Changes in combustible tobacco and SNP markets
Although market data alone has its limitations, it is possible to discern two key shifts in the tobacco and nicotine market: 1) the share of SNP in the total tobacco and nicotine market is increasing, and 2) inflation-adjusted combustible tobacco sales are declining, while SNP sales are experiencing rapid growth. Most of these changes have been in high-income countries, where consumers have more disposable income, access to online sales, fewer restrictions on SNP, and higher public awareness of the risks associated with smoking.
See "The Global State of Tobacco Harm Reduction 2024: A Situation Report" for more information.
Retail volume of cigarette and HTP markets in selected countries
Heated tobacco product (HTP) sales have seen significant growth since 2016, in Asia Pacific and Western and Eastern Europe. In many countries, this has coincided with a drop in cigarette sales. Data on retail volume sales of cigarettes and HTP are both measured in sticks, but one HTP stick may not be a perfect substitute for people who smoke, as it contains a lower dose of nicotine than one cigarette. Nevertheless, retail volume sales figures do suggest varied substitution effects in the following countries:
- approximately one–to-one substitution of HTP sticks for cigarettes: Hungary, South Korea, Italy, Germany.
- cigarette sales drop faster than HTP sales increase: Slovakia, Czech Republic, Russia, Japan, Greece.
- cigarette sales drop slower than HTP sales increase: Kazakhstan, Lithuania, Portugal.
See "The Global State of Tobacco Harm Reduction 2024: A Situation Report" for more information.
Estimated global number of vapers (2024)
Although challenging, the GSTHR team has continued to work hard to develop estimates for the global number of vapers. For our 2021 estimate, we employed a method of assumed similarity for countries with missing data, and averaged the prevalence of vaping across WHO regions, World Bank income classification groups, and the legal status of e-cigarettes in each country. Our final estimate was 82 million vapers globally in 2021. Our 2024 estimates were produced using new data and an improved forecasting method. The GSTHR now estimates that the global number of vapers has increased, reaching 114 million in 2023.
See "The Global State of Tobacco Harm Reduction 2024: A Situation Report" for more information.
At least one kind of SNP…
As of 2024, at least one category of safer nicotine product (nicotine vapes, heated tobacco products, snus or nicotine pouches) is legally available in 129 countries. This covers four billion people, which represents 71% of the global adult population. Meanwhile, as of 2024, 100% of the global adult population can legally purchase deadly combustible cigarettes.
See "The Global State of Tobacco Harm Reduction 2024: A Situation Report" for more information.
About 54% of the global adult population live in countries where nicotine vapes are legally available
About 54% of the global adult population, equivalent to 3.1 billion people, live in countries where nicotine vapes are legally available. In contrast, 36% (2 billion people) reside in countries where vaping is banned, while 10% (610 million people) are in countries with no specific legislation or available information. As of 2024, 100% of the global adult population can legally purchase deadly combustible cigarettes.
Excise tax burden on e-liquids (2023)
By 2023, among countries permitting the sale of nicotine vapes, at least 52 had implemented taxes on them. Of these, 37 tax all e-liquids, while 17 only tax those containing nicotine. Most impose a specific excise tax on e-liquids, with 30 applying a uniform tax rate and nine using a tiered system. Out of 52 countries which tax nicotine vapes, Belarus had the highest excise tax burden at 88%. This was followed by Portugal at 85%, Norway at 78%, and Kazakhstan at 77%. The lowest excise tax burdens were noted in Costa Rica and Paraguay (both at 4%), Kenya (3%), and Croatia (0%).
Legal availability of different safer nicotine products in 2024 (percentage of global adult population aged 18+)
Analysis of the global landscape for SNP by product type reveals significant regulatory diversity. About 54% of the global adult population live in countries where nicotine vapes are legally available, while 36% reside in countries where they are banned. HTP are legally available to 36% of the global adult population, while 50% of the population lives in areas where they are banned. Snus is legally available to 58% of the global adult population, making it more widely accessible than both vaping products and heated tobacco. But 32% of people live in countries where snus is banned. Nicotine pouches are legally available to 35% of the adult population, while 50% of the population resides in areas where they are banned. Meanwhile, as of 2024, 100% of the global adult population can legally purchase deadly combustible cigarettes.
