Media release - Burning Issues: The Global State of Tobacco Harm Reduction 2020

  • New report reveals only nine users of safer nicotine products for every 100 smokers worldwide 
  • Global tobacco control’s hostility to tobacco harm reduction is risking the health and lives of millions with LMIC worst hit, say experts

Today sees the launch of Burning Issues: The Global State of Tobacco Harm Reduction (GSTHR) 2020, the latest in a landmark report series from UK-based public health agency Knowledge Action Change (KAC), at an open access online event. Tobacco harm reduction supports people to quit smoking by using safer nicotine products (SNP) including vaping devices (e cigarettes), heated tobacco products (HTP) and pasteurised oral snus, improving health and reducing deaths by enabling people to use nicotine without the smoke that causes disease.

In a world first, the authors of Burning Issues reveal an estimate for the total global number of users of safer nicotine products,[i] showing that there is an urgent need to scale up tobacco harm reduction if its full public health potential is to be realised:

  • There are only nine SNP users for every 100 smokers globally, mainly in high income countries;
  • Overall, 98 million people are estimated to use safer nicotine products worldwide;
  • Of those, 68 million are vapers, with the largest vaping populations in the US, China, the Russian Federation, the UK, France, Japan, Germany and Mexico;
  • 20 million are HTP users; with most HTP users in Japan, where cigarette sales have dropped by 32% since 2016 when HTP were launched;
  • 10 million are US smokeless or snus users.

Official monitoring of SNP use is currently limited - yet is essential to understand their impact and potential in tackling smoking-related death and disease. Nevertheless, these numbers demonstrate the scale of consumer uptake and acceptance of these products as alternatives to combustible tobacco, which kills half its users.

Meanwhile, the global public health crisis of smoking is ongoing and deadly. 1.1bn people smoke worldwide, a figure that has remained unchanged for two decades despite billions spent by governments and the World Health Organization (WHO) on tobacco control. 80% of the world’s smokers live in low and middle income countries (LMIC), and eight million people die due to smoking-related disease every year. The WHO estimates that one billion people will die of smoking-related disease by 2100.

The urgent need to find new approaches is clear, especially in LMIC, where tobacco control measures are often poorly or partially implemented, smoking rates are high or plateauing, population growth is increasing the number of smokers, and health systems are least able to treat smoking-related disease effectively or offer smokers support to quit.

Since SNP have become available, accessible and affordable in countries such as Japan, the UK and Iceland, existing declines in smoking rates have accelerated.[ii] Yet despite the emergence of products that are demonstrably safer than combustible cigarettes, proven to be effective in smoking cessation and attractive to adult consumers who are quitting and switching in their millions, tobacco harm reduction continues to be seen by many in global health and tobacco control as a threat, not a public health opportunity.[iii]

Innovation rejected and tobacco policy distorted 

Burning Issues identifies the extent to which tobacco control policy both at the WHO and in individual nation states is being influenced by billions of dollars from US foundations that are actively supporting campaigns against tobacco harm reduction.[iv] In countries such as the UK and US where tobacco harm reduction already has a foothold, misinformation and manufactured moral panics about SNP’s risks are impacting on confidence – discouraging smokers from making the switch.[v]

Furthermore, governments in LMIC are being encouraged to ban SNP in the name of tobacco control,[vi] while the sale of tobacco continues unchecked. Rising concern over the influence of these actors was echoed in the Philippines House of Representatives a few weeks ago, with calls for a congressional inquiry into the Filipino Food and Drugs Administration’s acceptance of funding from US-based anti-vaping groups.[vii]

Major new data mapping project demonstrates illogical approach 

Launching today in tandem with the report is GSTHR’s major live data mapping project,[vii] which documents regulatory responses to SNP with live updates to over 200 regional and country profiles. The free-to-access resource shows that with the support of global tobacco control, 36 countries have banned vaping devices/e cigarettes, 39 have banned ban snus and 13 countries have banned HTP. By contrast, just one country (Bhutan) has enacted a ban on the sale of combustible tobacco, which is currently lifted due to COVID-19.

