Evidence for Tobacco Harm Reduction: Why Consumers Demand Safer Alternatives – Part 3

Safer nicotine products reduce harm

Combustible tobacco smoke contains thousands of chemicals, dozens of which cause cancer, heart disease and respiratory illnesses. Nicotine itself, while addictive, does not cause cancer. Harm‑reduction products, such as e‑cigarettes, heated‑tobacco devices, nicotine pouches and snus, deliver nicotine without burning tobacco. Major health organisations now recognise that:

1. E‑cigarettes are far less harmful than smoking. Public Health England’s 2015 review concluded that vaping is about 95 % less harmful than smoking and that there is no evidence it leads non‑smokers into tobacco use.
2. E‑cigarettes help smokers quit. The NHS states that nicotine vaping is one of the most effective tools for quitting; people who vape are roughly twice as likely to quit compared with those using traditional nicotine replacement therapy. In 2022 experts reviewed the evidence and found that vaping poses only a small fraction of the risks of smoking.
   
3. Non‑combustible nicotine products dramatically reduce exposure to carcinogens. Cancer Research UK notes that switching to vaping reduces exposure to toxic and cancer‑causing chemicals and that there is no good evidence of harm from second‑hand vapour.
4. Regulation should encourage safer choices. The Royal College of Physicians emphasises that providing nicotine without the harmful constituents of smoke can prevent most of the harm from smoking and that regulation should avoid making safer products less accessible.

Countries demonstrate harm‑reduction success

• United Kingdom: In 2023, only 11.9 % of UK adults smoked cigarettes, the lowest proportion since records began. Meanwhile, 9.8 % of adults used e‑cigarettes, showing that safer products are now mainstream tools, helping adults quit smoking. The UK government’s plan to achieve smoke‑free status by 2030 (≤5 % smoking prevalence) explicitly relies on promoting vaping and nicotine pouches to adult smokers, alongside restrictions on youth access.

• Sweden: The legal sale of snus and nicotine pouches has led to a near smoke‑free society. In 2024, only 5.4% of Swedes smoked daily; when immigrants are excluded, the figure is 4.5%. Sweden also has among the lowest rates of tobacco‑related cancer and cardiovascular disease in Europe. This success illustrates that risk‑proportionate regulation, treating low‑risk products differently from combustible tobacco, can save lives.

Why consumers insist on safer options

People who smoke often struggle with quitting because nicotine addiction and the ritual of smoking are powerful. Simply telling people to stop seldom works; about half of smokers attempt to quit each year, yet most relapse. When people are given realistic alternatives, products that satisfy nicotine cravings without the toxins of smoke, their chances of quitting soar. In countries where safer products are widely available and affordable, smoking rates have plummeted. Conversely, where e‑cigarettes are banned or heavily taxed, illicit markets flourish and smokers have little incentive to switch.

Consumers, therefore, demand policies that respect their agency and reflect the best available science:

• Access: Safer nicotine products should be accessible to adult smokers at a reasonable cost. Excessive taxes or bans merely protect the sales of cigarettes.
  
• Information: People deserve accurate information. Misleading claims that vaping is as harmful as smoking discourage smokers from switching and perpetuate the smoking epidemic.
  
• Proportionate regulation: High‑risk combustible products should face strict regulation, while lower‑risk products should be regulated based on their actual risk. This approach aligns with the FCTC’s own definition of tobacco control.
  
• Meaningful participation: Those affected by policies must have a seat at the table. Excluding consumer voices from COP11 contradicts the FCTC’s stated commitment to engage civil society and perpetuates the perception of a paternalistic, out‑of‑touch process.

Conclusion

The evidence is overwhelming: safer nicotine products dramatically reduce harm, help smokers quit and accelerate the decline of combustible tobacco use. Countries that embrace regulated harm reduction, such as Sweden, New Zealand, and the UK, are approaching smoke-free status. The FCTC originally defined tobacco control to include harm‑reduction strategies, yet COP11’s agenda frames harm reduction as an industry narrative and bars the participation of the very people whose lives are on the line.

Consumers and harm‑reduction advocates are not asking for the promotion of nicotine use; they are demanding that global tobacco‑control policy recognise reality. Millions of smokers are finding refuge in safer alternatives. Denying them a voice or denying the science behind harm reduction prolongs the tobacco epidemic. It is time for the FCTC to fulfil its own mandate and integrate harm reduction as an equal pillar alongside supply‑ and demand‑reduction measures.