Big Question 1 - What is Tobacco Harm Reduction and What are the Desired Outcomes?

THR in Action – Updated Evidence of Impact:

There is growing consensus among many members of the public health community and academics about the role of Smokeless Products as reduced-risk^*† alternatives to smoking.

1. Oral Nicotine Pouches: Extensive epidemiological evidence from Sweden shows that snus use, a form of Oral Tobacco Product, is associated with substantially lower risks than cigarette smoking^[11],[12]. This is reflected in the US FDA’s 2019 determination that completely switching from cigarettes to certain types of Swedish snus can reduce the risk of several major smoking-related diseases^[13]. Emerging evidence indicates that Oral Nicotine Pouches contain even fewer and lower levels of toxicants than snus and demonstrate reduced toxicological impact^[14], suggesting the potential for further risk reduction and highlighting the likelihood that Oral Nicotine products can be expected to present lower risk^*† than continued cigarette smoking.

Sweden provides the leading example for the effectiveness of THR.

Its long-standing regulatory and consumer acceptance of smokeless alternatives has coincided with a sustained decline in cigarette smoking over several decades. As a result, Sweden has the lowest smoking prevalence in Europe (5.4% in 2024)^[11] and the lowest mortality rates for cancers of the lung, trachea and bronchus in the EU^[12].

2. Vapour Products: Vapour Products remain the largest smokeless category globally, with an estimated 74 million current adult users worldwide^#. In 2015, Public Health England (PHE) released a landmark evidence review which estimated that responsibly manufactured and appropriately stewarded e-cigarettes are around 95% less harmful to health than conventional cigarettes^[6]. This conclusion has since been cited and refined through subsequent independent evaluations and supported by organisations such as the Office for Health Improvement and Disparities (OHID), the Royal College of Physicians (RCP), the National Institute for Health and Care Excellence (NICE), and the Medicines and Healthcare products Regulatory Agency (MHRA)^[7],[8],[9]. In the most recent review published by the OHID, it concluded: “Based on the reviewed evidence, we believe that the ‘at least 95% less harmful’ estimate remains broadly accurate… However, it might now be more appropriate and unifying to summarise our findings using our other firm statement: that vaping poses only a small fraction of the risks of smoking^[7].”

In the United Kingdom, for example, the prevalence of Vapour Product use surpassed that of cigarette smoking for the first time in 2026^[10].

3. Heated Products: By heating tobacco or other substrates rather than burning, Heated Products have the potential to be reduced-risk^*† compared to smoking. Although the current evidence base includes research conducted by the industry, an increasing number of independent reports are broadly aligned with the conclusions and support the findings that switching to Heated Products is a reduced-risk^*† alternative to smoking combustible cigarettes. Research commissioned as early as 2017 by the UK Department of Health found that people using Heated Products were exposed to around 50-90% less of the “harmful and potentially harmful” compounds compared with people smoking conventional cigarettes^[15].

In Japan, cigarette smoking prevalence continues to decline, while use of Heated Products continues to rise; they hold 46% share of the total tobacco product market in the country^[16]. Academic researchers in Tokyo have identified early epidemiological signals that point towards reduced acute coronary syndrome hospitalisations associated with the prevalence of Heated Product use (Figure 1)^[17].

We are aligned with many of the goals of governmental public health strategies to lower global smoking prevalence rates. The World Health Organization (WHO) considers countries to be “smoke free” when smoking prevalence is less than 5% of the population^[18].

Our Role in THR and Our Desired Outcomes

Our vision for success in Tobacco Harm Reduction (THR) is to create A Better Tomorrow™ by Building a Smokeless World. This world is one in which people, who would otherwise continue to smoke, can use forms of tobacco and nicotine that are less risky^*† than cigarettes and, as an extension, society realises a substantial reduction in projected population level smoking-related harm. Despite the interventions of tobacco control, and the availability of smoking cessation pharmacotherapies for several decades, the WHO report that there are still in excess of 1 billion smokers globally^[19]. Traditional tobacco control measures to date have not been sufficient in achieving smoke free status globally. Accelerated THR adoption is required to bridge this gap.

Advancing THR will depend on achieving a number of critical milestones that collectively support its credibility, acceptance, and implementation. These outcomes are central to enabling a transition toward a Smokeless World and ensuring that adult smokers, who would otherwise continue to smoke, have access to scientifically substantiated smokeless alternatives.

We Seek Three Main THR Outcomes: