- A global smoking rate below 5% by 2040 is described as “a realistic, measurable and equitable target”
- Current tobacco control measures alone are unlikely to reduce smoking fast enough
- Wider access to “regulated smoke-free nicotine alternatives” could accelerate declines significantly
- Evidence from countries using these alternatives shows faster reductions in smoking alongside youth protection
A major new analysis published in Nature Health suggests the world could come close to ending the smoking epidemic within the next 15 years – but only if safer nicotine alternatives are more widely embraced alongside existing tobacco control policies.
The paper argues that increasing the use of smoke-free nicotine products such as vapes could help drive global smoking prevalence below five per cent by 2040, a threshold often described as effectively “smoke-free”.
Despite decades of progress, smoking remains a major global health burden. The authors note it is still responsible for “more than seven million deaths each year”, with declines in smoking rates slowing in many countries.
They warn that population growth, ageing populations and uneven policy implementation mean “current approaches are unlikely to deliver reductions at the pace required” to meet global health targets.
Why progress is stalling
Global tobacco control efforts have largely focused on reducing demand through taxation, advertising bans, smoke-free laws and cessation support. While these measures have driven significant progress, the paper suggests their impact is now plateauing.
As smoking rates fall, the remaining population of smokers increasingly includes “older and disadvantaged adults” and those with higher nicotine dependence, many of whom have already tried and failed to quit.
This makes further reductions harder to achieve using traditional approaches alone.
At the same time, the global scale of the problem remains vast. Around one billion people still use tobacco, and smoking continues to be “the single largest avoidable cause of non-communicable diseases globally”.
The role of harm reduction
The analysis highlights the “rapid emergence of regulated non-combustible (smoke-free) nicotine products” as a potential turning point.
These include vapes, heated tobacco products, nicotine pouches and traditional nicotine replacement therapies. Because they do not involve combustion, they expose users to far fewer toxic substances than cigarettes.
The authors stress that “it is exposure to smoke from combustion – not nicotine – that drives tobacco-related disease”.
They argue that tobacco harm reduction, offering people who smoke access to less harmful alternatives, should be more formally integrated into global tobacco control strategies.
Although harm reduction is recognised within existing international frameworks, the paper says it has “remained underdeveloped, inconsistently regulated and politically contentious”.
Evidence from real-world use
The paper points to evidence from several countries where smoke-free alternatives have been widely adopted.
In Sweden, the use of oral nicotine products has been linked to some of the lowest smoking rates in Europe and significantly lower tobacco-related disease.
In Japan, the introduction of heated tobacco products coincided with “unprecedented declines in cigarette sales”.
Meanwhile, in the United States, falling smoking rates have occurred alongside increased uptake of vaping among adults who smoke.
New Zealand is highlighted as a particularly clear example. Smoking rates had been declining gradually for decades, but the pace of decline “accelerated sharply after 2018”, coinciding with wider access to regulated vaping products.
The steepest reductions were seen among disadvantaged groups, suggesting a potential role in reducing health inequalities.
Addressing concerns
The paper also addresses common concerns around harm reduction, including youth uptake, long-term health risks and dual use of cigarettes and alternatives.
It notes that while these concerns “warrant careful attention”, they should be weighed against the known harms of continued smoking.
On youth use, the authors highlight that smoking rates among young people have continued to decline in countries where vaping has become more common, often reaching historic lows.
They also point out that many studies linking youth vaping to later smoking are influenced by shared risk factors, such as behavioural traits and social environment.
On safety, the paper acknowledges uncertainty around long-term effects but states that “the absence of combustion makes these products intrinsically far less hazardous than cigarettes”.
A shift in global strategy
To reach a smoke-free 2040 target, the authors argue that policy needs to better reflect the relative risks of different nicotine products.
They call for a “risk-proportionate regulatory framework” that places the strongest restrictions on combustible tobacco, while allowing safer alternatives to remain accessible and effective substitutes.
This would include aligning taxation, regulation and public communication with the goal of encouraging smokers to switch away from cigarettes.
Clear messaging is also seen as critical. The paper highlights “widespread” misperceptions about nicotine, often driven by “alarmist media coverage and ambiguous public health messaging”.
The 2040 goal
Currently, around 16 per cent of the global population smokes. On current trends, this is expected to fall to around 10 per cent by 2040.
Reaching below five per cent would require a “substantial acceleration” in the rate of decline.
The authors argue that combining existing tobacco control measures with wider access to safer nicotine alternatives offers a “clear and achievable pathway” to reaching that goal.
They conclude that the tools to end the smoking epidemic already exist, but greater political will is needed to fully integrate harm reduction into global tobacco control strategies.
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