recreation and pleasure. They do not want to be stigmatized as being “patients.”
    3. Any innovation or improvement to a medically licensed reduced-risk product needs costly, lengthy and comprehensive re-appraisals by the regulating body with no guarantee of consumer acceptance. For industries specializing in fast-moving consumer goods, this can be a deterrent.

    What Is the Size of the Market?

    Companies need to look at data on the burden of disease and at data they have showing that an extremely high percentage of e-cigarette users switched from combustibles for health reasons. Global burden of disease data shows that 8 million people die annually from tobacco use. That figure hides the fact that hundreds of millions of tobacco users have early symptoms or signs of cancers, heart and lung disease or tuberculosis. It hides the fact that over 50 percent of people with serious mental illness smoke, that about 60 percent to 70 percent of people with early chronic obstructive pulmonary disease, tuberculosis and schizophrenia smoke at the point they are diagnosed. And that figure does not change much during their treatment, suggesting physicians’ failure to help their patients end smoking.

    It is not surprising that a recent Bloomberg analysis suggests that the size of the nicotine-replacement market could reach $100 billion by 2028. That should stimulate companies to invest in medically licensed options that consumers demand and enjoy in unprecedent numbers.

    How Would These Products Be Marketed?

    Marketing strategies would need to distinguish between products that are medically approved versus others. There are many precedents for designing marketing plans to reach two different audiences using the same basic product. The most recent being how Ozempic addresses the needs of people with diabetes while Wegovy (both made by Novo Nordisk) addresses obesity. Two brands, one set of active ingredients. In an analogous way, initially NRTs were prescription-only in most countries but were changed to “over the counter” use to improve access to “essential medicine,” and NRTs are noted as such in the WHO Model List of Essential Medicines.

    I could see this developing a comparable way for e-cigarettes and nicotine pouches.

    Conclusion

    There is a massive untapped need to get more efficacious cessation products on the market. Medically licensed e-cigarettes and nicotine pouches could well be the key to gaining widespread and critically needed physician support for the categories. That could unblock deep opposition to THR as it has happened with so many innovations that benefit health.