Yes. Population-level tobacco harm reduction (THR) occurs when a significant proportion of the population switches from high-risk combustible cigarettes to safer nicotine products (SNP), resulting in measurable improvements in public health outcomes. While clinical trials demonstrate individual success, real-world data from several countries provide compelling evidence that SNPs can drive down smoking prevalence and related disease on a massive scale.[1]

The Scandinavian Example: Swedish Snus and Norway

Sweden provides the longest-running evidence of population-level harm reduction. For decades, Swedish men have increasingly used snus—a non-combustible oral tobacco—instead of smoking. Consequently, Sweden now has the lowest smoking rate in Europe (5.3%) and the lowest levels of tobacco-related mortality and lung cancer among men in the European Union. Norway has experienced a similar shift; between 2005 and 2023, daily smoking dropped from 25% to just 7%, a decline that directly coincided with a rapid rise in daily snus use.[2]

The Japanese Experience: Heated Tobacco Products (HTP)

Japan offers a striking contemporary example of how quickly a market can transform. Since the introduction of HTPs in 2014, cigarette sales in Japan have plummeted by an unprecedented 52%. This decline happened at a rate five times faster than before HTPs were available. Statistical modelling suggests that if 50% of Japanese smokers switch to HTPs, the number of people treated for smoking-related diseases could decrease by as many as 12 million.[3]

Vaping in the UK and New Zealand

In countries that have actively endorsed vaping as a cessation tool, the impact on smoking rates has been profound.[4,5]

  • In New Zealand, smoking rates dropped from 15.1% in 2018 to 8.6% in 2023 as vaping rates rose to 11.9%. In some marginalised communities, such as Pacific Peoples, the number of smokers more than halved in just four years.[6]
  • In the UK, smoking prevalence has nearly halved since vaping became a mainstream alternative. Projections suggest that by 2025, the proportion of adults who vape will exceed those who smoke for the first time.

Modelling Lives Saved

Statistical models confirm the massive public health potential of these products. In the United States, substituting cigarettes with vaping could prevent up to 6.6 million premature deaths by the end of the century. In the UK, data indicate that the majority of the reduction in male smoking between 2012 and 2019 was due to vaping, a trend estimated to avert over 165,000 deaths by 2052. Even in low- and middle-income countries (LMIC), where 80% of the world’s smokers live, modelling suggests that combining SNP access with improved cancer diagnosis could save approximately 2.6 million lives in just four countries (Kazakhstan, Pakistan, South Africa, and Bangladesh) by 2060. [7, 8]

Conclusion

The evidence indicates that substitution occurs through three key mechanisms: as a cessation aid for those quitting, as a long-term alternative for those who would otherwise return to smoking, and as a diversion that prevents new users from starting on combustible cigarettes. While some international bodies remain cautious, real-world data shows that where SNPs are accessible, affordable, and acceptable, they are actively replacing cigarettes and saving lives.

References:

  1. The Global State of Tobacco Harm Reduction 2024: A Situation Report. Section 1: Global Perspective. London: Knowledge·Action·Change, 2024. https://gsthr.org/resources/thr-reports/the-global-state-of-tobacco-harm-reduction-2024-a-situation-report/
  2. The Global State of Tobacco Harm Reduction 2024: A Situation Report. Section 6: Norway. London: Knowledge·Action·Change, 2024. https://gsthr.org/resources/thr-reports/the-global-state-of-tobacco-harm-reduction-2024-a-situation-report/
  3. The Global State of Tobacco Harm Reduction 2024: A Situation Report. Section 4: Japan. London: Knowledge·Action·Change, 2024. https://gsthr.org/resources/thr-reports/the-global-state-of-tobacco-harm-reduction-2024-a-situation-report/
  4. The Global State of Tobacco Harm Reduction 2024: A Situation Report. Section 5: Aotearoa / New Zealand. London: Knowledge·Action·Change, 2024. https://gsthr.org/resources/thr-reports/the-global-state-of-tobacco-harm-reduction-2024-a-situation-report/
  5. The Global State of Tobacco Harm Reduction 2024: A Situation Report. Section 7: United Kingdom. London: Knowledge·Action·Change, 2024. https://gsthr.org/resources/thr-reports/the-global-state-of-tobacco-harm-reduction-2024-a-situation-report/
  6. Global State of Tobacco Harm Reduction. Country profile for New Zealand. https://gsthr.org/countries/profile/nzl/cigarettes/
  7. Mzhavanadze G, Stimson G, Jerzyński T Global Heated Tobacco Product User Estimates, 2014-2024: Descriptive Surveillance Study Using Manufacturer Disclosures JMIR Public Health Surveill 2026;12:e88761 URL: https://publichealth.jmir.org/2026/1/e88761 DOI: 10.2196/88761
  8. Tomasz Jerzyński, Giorgi Mzhavanadze, Gerry V. Stimson, Estimation of the global number of nicotine vapers in 2025, Global Epidemiology, Volume 11, 2026, 100257, ISSN 2590-1133, https://doi.org/10.1016/j.gloepi.2026.100257