THR Reports

The Right Side of History

GSTHR: The Right Side of History does not seek to replicate or revisit the previous GSTHR reports in detail. Instead, it steps back and casts an eye over the history of THR. Where did this history begin? And how has it developed? We bring the story right up to date with a final section that attempts to look into the near future.

The emergence of safer nicotine products, especially vaping, has brought seismic disruption to the commercial, clinical, public health, and legislative landscapes. This disruption has dominated the history of tobacco harm reduction so far. This report emphasises that effective harm reduction interventions, at minimal cost to governments and health agencies, can end smoking within a generation. The alternative is a continuation of approaches that will continue to fail those most in need. The price will be counted in the millions of lives that could have otherwise been saved.

The Right Side of History: The Global State of Tobacco Harm Reduction 2022 is the third of our biennial Global State of Tobacco Harm Reduction (GSTHR) reports. Since 2018, the series has been charting progress in the adoption of tobacco harm reduction (THR), an approach which encourages people who smoke or use risky tobacco to switch to the use of safer nicotine products (SNP). These products include nicotine vapes, Swedish-style snus, nicotine pouches and heated tobacco products.

Table of contents:

Introduction: The threat of disruption
Chapter 1: Dying for a smoke
Chapter 2: The genesis of tobacco harm reduction
Chapter 3: A stuttering evolution towards the quiet revolution
Chapter 4: Community innovation - and commercial expansion
Chapter 5: ‘Fear, Uncertainty and Doubt’
Chapter 6: Follow the money
Chapter 7: Regulating for health
Chapter 8: The right to use and the right to choose
Chapter 9: Future shoot

English 5089 PDF Document
Chinese (Mandarin) 93 PDF Document
French 117 PDF Document

Tobacco Harm Reduction: A Burning Issue for Asia

Harry Shapiro

The focus of this GSTHR briefing is Asia. Sixty per cent of the world’s smokers live in this region and almost half the global deaths from smoking occur here. Asia is also home to nine in every ten users of smokeless tobacco (SLT), leading to high rates of oral cancer. In a number of countries, public health is severely undermined where governments either control or have a significant stake in domestic tobacco companies. New solutions are needed to tackle the public health threat from smoking and tobacco use - but safer nicotine products are banned in many countries. Would tobacco harm reduction improve public health in Asia? And if so - what are the obstacles that stand in its way?

The formal launch event for the briefing took place online on Sunday 18 April 2021 and was co-hosted with Association of Vapers India.

English 1496 PDF Document
English 849 Website page

Fighting the Last War: the WHO and International Tobacco Control

Harry Shapiro (UK) - K•A•C

The latest report from K∙A∙C’s Global State of Tobacco Harm Reduction (GSTHR) argues that “tobacco control policy is frozen in time” while “innovative non-combustible nicotine technology and supporting evidence have moved forwards”. The status quo keeps adult smokers smoking rather than switching to safer nicotine, favouring the tobacco industry. Untangling the complex narratives underpinning the approach of the World Health Organisation and international tobacco control NGOs, this report aims to shed a light on the often hidden workings of these institutions, and the motivations behind their refusal to accept tobacco harm reduction as a valid approach to reduce the harms associated with high-risk tobacco use. Furthermore, this report argues that “THR has a complementary role to play in tobacco control and reducing cigarette consumption. Its potential can come to fruition if the international tobacco control community, led by the WHO, can disaggregate combustible from non-combustible tobacco products in its policy and legislative deliberations.”

Table of contents:

Chapter 1: Still too many left behind: the context for the report

Chapter 2: Hitting back against Big Tobacco: the background to the Framework Convention on Tobacco Control

Chapter 3: International tobacco control: structure and functions

Chapter 4: Tobacco harm reduction

Chapter 5: Trench warfare: the WHO, allies and funders

Chapter 6: What can be done? New thinking for the 21st century

Chapter 7: Final thoughts

English 2913 PDF Document
French 98 PDF Document

Tobacco Harm Reduction and the Right to Health

Ruth Goldsmith (UK) - Knowledge•Action•Change

Tobacco harm reduction and the right to health offers an introduction and overview of key issues in tobacco harm reduction, its public health potential and its relationship with human rights. The report is available in English and 12 other languages: Arabic, Chinese, French, German, Hindi, Indonesian, Japanese, Polish, Portuguese, Russian, Spanish and Swahili.

