Tag: The Global State of Tobacco Harm Reduction

Report: Transition to Safer Products Underway

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A new report from Knowledge Action Change (KAC) describes the extent to which safer nicotine products (SNP) are replacing and substituting for combustible and risky oral tobacco products.
Co-authored by experts in harm reduction, data science and economics, The Global State of Tobacco Harm Reduction 2024: A Situation Report (GSTHR 2024) considers what is driving these changes, how different regulatory environments have developed, and the complex interplay between products, consumers, and policy and regulation.
The latest market data shows that while sales of combustible tobacco remain significantly higher than sales of SNP, two key shifts are occurring in the tobacco and nicotine market: first, the total market share of SNP is increasing, and second, inflation-adjusted combustible tobacco sales are declining, while SNP sales are experiencing rapid growth.
Although the nominal value of combustible tobacco sales increased from $752 billion in 2015 to over $1 trillion in 2024, when adjusted for inflation (and assuming a constant currency value), combustible tobacco sales actually decreased to $685 billion in 2024—an 8.9 percent decline. Meanwhile, inflation-adjusted SNP sales grew nearly sixfold from 2015, reaching, in non-adjusted terms, $96 billion in 2024.
Further analysis shows, however, that Chinese data skews these figures. China’s tobacco market accounts for an astonishing $344 billion of the $1 trillion global combustible tobacco market. Despite being the global center of production for nicotine vapes, the Chinese market for all SNP is extremely small, at less than 1.2 percent of its market for combustibles. GSTHR analysis removing China from the calculations reveals the true scale of the acceleration in the global SNP market: it has reached 12.3 percent of the total tobacco and nicotine market in 2024, up from virtually zero in 2004.

The evidence from this report shows that when safer products are appropriate, acceptable, accessible and affordable—people will switch.
Gerry Stimson, founder, KAC
According to KAC, legal access to a range of SNP will be essential for the billion people who smoke worldwide to benefit from tobacco harm reduction (THR). Research undertaken for GSTHR 2024 shows that more than two-thirds of the world’s adult population can now legally access at least one form of SNP. Access to combustible tobacco products, by contrast, remains legal for 100 percent of the world’s adult population. The report also reveals that the global number of vapers has increased from 58 million in 2018, to reach an estimated 114 million in 2023. With 30 million people using other safer nicotine products, this means the GSTHR estimates there are now around 144 million users of SNP worldwide.
“Harm reduction is often thought about as policies and strategies, driven by public health. But it isn’t only this. It’s also what people do themselves to reduce risks and improve their own health,” said KAC Founder Gerry Stimson in a statement. “Governments and both international and national health organizations, need to help create an environment in which people can be informed and empowered to make those safer choices. And the evidence from this report shows that—when safer products are appropriate, acceptable, accessible and affordable—people will switch, in fact they are already switching, in their millions.”
November 18, 2024
New Briefing Details THR Success for IQOS in Japan

Photo: wachiwit
Knowledge Action Change (KAC) has released a briefing paper on the rapid fall in cigarette sales in Japan following the introduction of heated-tobacco products (HTP).
Titled “Cigarette Sales Halved: Heated-Tobacco Products and the Japanese Experience,” the paper explores some of the social and cultural factors that have made Japan particularly suited to HTP and provides a case study showcasing the potential of tobacco harm reduction through the adoption of safer nicotine products.
As well as referencing a number of peer-reviewed science papers, the briefing paper, available in 12 languages, also includes some new Global State of Tobacco Harm Reduction research, which compares up-to-date sales figures that emphasize the changing nature of cigarette and HTP consumption.
According to KAC, the success of HTP in Japan offers significant hope of their potential to reduce cigarette sales in other similar countries.
“The speed and scale of the change in Japan shows just how quickly things can improve when those people already consuming nicotine are given access to a safer alternative,” said KAC Director David MacKintosh in a statement.
“This is not the result of a specific government policy or initiative, yet the benefits to individuals and society are significant. There are lessons to be learnt from Japan by all those who wish to see the use of combustible tobacco consigned to the history books. Harm reduction is about giving people the opportunity to improve their own health and the health of those around them. Given the chance, most people will do just that.”
May 15, 2024
Study: Number of Global Vapers up by 20% From 2020

