Oxford University Press has released a new paper titled "The Availability and Marketing of Nicotine Pouches at Tobacco-selling Point-of-Sale in Pakistan" (Farzeen, 2025). It explores the impact of the innovative smoke-free product in the South Asian Republic.
Considering that smoking-related deaths total around 130,000 per year in Pakistan, you may think the authors would be excited about the adoption of these innovative harm-reduction products. Of course, you’d be wrong.
Let’s take a look.
The paper
The paper provides an interesting snapshot of the growth of pouches in Pakistan. In fact, pouches have become so popular in the Land of Pure People that they are now VELO’s third-largest global market, with 40 million sold each month in the region despite being introduced just five years ago.
Per the paper, “nicotine pouches were available in all four provinces, eight of nine surveyed districts, and 56 of 711 (7.9%) points of sale. However, while this rapid market penetration is great news for executives at British American Tobacco (BAT), the authors are less pleased.
They believe that VELO has captured 85% of the existing market by offering:
- Six flavours that target youths.
- Affordable products ($0.45 per tin).
- Choice of strengths (4mg, 6 mg, 10 mg).
Now, I don’t know about you, but sensible strengths, low prices, and a decent choice of flavours seem like a good deal for consumers. It also suggests that BAT is essentially self-regulating in Pakistan, which significantly undercuts the paper’s inevitable conclusion that more regulation is required.
Other points in the paper suggest that BAT is advertising at the shops where pouches are sold and that pouch use is a more urban phenomenon at this stage.
The inevitable recommendations
Read enough papers about vaping and pouches, and you’ll notice the same thing over and over again. Despite the appearance of scientific inquiry, it’s hard to escape the feeling that the “work” exists only to advance the case for more governmental control over citizens.
Sure enough, the paper suggests that age restrictions, health warnings, flavour bans, and taxation are required. We are meant to suspend our disbelief and believe there was some version of reality where the academics would not call for these exact interventions based on their findings. I’m well aware that objecting to this theatre is about as logical as being angry with the sun coming up in the morning, but it still gets to me.
The smoking situation in Pakistan
As outlined above, It’s easy to grow weary of this kind of work. With the exception of restricting the sale of these products to minors, the other suggestions will only make the products less accessible and less appealing to Pakistani citizens. And look, I get it—that is the essential function of these papers, even if they’re disguised as public health.
However, what makes this all so frustrating is that Pakistan has a serious tobacco problem. Currently, the annual smoking-related death rate is 91.1 per 100,000 people, which is higher than the South Asian (78.1) and global (72) averages.
To add to the problem, smokeless tobaccos like Naswar, Gutka, and Paan are also popular. Each substance has known links to cancer and basically a whole host of health issues, like heart disease, strokes, and organ damage.
If there was ever a country that could really do with the widespread availability of nicotine pouches, it’s Pakistan. Sadly, the authors can’t see past their own paternalism to understand the impact that a product like nicotine pouches could have on the quality of life for Pakistani smokers and their families.
Final thoughts
The authors of papers like this probably think they are doing a tremendous public service in the fight against big tobacco. But they’re just getting in the way with their soft lobbying for excessive regulation of products that will save the lives of smokers in Pakistan.
Smokeless tobacco is a big part of the culture in the region. The widespread availability of nicotine pouches, which are the safest way to consume nicotine, would reduce the reliance on these hazardous and toxic products and help to cut the country's excessively high smoking rates.
It’s a topsy-turvy world when BAT is doing more to reduce cancer rates in Pakistan than public health researchers, but I fear that’s the world we’re living in.
