Global State of Tobacco Harm Reduction has released a new paper titled
The Next Wave of Tobacco Harm
Reduction?
The paper focuses on heated tobacco products (HTP), vaping and other
non-combustible nicotine products. It looks at how people are moving
from smoking to alternative nicotine products in South Korea, Ireland
and Estonia.
While we’d definitely recommend reading it for yourself, here are some
interesting points raised by the paper.
Interesting finds from The Next Wave of Tobacco Harm Reduction
As mentioned above, the paper examines three countries: South Korea,
Ireland, and Estonia. These three countries are a good choice because
they represent different products, consumer behaviours, and regulatory
pressures in the fight to reduce smoking rates.
Here are a few of the more eye-catching observations from the paper that
show how each of these factors can impact smoking rates.
1. South Korea shows how marketing impacts use
Poly-nicotine use among Korean men (defined in the paper as using at
least two nicotine products) rose from 1.8% in 2013 to 6.9% in 2023.
Additionally, the paper cited previous research that suggests about 90%
of Korean HTP users also smoked. From a UK or US perspective, this data
is interesting. While dual-use happens in our markets, harm-reduction
products are, in general, seen as a transition away from smoking.
So, what is happening in Korea? A big part of the dynamic can be
explained by how HTPs were initially introduced to the East Asian
nation. The product was marketed around convenience and social
acceptability, which makes sense if you’ve ever spent time in those
regions.
Korean campaigns emphasised being clean, having no fire, ash or
cigarette-like smell, as well as reduced-harm claims. That makes an HTP
easy to use at home, around other people or in places where smell is
unacceptable, while cigarettes can remain the preferred product at other
times.
Indeed, per the paper, around 71% of Koreans cited reducing the smell of
smoking as their primary reason for using HTP. Only a third of users
cited quitting smoking as a reason for buying these products.
Another factor we need to consider is price. Taxes made up 73.8% of the
retail price of cigarettes versus 66.8% for HTPs. While HTPs are
cheaper, the difference is modest, meaning smokers have one less reason
to quit.
Overall, it’s interesting to consider that the cultural advantages that
helped HTPs break into Korea could also be holding back the country's
ability to reduce smoking. Other countries, especially those that have
yet to truly embrace harm reduction, should take note.
2. Estonia shows that harm reduction can dramatically reduce smoking
Smoking has declined across the world over the last 70 years. However,
most charts show slow and steady dips. Estonia is different.
Smoking fell from 34.2% in 2012 to 26.1% in 2020, a reduction of 8.1
percentage points over eight years. It then fell another 7.1 percentage
points (to 19.0%) in the four years between 2020 and 2024. Over the same
period, vaping rose from 3.8% to 13.5% of adults.
These changes show something that we’ve observed in the UK and other
markets. Simply put, generation declines in smoking are far quicker when
good quality, sensibly priced harm reduction products are available.
The other thing to note is that the Estonian government didn’t promote
vapes. It retains EU-style precautions such as advertising and flavour
restrictions, limits on distance sales and restrictions on use in public
places. However, they got out of the way enough to let the market decide
how it wanted to consume nicotine.
The big lesson here is that governments do not need to actively promote
vaping for harm reduction to occur. But they can prevent it from
occurring if they make switching excessively difficult.
3. Ireland shows how misinformation can impact “smoke-free” targets
Ireland is a textbook example of how to squander the potential of harm
reduction products. Between 2015 and 2019, Ireland’s smoking rate fell
quickly from 23% to 17%, while vaping rose from 3% to 5%. By 2023,
vaping had reached 8% of adults, but then remained at 8% in both 2024
and 2025. Smoking likewise remained fixed at 17% from 2019 through 2025.
So, what caused the plateau?
One likely reason is how public perception around vaping has been shaped
by negative propaganda from the government, media, and health bodies.
The consequence of this, as shown in the paper, is that a staggering 74%
of adults think vaping is as harmful as or more harmful than smoking.
Just one in ten people understand the clear scientific consensus.
Ireland fell embarrassingly short of its 2025 “smoke-free” target of 5%.
However, half of all vapers are former smokers. The fact that the penny
hasn’t dropped among officials is a terrifying indictment of the
unseriousness of Irish public life. The lesson to other countries is
that putting ideology before your citizens produces poor health
outcomes.
Final thoughts
The GSTR paper does an excellent job of highlighting the various
approaches that countries take with harm reduction. Overall, one strong
theme emerges between the three example countries: Governments don’t
need to promote harm-reduction products for them to have a big impact.
Instead, sensible regulations and messaging allow citizens to make the
right choices about their health. This, and the other lessons above,
will be crucial for reducing smoking rates in the future.