Illustration: GSTHR
The number of vapers worldwide increased by 20 percent from 2020 to 2021, according to the latest research by the Global State of Tobacco Harm Reduction (GSTHR), a project from Knowledge Action Change. The organization estimates that there are now 82 million vapers worldwide.
The updated calculation was made possible by the release of a range of new data, including the 2021 Eurobarometer 506 survey, and is revealed in a new GSTHR briefing paper. The figure is based on 49 countries that have produced viable survey results on vaping prevalence.
To address the problem of missing data, the GSTHR used an established method of estimating vaper numbers in countries that currently have no information by assuming a similarity with countries in the same region and economic condition for which data points were available.
This estimate considers three factors—sales regulation status, World Health Organization regions and World Bank income groups—along with the Euromonitor data on vaping product market size from 2015 to 2021.

This [increase in vapers] is in spite of prohibitive policies in many countries who follow the World Health Organization’s anti-scientific stance against tobacco harm reduction, thanks to Michael Bloomberg’s billions and his personal zeal for a war on nicotine.”
Gerry Stimson, director, KAC
“As well as the substantial growth in the number of vapers globally, our research shows there has been rapid uptake of nicotine vaping products in some countries in Europe and in North America,” said Tomasz Jerzynski, data scientist at GSTHR. “This increase is particularly significant, because in most markets, these products have been available for only a decade.”
Indeed, the rise in the number of global vapers comes despite the GSTHR’s database showing nicotine vaping products are banned in 36 countries, including India, Japan, Egypt, Brazil and Turkey.
The new data also shows the U.S. is the largest market for vaping at $10.3 billion, followed by Western Europe ($6.6 billion), Asia-Pacific ($4.4 billion) and Eastern Europe ($1.6 billion).
“As this updated data from the Global State of Tobacco Harm Reduction shows, consumers find nicotine vaping products attractive and are switching to use them in increasing numbers worldwide,” said Gerry Stimson, director of KAC and emeritus professor at Imperial College London. “This is in spite of prohibitive policies in many countries who follow the World Health Organization’s anti-scientific stance against tobacco harm reduction, thanks to Michael Bloomberg’s billions and his personal zeal for a war on nicotine.”

March 9, 2022
More Calls for Tobacco Harm Reduction Ahead of COP9

Photo: andriano_cz
Activists continue to urge participants in the ninth Conference of the Parties (COP9) to the World Health Organization’s Framework Convention on Tobacco Control to seriously consider tobacco harm reduction in their deliberations.
COP9 will take place Nov. 8-13 online. During the convention, delegates will debate measures to reduce smoking-related death and disease. To the frustration of many tobacco harm reduction proponents, the WHO has been suspicious of vaping and other reduced-risk products, viewing them as an industry tool to keep consumers hooked on nicotine.
“Tobacco harm reduction is a chance for smokers to switch from an extremely harmful to a significantly less harmful alternative,” the Independent European Vape Alliance (IEVA) wrote in a statement ahead of the gathering.

We would like the WHO, together with other representatives from politics and science, to develop a targeted strategy for reducing the damage caused by smoking.
Dustin Dahlmann, president, IEVA
“Unfortunately, the WHO has lost sight of this in recent years. But it is not too late to repent. It must focus on the future of millions of smokers worldwide—a future that is much brighter should they switch to vaping—rather than its own counterproductive ‘quit-or-die’ dogma.”
“As a European association that is independent of the tobacco industry, we would like the WHO, together with other representatives from politics and science, to develop a targeted strategy for reducing the damage caused by smoking. Of course we as an industry are ready for this critical dialogue,” said Dustin Dahlmann, president of IEVA.
“The World Health Organization’s failure to declare a global emergency in 2020 [in the wake of the coronavirus pandemic] will be repeated in 2021 when the WHO will likely abandon international tobacco harm reduction efforts and condemn millions of smokers to an early death,” said Nancy Loucas, a leading consumer advocate based in New Zealand.