EMPOWERED model
The WHO’s MPOWER model should be broadened to accommodate the huge potential of harm reduction, as shown in our EMPOWERED diagram. The revised system must monitor the degree to which countries are assisting adult tobacco users to switch away from the most dangerous modes of consumption. Under the new EMPOWERED model, enforcement interventions would be balanced with a broader public health approach that enables adults who use risky tobacco to make informed choices about their health.
The relative risk spectrum of 15 nicotine product categories
The crucial difference between all safer nicotine products and traditional cigarettes is that none of them deliver nicotine to the user through the combustion of tobacco. By not burning tobacco, all of these products, to varying degrees, are safer than continued smoking. A 2022 systematic review and meta-analysis by Rachel Murkett and colleagues showed the relative risk of different nicotine-containing products, and the stark difference in risk between those that are combustible and non-combustible.
The three-dimensional framework for harm minimisation
Dependence on nicotine - a compulsion to continue using it - is certainly a reality. But when isolated from smoking, nicotine has relatively low health risks. David Abrams and colleagues developed what they called “a three-dimensional framework for harm minimisation”. This proposes a ‘sweet spot’ for safer nicotine products, an optimal point where the risks to health are low, but the appeal to the user is high, due to the product’s ability to deliver nicotine in a way that is on a par with smoking.
Changes in the SNP market
As of 2024, the global safer nicotine product (SNP) market is undergoing significant changes. Market estimates suggest that nicotine vaping products are no longer dominant by value, having been replaced in 2020 by heated tobacco products (HTP). This was due to both an increase in the number of HTP users, and the fact that HTP are generally more expensive than vapes.
Limitations on the availability of flavours in legal sales of nicotine vaping products (2024)
Access to flavours is another important factor incentivising the substitution of smoking by safer nicotine products or helping avoid a relapse to smoking. The regulation of flavours varies significantly across different countries: there are no restrictions on flavours for nicotine vapes in 41 countries, allowing a wide range. However, 10 countries have implemented restrictions, permitting only tobacco, mint, and menthol flavours, or in some cases, only tobacco, or no flavours at all.
Limitations on the availability of flavours in legal sales of heated tobacco products (2024)
Access to flavours is another important factor incentivising the substitution of smoking by safer nicotine products or helping avoid a relapse to smoking. The regulation of flavours varies significantly across different countries: 30 countries allow all heated tobacco product flavours, whereas 25 countries have put restrictions in place.
Legal availability of heated tobacco products (2024)
Heated tobacco products are legally available to 36% of the global adult population, while 50% of the population lives in areas where these products are banned. The remaining 14% are in regions with no clear regulatory stance. Meanwhile, as of 2024, 100% of the global adult population can legally purchase deadly combustible cigarettes.
Legal availability of snus (2024)
Snus is legally available to 58% of the global adult population, making it more widely accessible than both vaping products and heated tobacco. However, 32% of people live in countries where snus is banned, and 10% are in areas with unclear regulations. Meanwhile, as of 2024, 100% of the global adult population can legally purchase deadly combustible cigarettes.
Excise duty on nicotine vaping products compared to excise duty on cigarettes
Taxation of safer nicotine products and rates of excise tax are rapidly changing worldwide, along with regulatory frameworks. An increasing number of countries are introducing excise taxes on these products, or raising existing excise tax rates. However, as of 2024, where safer nicotine products are legally available, they generally enjoy more favourable taxation compared to cigarettes – although not always proportionate to their relative harms. This map illustrates the diverse taxation approaches to nicotine vaping products globally.
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.
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.
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
Forewords
Introduction
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
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.
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.
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
No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018 - 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.
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.