English 1705 PDF Document
English 918 Website page
Arabic 2547 PDF Document
Chinese (Mandarin) 1499 PDF Document
French 1487 PDF Document
German 1447 PDF Document
Hindi 1120 PDF Document
Indonesian 1319 PDF Document
Japanese 1892 PDF Document
Polish 1542 PDF Document
Portuguese 1234 PDF Document
Russian 1368 PDF Document
Spanish 1299 PDF Document
Swahili 2298 PDF Document

Burning Issues: The Global State of Tobacco Harm Reduction 2020

Harry Shapiro - Knowledge•Action•Change

Burning Issues: The Global State of Tobacco Harm Reduction 2020 is the second in our biennial GSTHR series which documents the development of tobacco harm reduction and the use, availability and regulatory responses to safer nicotine products around the world. Burning Issues picks up the story after our first GSTHR report, No Fire, No Smoke, published in 2018.

Central to this report is the universal right to health for those who for whatever reason continue to engage in risky behaviours. Harm reduction refers to a range of policies that reduce the risks associated with these behaviours, or encourage less risky behaviours, thereby enabling people to survive and live better – in this case through access to safer nicotine products (SNP) aimed at encouraging people to switch away from cigarettes, one of the most dangerous ways of consuming nicotine.

Despite a more globally hostile environment for THR, our exclusive survey of global prevalence of safer nicotine products, included in this report, estimates that the overall figure stands at approximately 98m, of whom 68m are vapers. While from a public health perspective this is good news, it still means that after more than a decade of product availability, there are only nine users of SNP for every 100 smokers.

Table of contents:

About the report



Chapter 1: Smoking: the slow-burning killer

Chapter 2: Market forces: products and consumers

Chapter 3: Not just the nicotine: consumers speak

Chapter 4: Clearing the smoke: safer nicotine products and health

Chapter 5: Project fear: the war against nicotine

Chapter 6: The politics of health: SNP regulation and control

Chapter 7: The right to health and the people left behind

Chapter 8: Burning issues: conclusions and recommendations

Annex: Estimation of the global number of vapers

English 6417 PDF Document
Chinese (Mandarin) 1340 PDF Document
English 967 Website page
French 1054 PDF Document
Spanish 394 PDF Document
Russian 385 PDF Document

Burning Issues: The Global State of Tobacco Harm Reduction 2020 - Executive Summary

Harry Shapiro - Knowledge•Action•Change

A brief summary of our second GSTHR report which documents the development of tobacco harm reduction and use, availability and regulatory responses to safer nicotine products around the world.

English 1820 PDF Document
Arabic 1148 PDF Document
Chinese (Mandarin) 1138 PDF Document
French 1011 PDF Document
Hindi 929 PDF Document
Indonesian 306 PDF Document
Portuguese 1013 PDF Document
Russian 1038 PDF Document
Spanish 1058 PDF Document
Swahili 1429 PDF Document

No Fire, No Smoke - Executive Summary

Harry Shapiro - Knowledge•Action•Change

Executive Summary of "No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018". The executive summary is available in Arabic, English, French, Hindi, Indonesian, Japanese, Mandarin, Polish, Portuguese, Russian and Spanish.

English 1106 PDF Document
Arabic 1029 PDF Document
Chinese (Mandarin) 1218 PDF Document
French 1023 PDF Document
Hindi 1047 PDF Document
Indonesian 1087 PDF Document
Japanese 1068 PDF Document
Polish 1040 PDF Document
Portuguese 1073 PDF Document
Russian 1147 PDF Document
Spanish 1821 PDF Document

No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018

Harry Shapiro - Knowledge•Action•Change

No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018 was the first in the series of biennial GSTHR reports. Inspired by the drug harm reduction reports of Harm Reduction International, published on a biennial basis since 2006, this landmark publication was the first to document the history and development of tobacco harm reduction, as well as the use, availability and regulatory responses to safer nicotine products around the world. This GSTHR report mapped for the first time the global, regional and national availability and use of safer nicotine products, the regulatory responses to these products, and the public health potential of tobacco harm reduction. This report explores in detail the potential of safer nicotine products to unlock a public health revolution, if and when these products are embraced globally.

The GSTHR report series is founded on the principle of harm reduction. Harm reduction refers to policies, regulations and actions focussed on reducing health risks, usually by providing safer forms of hazardous products or encouraging less risky behaviours, rather than simply banning products or behaviours. Harm reduction is a proven public health strategy.

You can find an Executive Summary of this report, containing its key findings and conclusions, at this link.

Table of contents:

Chapter 1: Introduction: tobacco harm reduction

Chapter 2: The continuing global epidemic of cigarette smoking

Chapter 3: Safer nicotine products: a global picture

Chapter 4: Consumers of safer nicotine products

Chapter 5: Safer nicotine products and consumer health

Chapter 6: Regulation and control

Chapter 7: Human rights, public health and tobacco harm reduction advocacy

The "vaping timeline" infographic can be downloaded here.

The full report is available in English and Mandarin.

English 2239 PDF Document
Chinese (Mandarin) 2525 Document
English 96 PDF Document
Chinese (Mandarin) 91 PDF Document
Chinese (Mandarin) 93 PDF Document