A newly published article in the renowned scientific journal Nature makes a strong case for rethinking global tobacco control. The authors argue that current strategies alone will not be enough to end the smoking epidemic — and that integrating harm reduction is essential to achieving meaningful progress.
Current policies are not reducing smoking fast enough. Smoking still causes more than seven million deaths annually, and in many high-burden countries, declines in smoking prevalence are stagnating. Under current policy trajectories, global targets for reducing smoking-related disease are unlikely to be met.
In short, existing approaches — while important — are not delivering the speed of change required.
Public health must focus on smoke, not nicotine
A central argument of the paper is that public-health policy has lost focus on the real driver of harm: combustion. The overwhelming scientific evidence shows that it is the inhalation of toxic substances from burning tobacco — not nicotine itself — that causes smoking-related diseases. Yet in many policy debates, nicotine is treated as the primary problem.
The authors argue that this framing is misguided. Effective tobacco control should prioritize eliminating exposure to smoke, rather than aiming to eliminate nicotine use altogether.
Harm reduction must be part of the solution
The article calls for the formal integration of tobacco harm reduction into global tobacco control strategies. Smoke-free nicotine products — including e-cigarettes — provide alternatives that are significantly less harmful than cigarettes because they eliminate combustion.
Importantly, the authors stress that harm reduction is not a replacement for existing measures, but a complement to them. When combined with traditional tobacco-control policies, these alternatives can accelerate declines in smoking.
Real-world evidence supports this approach. Countries that have embraced smoke-free alternatives have seen faster reductions in smoking prevalence, while still maintaining strong youth-protection measures.
A global “smoke-free 2040” goal is within reach
To drive progress, the authors propose a clear and measurable objective: reducing adult daily smoking prevalence to below 5% by 2040. This “smoke-free 2040” target is presented as ambitious but achievable — provided that governments combine established FCTC measures with broader access to regulated smoke-free alternatives.
Without such a shift, global smoking rates are projected to decline too slowly to meet public-health goals. With it, the pace of decline could increase significantly.
Smart regulation: proportionate to risk, protective of youth
The paper also highlights a key policy principle: regulation should reflect the relative risks of different products. Cigarettes — the most harmful form of nicotine consumption — should face the strictest regulations and highest taxes. At the same time, less harmful alternatives should remain accessible under appropriate safeguards.
This includes:
- Ensuring product safety and quality standards
- Preventing youth uptake through targeted restrictions
- Providing clear, evidence-based communication about relative risks
Misaligned regulation — where safer alternatives are more restricted than cigarettes — risks slowing down progress and protecting the most dangerous products.
A call for evidence-based policymaking
The Nature article sends a clear message: the tools to end the smoking epidemic already exist, but they must be used more effectively.
Integrating harm reduction into tobacco control, focusing on the elimination of smoke, and adopting risk-proportionate regulation could dramatically accelerate the decline in smoking worldwide.
Dustin Dahlmann, President of IEVA: “For policymakers, the implication is straightforward: evidence — not ideology — should guide regulation. A balanced, science-based approach offers the best chance of reducing smoking-related disease and achieving a smoke-free future.“
