By R.Perera
The World Health Organization’s latest Global Report on Trends in Tobacco Use 2000–2024 and Projections 2025–2030 presents a familiar story: smoking rates worldwide are declining, suggesting that tobacco control policies are having a positive effect. According to the report, the number of tobacco smokers dropped from 1.38 billion in 2000 to 1.2 billion in 2024. Although this is encouraging, the report pays comparatively little attention to how smokeless alternatives have contributed to this progress.
For the first time, the WHO estimates that over 100 million people use e-cigarettes globally, including around 15 million adolescents aged 13 and 15 and 86 million adults, mostly in high-income countries. The report presents these changes primarily as a concern, especially in relation to youth nicotine use, rather than highlighting that many adult smokers are switching to potentially reduced-risk products. This perspective overlooks a growing body of independent data showing that vaping and other smokeless nicotine products pose only a small amount of risk in comparison to conventional smoking. For instance, the UK Office for Health Improvement and Disparities’ 2022 review reaffirmed that combustible tobacco, not nicotine, is the primary driver of smoking-related disease. Similarly, the World Health Organization’s International Agency for Research on Cancer (IARC) does not classify nicotine as a carcinogenic agent in its Monographs on the Identification of Carcinogenic Hazards to Humans (Volumes 1–139).
There is evidence that adult smokers who switch to regulated nicotine alternatives like e-cigarettes or oral nicotine pouches significantly reduce their health risks, even though caution over young uptake is still important. It has been shown that enacting science-based regulatory frameworks for reduced-risk nicotine products can result in measurable gains in public health in countries like the UK, Sweden, and New Zealand. In Sweden, where smoking has been largely replaced by oral tobacco products for the last 70 years and oral nicotine products since 2018, has resulted in the lowest smoking rates in Europe (5.6% relative to the EU average of 23% in 2023) and, as a result, has the lowest incidence of lung cancer mortality in Europe.
Sri Lanka is also steadfast in its commitment to reducing the rates of smoking and smokeless tobacco usage. Although there has been significant progress in reducing cigarette smoking over the years, issues with smokeless tobacco, such as betel and areca nut use, still exist. To this end, the National Authority on Tobacco and Alcohol (NATA) Act prohibits the manufacturing, importation, and sale of any smokeless tobacco or any e-cigarette that contains tobacco. Despite these measures, betel quid (a mixture of tobacco, crushed areca nut and other ingredients) chewing remains highly prevalent among adults, especially in rural areas, and illegal sale and distribution of e-cigarettes are still largely present in the more urban areas.
In light of this, a more sophisticated, scientifically based approach to tobacco harm reduction may complement rather than replace existing tobacco control measures. Research indicates that giving adult smokers access to regulated, potentially less dangerous alternatives, in addition to strong underage access prevention methods and effective enforcement of illegal products, can accelerate declines in smoking and reduce illegal trade. Therefore, regulation rather than complete prohibition of these novel nicotine products might be a sensible course of action that strikes a balance between protecting the public’s health and allowing adults to make educated decisions.
Looking ahead, it will be crucial for national authorities, public health agencies, and organizations like the WHO to continue working together. Transparent research and appropriate legislation may guarantee that advancements in tobacco control remain evidence-based and sustainable, while global mediation to stop the cross-border traffic in illegal smokeless tobacco and unregulated nicotine products can strengthen national efforts.
In order to protect youth and maintain public health priorities, policymakers can better support adult smokers who want to reduce the health impact by distinguishing combustible and non-combustible products within a strong regulatory framework.
(The writer is a tenured journalist, with 14-years of experience in the fields of Advertising and Public Relations. He has contributed to thought leadership articles covering multiple fields including Public Health, FMCG, Business and more.)