The WHO got it totally wrong on Covid-19, and it’s no surprise they’ve also got it very wrong with safer nicotine products such as vaping.
Nancy Loucas, consumer advocate
“The WHO got it totally wrong on Covid-19, and it’s no surprise they’ve also got it very wrong with safer nicotine products such as vaping,” she added. “As an ex-smoker, vaping has improved my health and arguably saved my life, yet the WHO and its sponsor American Michael Bloomberg have pressured countries like mine to ban it.”
On Oct. 18, 100 international health experts sent a public letter urging the COP9 parties to take a more positive stance on tobacco harm reduction. That same month, the Global State of Tobacco Harm Reduction (GSTHR) released a report urging the WHO to update its policies, which the GSTHR described as “frozen in time” as they dated from before the arrival on the market of many less-harmful nicotine delivery devices.
A group of tobacco harm reduction experts will hold a round-the-clock broadcasting event Nov. 8-12, to challenge and scrutinize COP9, which will take placed behind closed doors.
November 5, 2021
WHO Urged to Embrace Tobacco Harm Reduction
The ninth Conference of the Parties (COP9) to the World Health Organization Framework Convention on Tobacco Control (FCTC) will operate under conditions of secrecy comparable to those of the U.N. Security Council, according to a new report by the Global State of Tobacco Harm Reduction (GSTHR) titled, Fighting the Last War: The WHO and International Tobacco Control.
The public and media are banned from attending all but one largely ceremonial opening plenary, yet millions will be affected by the decisions taken at COP9, which is scheduled to take place virtually Nov. 8–13.
The report contends that current implementation of the FCTC is a global public health failure. In force since 2005, when there were 1.1 billion smokers around the world, the FCTC set out the principles of global tobacco control—to reduce the death and disease caused by smoking. In 2021, however, there are still 1.1 billion smokers worldwide and 8 million smoking-related deaths each year. What’s more, the number of smokers is predicted to rise, and the number of smoking-related deaths is set to top 1 billion this century.
Change is urgently needed, and harm reduction for tobacco offers the opportunity for that change, according to the GSTHR.

Fighting the Last War notes that while tobacco control policy has remained frozen in time, innovative noncombustible nicotine technology and supporting evidence have moved forward. Vaping devices, snus, nicotine pouches and heated-tobacco products are significantly safer than cigarettes as they deliver nicotine without combustion, according to the report’s authors. This, they argue, enables people who cannot or do not want to stop using nicotine to quit deadly smoking and switch to less risky products.
“Just as delegates at COP26 will be discussing the world’s urgent need to stop fossil fuel combustion, the technology is now in place to ensure the end of the age of combustion for tobacco as well,” the GSTHR wrote in a press note. “A number of Parties to the FCTC, such as the United Kingdom and New Zealand, have successfully introduced tobacco harm reduction policies alongside their tobacco control regimes and have seen marked decreases in smoking rates.”
When given accurate information about comparative risk, many smokers switch, the organization notes. Worldwide, the GSTHR estimated in 2020 that 98 million people worldwide were using safer nicotine products.
The authors also point out that the concept of harm reduction is embedded in the WHO response to drug use and HIV/AIDS. It is explicitly named as the third pillar of tobacco control alongside demand and supply reduction in the FCTC. Yet the WHO has remained implacably opposed to harm reduction for tobacco and is increasingly viewed as having overseen a “mission creep,” which now sees international tobacco control setting its sights on prohibition for nicotine in all its forms.
“There are concerning signs in published agenda and briefing papers that the FCTC secretariat and leadership continue to urge Parties against increasing access to, or even to prohibit, safer nicotine products,” the GSTHR wrote.
Fighting the Last War considers the motivations—ideological, financial and historical—that have led to many global tobacco control practitioners becoming so hostile to what others see as the greatest potential public health advance in decades.
The report argues that Parties to the FCTC need to seize back control of the COP meetings from the FCTC secretariat, which it says has become overly influential with little oversight. FCTC Parties should press for more evidence-based discussions, calling upon the widest breadth of scientific, clinical and epidemiological expertise on safer nicotine products and tobacco harm reduction, according to the authors. “This should include evidence from Parties that have implemented harm reduction policies, those involved in manufacturing safer nicotine products and the lived experience of consumers,” they wrote. “The establishment of a working group on tobacco harm reduction would offer a pragmatic route to move the FCTC toward a tobacco control regime fit for purpose in the 21st century.”

