“People talk about a war on smoking, a war on nicotine or a war on vapes,” Harry Shapiro told Filter. “But you don’t conduct a war against inanimate objects. This is a war against people.”
Shapiro is a British author and journalist whose extensive resume includes biographies of music figures like Jimi Hendrix, and books about drug culture and policy, such as Fierce Chemistry: A History of UK Drug Wars (2021). He’s worked for drug-related charities, too, and is the director of DrugWise.
But I wanted to speak with Shapiro in the context of another of his roles, as lead author of the invaluable series of biennial Global State of Tobacco Harm Reduction reports, published by Knowledge-Action-Change. As Filter has reported, these have included “No Fire, No Smoke” (2018), “Burning Issues” (2020) and “The Right Side of History” 2022.
The report estimates that global sales of safer alternatives to combustible tobacco have grown six-fold since 2015.
Earlier in November, I attended the London launch event for the latest edition, “The Global State of Tobacco Harm Reduction 2024: A Situation Report.” Its 200-plus pages give many insights into how, and how much, use of safer nicotine products (SNP) is replacing smoking in people’s lives.
It’s happening more and more. The report estimates that global sales of safer alternatives to combustible tobacco have grown six-fold since 2015.
“This growth indicates that SNP have moved beyond their niche status,” it states. “In 2015, SNP accounted for only 1.4% of the total tobacco and nicotine market. By 2024, this figure had increased to 8.8%, with [heated tobacco products] at 4.2%, nicotine vaping products at 3.2%, nicotine pouches at 1.1%, and snus at 0.3%.”
Excluding China’s vast tobacco market from the total makes the impact elsewhere even clearer, the report notes. China accounts for over one third of the world’s combustible tobacco sales; despite the country being the world’s biggest manufacturer of vapes, few are sold domestically. Without China, 12.3 percent of the world’s tobacco and nicotine sales are now of safer products—up from practically zero in 2004.
Shapiro and his coauthors draw on various evidence to show how these sales are associated with declines in smoking, at rates far faster than traditional tobacco control measures have achieved.
But this global transition is often happening despite, not because of, countries’ governments—and going slower than it would if governments were supportive.
Close to one third of the world’s population still cannot legally buy any safer nicotine alternatives.
Sweden is a standout success story. It just became the world’s first country to reach “smoke free” status, with a smoking rate below 5 percent. But even there, Shapiro doesn’t give the authorities much credit.
“To be honest, I’m not sure the government did much to encourage this,” he said. “It has basically been the result of Swedish smokers acknowledging the dangers of smoking—allied to an available, accessible, affordable and acceptable product in the form of snus.”
Meanwhile, close to one third of the world’s population still cannot legally buy any safer nicotine alternatives like vapes, pouches or heated tobacco products. And though residents of nearly 130 countries can access at least one of those options, very few can access all of them in a way that would best position different people to quit smoking.
Combustible tobacco is available everywhere, and claims 8.9 million lives each year, according to the report.
“Those against tobacco harm reduction don’t want people to use safer nicotine products,” Shapiro said, describing what amounts to support for cigarette sales.
“WHO targets for reducing the toll from non-communicable diseases could be approached with little or no cost to governments.”
His latest report is split into two sections: “A Global Perspective” and “Regional and National Insights.” The latter includes in-depth assessments of two regions with very challenging situations—Latin America and Eastern Europe/Central Asia—plus detailed updates on four countries which have made big progress: the United Kingdom, Japan, Norway and New Zealand.
Shapiro said that overall, the report “demonstrates the potential for SNP to make a significant contribution to reducing death and disease from smoking and the use of dangerous oral [tobacco] products.”
Part of the attraction for lawmakers, he suggested, should be that “World Health Organization targets for reducing the toll from non-communicable diseases could be approached with little or no cost to governments.”
That’s because simply allowing people to access SNP requires little expenditure; governments just “need to create an environment which encourages adult smokers to switch away from smoking,” Shapiro said.
Among the levers governments should use to encourage safer choices is taxation, he continued. Imposing no tax on SNP can go a long way to making them a more attractive option than heavily-taxed cigarettes.
Regarding flavors—a big part of the attraction for adults, but so often a target for opponents of SNP, due to their perceived role in youth use—Shapiro suggested that New Zealand has a reasonable way to ward off such attacks. The country rules out “unnecessary flavor labels that might be seen to encourage youth vaping, but still allows many flavors and flavor descriptors,” he said—retaining the substance of flavors’ ability to aid switching.
“It’s like your local Sunday football team taking on Real Madrid!”
Another thing Shapiro wants to see from governments is also free, yet often in short supply: courage.
“Those countries which have taken a more pragmatic approach, like the UK, should be more willing to openly endorse SNP,” he said, “and not let the teen-vaping narrative dominate the story, which it does.”
Speaking of the UK, both there and in neighboring Ireland, flavor bans and other restrictive measures have recently gained political traction.
“It is often the case of two steps forward and one step back when it comes to making progress towards acceptance of tobacco harm reduction,” Shapiro commented. “So this kind of non-evidence-based policy clearly blocks progress. This is all part of the teen vaping epidemic narrative, which does not hold up to much scrutiny. Teen vaping in the States, for example, has been falling for the past six years.”
The report also discusses grassroots SNP consumer advocacy groups, and I asked Shapiro about their importance, as well as the barriers they face.
“Despite all the hurdles, safer nicotine products are here to stay.”
“It is very hard for the voices of consumer groups to be heard when faced with a global network of well organized, well funded NGOs—medical and public health organizations right up to the WHO,” he replied. “It’s like your local Sunday football team taking on Real Madrid!”
“But they keep on keeping on, and they are doing something pretty unique in the history of consumer activism,” he continued. “Normally, these groups are campaigning against multinational companies for one reason or another—the impact of fast food on health, polluting energy and water companies, unsafe products, and so on. Here, you have consumer activists campaigning for access to a consumer product for the benefit of their health.”
It is in consumers, and the way more and more people are managing to make safer choices even when they’ve been deluged with misinformation, that tobacco harm reduction advocates can readily find hope.
Asked for the biggest takeaway from his new report, Shapiro’s reply reflected this: “Despite all the hurdles, safer nicotine products are here to stay.”
Image via Picryl/Public Domain
The Influence Foundation, which operates Filter, has received restricted grants and donations from Knowledge-Action-Change. Both The Influence Foundation and KAC have received grants from Global Action to End Smoking. Filter’s Editorial Independence Policy applies.
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