The Right Side of History: The Global State of Tobacco Harm Reduction 2022
The Right Side of History: The Global State of Tobacco Harm Reduction 2022 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
Estado mundial sobre la reducción del daño del tabaco 2024: Un informe de situación
The Global State of Tobacco Harm Reduction 2024 (Estado mundial sobre la reducción del daño del tabaco 2024): Un informe de situación es una publicación multicomponente, agrupada en dos partes, Perspectivas mundiales y Percepciones regionales y nacionales. La medida en que los productos de nicotina más seguros están reemplazando y sustituyendo los productos de tabaco combustibles y orales riesgosos es la idea central.
Perspectivas mundiales utiliza la evidencia más reciente y los nuevos proyectos de datos para informar sobre la situación mundial actual de la reducción del daño del tabaco y su potencial para reducir rápidamente la carga de la enfermedad y la mortalidad asociada con el consumo de tabaco riesgoso. Midiendo los cambios en la adopción, la política y la regulación de los productos de nicotina más seguros, considera la manera en que estos factores se interrelacionan para apoyar o socavar el progreso.
Capítulo uno: Epidemia mundial de tabaquismo y papel de la reducción del daño del tabaco.
Capítulo dos: Evidencia de la reducción del daño del tabaco.
Capítulo tres: Progreso mundial en la reducción del daño del tabaco.
Capítulo cuatro: Regulación y control mundial.
Capítulo cinco: Retos de la reducción del daño del tabaco.
Capítulo seis: Conclusiones
Percepciones regionales y nacionales considera el estado del consumo del tabaco y la reducción del daño del tabaco a nivel regional o nacional. El documento que está a punto de leer se centra en Latinoamérica; está disponible un informe equivalente para Europa Oriental y Asia Central. También se describen cuatro países que han permitido que la reducción del daño del tabaco disminuya el índice de tabaquismo: Nueva Zelanda, Japón, Noruega y Reino Unido.
The Global State of Tobacco Harm Reduction 2024: A Situation Report
The Global State of Tobacco Harm Reduction 2024: A Situation Report is a multi-component publication, grouped into two parts, A Global Perspective and Regional and national insights. The extent to which SNP are replacing and substituting for combustible and risky oral tobacco products is the unifying theme.
A Global Perspective uses the latest evidence and new data projections to report on the current global THR situation and its potential to rapidly reduce the burden of disease and mortality associated with risky tobacco use. Measuring changes in SNP uptake, policy and regulation, it considers how these factors interrelate to support or undermine progress.
- Chapter One: The global smoking epidemic and the role of tobacco harm reduction
- Chapter Two: The evidence for tobacco harm reduction
- Chapter Three: Global progress in tobacco harm reduction
- Chapter Four: Global regulation and control
- Chapter Five: The challenges to tobacco harm reduction
- Chapter Six: Conclusions
Regional and national insights considers the status of tobacco use and THR at the regional or national level. A broader regional focus is applied to Latin America (Section 2) and Eastern Europe and Central Asia (Section 3). Profiles for Japan (S. 4), Aotearoa New Zealand (S. 5), Norway (S. 6), and the UK (S.7) are also available.
L’état mondial de la réduction des risques du tabac 2024: un rapport de situation
« L’état mondial de la réduction des risques du tabac 2024 » : un rapport de situation est un document à plusieurs composantes. Cette publication est divisée en deux parties : « Perspectives mondiales » et « Perspectives régionales et nationales ». La mesure dans laquelle les PNRR remplacent et se substituent au tabac oral combustible et à risque en est le thème fédérateur.
« Perspectives mondiales » s’appuie sur les données les plus récentes et les nouvelles projections de données pour rendre compte de la situation actuelle de la RdRT dans le monde et de son potentiel à réduire rapidement la charge de morbidité et de mortalité associée à l’usage du tabac à risque.
Mesurant l’évolution de l’adoption des PNRR, de la politique et de la réglementation, on y examine la manière dont ces facteurs interagissent pour soutenir ou entraver les progrès.
Chapitre 1 : L’épidémie mondiale de tabagisme et le rôle de la réduction des risques du tabac
Chapitre 2 : Les données probantes de la réduction des risques du tabac
Chapitre 3 : Progrès mondiaux en matière de réduction des risques du tabac
Chapitre 4 : Réglementation et contrôle au niveau mondial
Chapitre 5 : Les défis de la réduction des risques du tabac
Chapitre 6 : Conclusions
Les aperçus régionaux et nationaux examinent la situation de l’usage du tabac et de la RdRT au niveau régional ou national. Le document que vous êtes sur le point de lire est consacré à l’Amérique latine. Un rapport équivalent est disponible pour l’Europe de l’Est et l’Asie centrale. Quatre pays qui ont permis à la RdRT de faire baisser les taux de tabagisme – Aotearoa Nouvelle-Zélande, Japon, Norvège et Royaume-Uni – font aussi l’objet d’un profil.
Глобальное состояние снижения вреда от табака – 2024: Ситуационный отчет
«Глобальное состояние снижения вреда от табака – 2024: Ситуационный отчет» — это многокомпонентная публикация, состоящая из двух частей: «Глобальные перспективы» и «Региональные и национальные аспекты». Тема, объединяющая эти части — это степень, на которую БНП заменяют и замещают сжигаемые и рискованные табачные продукты орального применения.
Глава первая: Глобальная эпидемия курения и роль снижения вреда от табака
Глава вторая: Фактические данные в пользу снижения вреда от табака
Глава третья: Глобальный прогресс в снижении вреда от табака
Глава четвёртая: Глобальное регулирование и борьба
Глава пятая: Трудности снижения вреда от табака
Глава шестая: Заключение
В части «Региональные и национальные аспекты» рассматривается состояние потребления табака и СВТ на региональном и национальном уровнях. Документ «Великобритания, свободная курения? Как исследования, политика и вейпы сократили показатели курения.», с которым вы сейчас ознакомитесь, представляет собой один из четырех обзоров стран, позволивших СВТ снизить показатели курения. Также доступны аналогичные обзоры для Аотеароа – Новой Зеландии, Японии и Норвегии. Более широкое региональное внимание уделено Латинской Америке, Восточной Европе и Центральной Азии.
O Estado Global da Redução de Danos do Tabaco 2024: Um Relatório de Situação
O Estado Global da Redução de Danos do Tabaco 2024: Um Relatório de Situação é uma publicação de múltiplos componentes, agrupada em duas partes: Perspectivas globais e Percepções regionais e nacionais. O quanto os PNS estão substituindo e servindo como alternativa aos produtos de tabaco combustíveis e ao tabaco oral de alto risco.
Perspectivas globais utilizam as evidências mais recentes e novas projeções de dados para relatar a atual situação global da RDT e seu potencial para reduzir rapidamente a carga de doenças e a mortalidade associadas ao uso arriscado do tabaco. Ao medir as mudanças na adoção de PNS, nas políticas e na regulamentação, considera como esses fatores se inter-relacionam para apoiar ou prejudicar o progresso.
Capítulo Um: A epidemia global do tabagismo e o papel da redução de danos do tabaco
Capítulo Dois: As evidências da redução de danos do tabaco
Capítulo Três: O progresso global na redução de danos do tabaco
Capítulo Quatro: Regulamentação e controle global
Capítulo Cinco: Os desafios da redução de danos do tabaco
Capítulo Seis: Conclusões
Perspectivas regionais e nacionais consideram o status do uso de tabaco e RDT em nível regional ou nacional: relatórios para América Latina, Europa Oriental e Ásia Central estão disponíveis. Quatro países que permitiram que a RDT reduzisse as taxas de tabagismo – Aotearoa (Nova Zelândia), Japão, Noruega e Reino Unido – também são analisados.
The FCTC COP10 Agenda and supporting documents: implications for the future of tobacco harm reduction
Our latest Briefing Paper looks ahead to the upcoming COP10 meeting in Panama and assesses what the Agenda could mean for the future availability of the safer nicotine products that underpin tobacco harm reduction.