“As global leaders prepare to make important pledges on climate change under the glare of the media spotlight at COP26, we urge them to demand more from their delegations inside the closed and unscrutinized rooms of COP9,” says Gerry Stimson, director of Knowledge-Action-Change and emeritus professor at Imperial College London. “Every day, more than one billion smokers are being failed by the international tobacco control regime. The age of combustion—for tobacco as for fossil fuels—must end.
“Tobacco harm reduction offers new routes out for adult smokers. GSTHR estimates suggest that 98 million of them have already switched. At COP9, government delegations must seize back control and prevent the slide into outright nicotine prohibition that would see many return to smoking and many millions more never succeed in quitting.”
“The fight to reduce eight million smoking-related deaths a year is now being actively undermined by the WHO and the international tobacco control establishment,” said report author Harry Shapiro. “Together, they are fighting the last war against the tobacco industry—to direct attention away from the evidence that safer nicotine products can make a significant contribution to reducing that death toll.”
“If those who dominate the global tobacco control discourse were truly committed to public health imperatives, harm reduction principles and policies would be front and center,” said Ethan Nadelmann, founder of the Drug Policy Alliance. “This valuable report exposes the ways in which international institutions have turned their backs on scientific evidence and the human and political rights of hundreds of millions of people whose lives might be saved by safer nicotine products.”
“Fighting the Last War provides an insight into the dark arts of the WHO that many would find breathtaking and incomprehensible,” said Jeannie Cameron from JCIC Consulting. “It shows a concerning difference between the world’s preparations for COP26 on climate change and COP9 on tobacco. Governments need to stand up at COP9 to support tobacco harm reduction against the outdated views of the WHO.”

The fight to reduce eight million smoking-related deaths a year is now being actively undermined by the WHO and the international tobacco control establishment. Together, they are fighting the last war against the tobacco industry—to direct attention away from the evidence that safer nicotine products can make a significant contribution to reducing that death toll.”
Harry Shapiro, author, ‘Fighting the Last War’
“The challenge for lower and middle-income countries while fighting the last war and promoting real tobacco control is about two major issues,” said Nataliia Toropova from Healthy Initiatives. “Firstly, the current provisions of the WHO FCTC have not been properly implemented due to stretched government resources. Thus, smoking cessation programs are nonexistent, and adult smokers feel hopelessly stuck while making their numerous unsuccessful attempts to quit with no medical help or guidance provided. Secondly, the lack of a comprehensive harm reduction strategy is aggravated by a massive misinformation campaign about harm reduction products and a declared war on nicotine. Unless these two issues get tackled, unless the powerful voice of doctors becomes loud and gets heard, unless education and awareness building campaigns take place, no changes will occur, and this last war will be lost.”
October 27, 2021
Experts Challenge WHO Position on Safer Nicotine

Photo: Tom
The Global State of Tobacco Harm Reduction (GSTHR), a Knowledge·Action·Change (KAC) project, launches a new series of briefing papers ahead of the publication of its latest report, Fighting The Last War: The WHO and International Tobacco Control on 27 October.
The suite of new GSTHR publications aim to draw attention to, and challenge the direction of travel of, the Framework Convention on Tobacco Control (FCTC) Conference of the Parties 9 (COP9), a major global meeting on tackling smoking. The meeting is being held virtually in early November. According to the GSTHR, the FCTC agenda and briefing papers indicate the FCTC Secretariat and leadership are continuing to urge parties against the adoption of tobacco harm reduction approaches that could help save millions of lives.
The GSTHR briefing papers offer analyses, commentaries or explainers on topics related to tobacco harm reduction and its role in combating the death and disease caused by smoking.
The first paper provides a brief overview of both the FCTC and the Conference of the Parties biennial meetings, explaining their role in global tobacco and nicotine policy, as well as highlighting some of the problematic elements of their current operation. A deeper analysis of these issues will be revealed when Fighting The Last War is published later in the month.
The second GSTHR briefing paper focuses on the U.K.’s potential leadership role at COP9. According to the GSTHR, the U.K. has successfully implemented important aspects of a domestic tobacco harm reduction policy, while retaining a strong tobacco control record. Currently, the FCTC project does not reflect the U.K. approach–yet the U.K. is one of the most consistent and generous financial backers of both the FCTC and the WHO. At COP9, the paper argues, the U.K. must be prepared to take a strong line and advocate for policies it has enacted that are demonstrably increasing the numbers of people successfully quitting smoking.
These issues and more will be explored in depth in the GSTHR’s forthcoming report, to be published on Oct. 27 at a hybrid launch event, free to attend online. In Fighting The Last War: The WHO and International Tobacco Control the report’s author, Harry Shapiro, takes a close look at the history, development and often secretive processes of the FCTC COP, its early battles with the tobacco industry – and the range of influences shaping international tobacco control’s response to safer nicotine products in 2021.
The report launch will be broadcast on Oct. 27 from the Kia Oval in London. Two roundtable sessions will be livestreamed from 11 am British Summer Time, with time allowed for questions from those watching in the room and from afar. Will Godfrey of Filter will host the first session, “The FCTC: past, present and future,” which features Harry Shapiro, KAC, report author; Derek Yach, Foundation for a Smoke-Free World, former WHO cabinet director and executive director for noncommunicable diseases and mental health; and Tom Gleeson of the New Nicotine Alliance Ireland.
The second session will be hosted by Jeannie Cameron of JCIC Consulting and will be centered on the “Challenges to making the FCTC an inclusive international framework convention.” Audience members will hear from Ethan Nadelmann, founder, Drug Policy Alliance; Nataliia Toropova, Healthy Initiatives and Professor Gerry Stimson, director, KAC.

Parties to the FCTC must seize the opportunity to consider evidence from countries where tobacco harm reduction is succeeding, including the U.K., New Zealand, Sweden, Norway and Japan.
Gerry Stimson, director, KAC
“We’re gravely concerned by the WHO’s continued rejection of tobacco harm reduction,” said Stimson. “It already accepts harm reduction as a valid, evidence-based public health intervention for drug use and HIV/AIDS. Harm reduction is explicitly named as one of three tobacco control strategies in the opening lines of the Framework Convention on Tobacco Control. Adoption could hasten the end of the public health crisis caused by smoking.
“Instead the WHO rejects and, worse, repeatedly misinforms the public about safer nicotine products, demonstrating a disregard both for the lives of over one billion adult smokers and the eight million deaths each year due to smoking. Parties to the FCTC must seize the opportunity at COP9 to consider evidence from countries where tobacco harm reduction is succeeding, including the U.K., New Zealand, Sweden, Norway and Japan—and ask why the WHO and its influential financial backers are refusing to do the same.”
October 15, 2021
New Report Urges Global Tobacco Harm Reduction
A new report urges regulators to scale up tobacco harm reduction (THR) around the world to help smokers make the switch. Burning Issues: The Global State of Tobacco Harm Reduction 2020 (GSTHR), the recently released second edition of a major biennial report produced by Knowledge-Action-Change, found that smoking-related death and disease disproportionately impact poor and marginalized groups, especially in low- and middle-income countries.
Credit: Kevin Phillips
Author Harry Shapiro, coins new terms in the report, calling e-cigarettes “safer nicotine products” (SNP) and EVALI (E-cigarette or Vaping Lung Injury) is now “Vitamin E-Related Lung Injury” (VITERLI).
The report found that there are only nine SNP users for every 100 smokers globally; most live in high-income countries. Overall, 98 million people are estimated to use SNP worldwide. Of those, 68 million are vapers, with the largest vaping populations in the US, China, the Russian Federation, the UK, France, Japan, Germany and Mexico and 20 million are heated tobacco product users—most of whom live in Japan, where cigarette sales have dropped by 32 percent since 2016.
Shapiro also criticizes bad science in the vaping industry, such as studies by discredited researcher Stanton Glantz. GSTHR examines two of his studies that were severely criticized by leading tobacco experts and one study that was retracted. It compares Glantz to Harry Anslinger, the former head of the Federal Bureau of Narcotics who used fear-mongering and moral panics to enact cannabis prohibition.
“SNP is one of the most startling public health success stories of modern times … THR offers a global opportunity for one of the most dramatic public health innovations ever to tackle a non-communicable disease,” Shapiro writes. “In a time of COVID-19 when global health and public finance systems are stretched to breaking point and may not recover for some time, the imperative to drive forward with THR has never been more urgent.”
The report makes several conclusions, including:

SNPs have the potential to substantially reduce the global toll of death and disease from smoking, and to effect a global public health revolution.

Many US and US-funded organizations have manufactured panics about young people and vaping, about flavors and the outbreak of lung disease, overshadowing the real public health challenge, which is to persuade adult smokers to switch.

The increasingly prohibitionist emphasis risks many consequences, including that current smokers may decide not to switch, current users of SNP may go back to smoking, and the growth of unregulated and potentially unsafe products.
December 3, 2020
Tobacco Control Urged to Embrace Harm Reduction

Graph: KAC
A new report published by the U.K. public health agency Knowledge Action Change (KAC) demonstrates an urgent need to scale up tobacco harm reduction, which enables smokers to switch to safer nicotine products, eliminating the smoke that causes death and disease.
Titled “Burning Issues: The Global State of Tobacco Harm Reduction (GSTHR),” the report reveals that an estimated 98 million people use these products globally, including 68 million vapers, 20 million users of heated tobacco products and 10 million consumers of U.S. smokeless or pasteurized oral snus.
While showing huge demand for safer alternatives, these numbers are dwarfed by the global total of 1.1 billion smokers—a figure that has remained static for two decades despite billions spent on tobacco control. Eight million people die due to smoking-related disease every year.
During the report’s online launch, co-hosted with Lilongwe-based NGO THR Malawi on Nov. 4, the report authors showed that both access to and adoption of safer nicotine products largely remains the preserve of higher income countries, while 80 percent of the world’s smokers live in low- and middle-income countries poorly equipped to implement tobacco control or treat smoking-related disease.
The report further shows how tobacco control policy at the World Health Organization is being influenced by billions of dollars from U.S. foundations campaigning against tobacco harm reduction, while misinformation is discouraging smokers from switching to safer products.
KAC Director Gerry Stimson believes the world’s 1.1 billion smokers deserve better. “Integrated into tobacco control, harm reduction could be a gamechanger in the battle against noncommunicable disease,” he said in a statement. “Global tobacco control policymakers must listen to consumers and deliver policies that genuinely focus on reducing smoking-related deaths by all available means.”
Professor David Nutt argued that to reject the opportunity of tobacco harm reduction “is perhaps the worst example of scientific denial since the Catholic Church banned the works of Copernicus in 1616.”
November 9, 2020
‘State of Tobacco Harm Reduction’ Released

Image: Knowledge-Action-Change
Knowledge-Action-Change has launched a new report documenting the advances and significant challenges facing tobacco harm reduction in 2020.
Titled, “Burning Issues: The Global State of Tobacco Harm Reduction 2020,” the report is the second in a biennial series from the Global State of Tobacco Harm Reduction (GSTHR), a project established to map the development of tobacco harm reduction and use, availability and regulatory responses to safer nicotine products around the world.
Harry Shapiro
Written by Harry Shapiro, “Burning Issues” addresses both progress and achievements in the field since the first edition was published in 2018 but also identifies the major obstacles preventing tobacco harm reduction from fulfilling its public health potential worldwide.
Launching in tandem with the report is GSTHR’s major live data mapping project, which documents regulatory responses with live updates to more than 200 regional and country profiles. The free-to-access resource shows that with the support of global tobacco control, 36 countries have banned vapor devices/e cigarettes, 39 have banned ban snus and 13 countries have banned heated tobacco products.
By contrast, just one country (Bhutan) has enacted a ban on the sale of combustible tobacco, which has been temporarily lifted due to Covid-19.
November 5, 2020