International health experts are calling on governments to embrace safer nicotine alternatives as proven tools to cut smoking, prevent disease and save lives.
The appeal comes in The Safer Nicotine Revolution: Global Lessons, Healthier Futures, a landmark new report published ahead of the World Health Organisation (WHO)’s COP11 global tobacco summit in November.
The report highlights how four countries have used products such as snus, heated tobacco and vaping to drive down smoking and improve health outcomes.
Sweden leads the way
Sweden has cut smoking to 5.3 per cent of the population – the lowest rate in Europe – by making snus and nicotine pouches widely available. Among Swedish-born adults, the rate is below the five per cent threshold commonly used to define a “smoke-free” society.
Swedish men now have 61 per cent lower lung cancer rates than the European Union (EU) average, and overall cancer deaths are a third lower. Without smoke-free alternatives, smoking-related male mortality would have been 70 per cent higher. Overall, the shift is estimated to be saving around 3,000 lives a year.
Japan has halved cigarette sales since heated tobacco products were introduced a decade ago, while smoking prevalence has dropped from 21 per cent to 16 per cent. Modelling suggests that switching just half of smokers could prevent 12 million cases of smoking-related disease.
In the UK, vaping has been integrated into NHS quit-smoking services. Smoking rates fell from 20.2 per cent in 2011 to 11.9 per cent today, with around 5.5 million adults now vaping – more than half of whom have quit smoking entirely.
Vaping is projected to prevent 166,000 premature deaths by 2052, with data already showing declines in cardiovascular deaths, cancer mortality and COPD cases.
New Zealand has halved smoking in just six years since legalising vaping and heated tobacco. Almost 80 per cent of daily vapers are ex-smokers, while COPD hospitalisations are down nearly 30 per cent and cardiovascular deaths 20 per cent. Modelling projects a gain of 195,000 quality-adjusted life years.
“These figures make one thing clear: safer nicotine alternatives are saving lives today,” said Dr. Delon Human, leader of Smoke Free Sweden and co-author of the report.
“COP11 is a moment of truth. If Parties adopt harm reduction within the framework of the FCTC [Framework Convention on Tobacco Control], millions of lives could be saved worldwide. This report should be essential reading for every policymaker in Geneva.”
Co-author Dr. Marewa Glover, a New Zealand tobacco control researcher, said: “Our report shows that if you make safer nicotine alternatives accessible, acceptable and affordable, smokers will switch – and the result is healthier lives.
“We’re already seeing fewer hospitalisations for lung disease, fewer cardiovascular deaths and longer life expectancy in countries that embrace safer nicotine alternatives. This is the true measure of success, and it’s a lesson the world should learn from.”
New study on nicotine pouches
Fresh evidence also suggests that nicotine pouches could help some smokers and vapers move away from more harmful products. A study published in JAMA Network Open found people were nearly four times more likely to use nicotine pouches daily if they had recently quit smoking.
“Our results suggest that adults may be using nicotine pouches for harm reduction given that use is highest among those that have recently quit another tobacco product or e-cigarettes,” said lead researcher Cristine Delnevo, director of the Rutgers University Institute for Nicotine and Tobacco Studies.
For the study, researchers analysed data from more than 110,000 Americans surveyed in 2022 and 2023. Few had ever tried nicotine pouches – about 2.6 per cent – and use among people who had never used tobacco was virtually non-existent. Instead, pouch use was concentrated among people who smoke, vape or use smokeless tobacco.
Occasional smokers were 2.4 times more likely to use pouches, occasional vapers 3.9 times more likely, and smokeless tobacco users more than 10 times as likely. People who had quit smoking were also 3.9 times more likely to use them.
“This study offers a snapshot of use patterns that is informative and, at least for now, somewhat reassuring,” said researcher Mary Hrywna, associate professor at Rutgers School of Public Health.
The findings come as the U.S. Food and Drug Administration prepares to fast-track review of four tobacco companies’ pouch products. Earlier this year, the FDA gave its first-ever authorisation to Zyn, a pouch made by a Swedish company, which remains the only brand currently approved.
Delnevo cautioned that nicotine is addictive and can affect heart health, though unlike smoking, it has not been linked to cancer. “People who have never used tobacco products should not suddenly be using nicotine pouches,” she said.
“But for people who smoke or use other nicotine products and don’t want to stop using nicotine, switching completely from the more harmful product and moving down the risk continuum with nicotine pouches is a likely good for public health.”