At the launch, expert speakers will call for change

Today’s free, open access online launch, co-hosted by KAC in London and Lilongwe-based NGO THR Malawi, will hear from a range of speakers including Emeritus Professor at Imperial College London and KAC Director Professor Gerry Stimson, Burning Issues Executive Editor Harry Shapiro, and leading neuropsychopharmacologist and drug policy expert Professor David Nutt.

Professor Gerry Stimson, Emeritus Professor at Imperial College London and KAC Director, will say:

“This is a decisive moment for the future health of 1.1 billion smokers around the world, who deserve better than the status quo. Policymakers engaged in the current European Commission Tobacco Products Directive revision and next year’s WHO FCTC Conference of the Parties must consider the evidence for tobacco harm reduction’s role, listen to consumers, and deliver policies that genuinely focus on reducing the global toll of smoking-related disease and deaths as quickly as possible. If integrated into tobacco control, harm reduction could be a gamechanger in the battle against non-communicable disease.”

Guest speaker Professor David Nutt, founder of DrugScience and Edmund J. Safra Professor of Neuropsychopharmacology at Imperial College London will say:

“My work leading a multicriteria decision analysis on the harms of different nicotine products back in 2013 contributed to the understanding that e-cigarettes are around 95 per cent less harmful than cigarettes. Yet many so-called ‘experts’ rebuff scientific evidence on vaping or snus safety and deny relative harm data, while insulting and libeling scientists like myself. To reject the opportunity of tobacco harm reduction is, perhaps, the worst example of scientific denial since the Catholic Church banned the works of Copernicus in 1616.”

Harry Shapiro, Executive Editor of Burning Issues, will say:

“Our data shows that, worldwide, millions of people are choosing to improve their own health by switching from combustible tobacco. But this needs to scale up, fast. Tobacco harm reduction should become a genuine consumer-led public health success. But instead, we are seeing the start of a war on nicotine.”

Samrat Chowdhery, President of The International Network of Nicotine Consumer Organizations, Director of the Association of Vapers India, and vaping consumer will say:

“Given that over 80 per cent of tobacco users are in low- and middle-income countries with meagre means to deal with tobacco-related consequences, the focus ought to be unwaveringly on harm prevention, by allowing people to exercise the choice of avoiding death and disease by switching to affordable and accessible risk-reduced alternatives.”


Notes to editors


The GSTHR project is produced with the help of a grant from the Foundation for a Smoke-Free World, a US non profit 501(c)(3), independent global organisation. The project and its outputs are, under the terms of the grant agreement, editorially independent of the Foundation. The contents, selection and presentation of facts, as well as any opinions expressed in the report, are the sole responsibility of the authors and under no circumstances should they be regarded as reflecting the positions of the Foundation for a Smoke-Free World, Inc.

[i] For a full explanation of the accepted epidemiological methods used to form the estimations of the number of safer nicotine product users, please turn to the appendix of Burning Issues, from pp. 151.

[ii] See case studies on p51 (Japan), p52 (UK) and p53 (Iceland) in Burning Issues

[iii] See Burning Issues Chapter 5 – Project fear: the war against nicotine

[iv] See Burning Issues Chapter 5 – Project fear: the war against nicotine

[v] In March 2020, Public Health England stated that “it is of concern that negative beliefs about the harms from vaping might prevent smokers from switching to vaping and they would therefore continue to be exposed to the extremely high levels of harm caused by smoking.” For risk perception data comparisons and full PHE reference, see p. 97-8 Burning Issues

[vi] See p. 115 Burning Issues and also Where bans are best: why LMICs must prohibit e-cigarette and HTP sales to truly tackle tobacco (The Union, position paper 2020)

[vii] The GSTHR live data mapping resource is open to all, giving access to over 200 country and regional profiles with available data on smoking prevalence and related mortality, SNP use and regulation.