The Framework Convention on Tobacco Control (FCTC) and the Conference of the Parties (COP): an explainer (updated April 2023)
With the Tenth Meeting of the Conference of the Parties (COP) to the Framework Convention on Tobacco Control (FCTC) taking place in November 2023, here's our updated guide to explain how the meeting works. Scroll down to access this document in multiple languages.
What are nicotine pouches?
Nicotine pouches are a relatively new product which can provide users of high-risk tobacco with an alternative that poses fewer risks to their health. Here we provide an introduction to the tobacco harm reduction potential of this category.
What is Tobacco Harm Reduction?
Tobacco harm reduction is a potentially life-saving intervention for millions of people across the world who use high-risk tobacco products, offering them the chance to switch to a range of safer nicotine products. Here, we provide a detailed introduction to the principles, history and evidence for this vital public health strategy.
Tobacco harm reduction in Sub-Saharan Africa
With the number of tobacco users across the continent set to rise by 2025, we look at the current state of tobacco harm reduction in the region, assessing the progress made so far and the obstacles preventing greater adoption of safer nicotine products.
The right to health and the right to tobacco harm reduction
Tobacco harm reduction is not only a potentially life-saving public health intervention for the world’s 1.1 billion smokers, it's also supported by international human rights law. Here we make the case for promoting tobacco harm reduction as a health rights issue.
The Global State of Tobacco Harm Reduction 2022: The Right Side of History
This Briefing Paper summarises The Global State of Tobacco Harm Reduction 2022: The Right Side of History, which charts the history of tobacco harm reduction to date, and considers the future for a strategy that could end smoking.
What is snus?
Used in Scandinavia for more than 200 years, snus is providing smokers in Sweden and Norway with an alternative to combustible cigarettes, but what is it and why is it considered a safer nicotine product? This Briefing Paper aims to provide the answers.
82 million vapers worldwide in 2021: the GSTHR estimate
The popularity of nicotine vaping products continues to grow around the world as smokers choose to make the switch to safer alternatives and our latest research estimates the global number of vapers increased by 20% between 2020 and 2021.
Fighting the Last War: the WHO and International Tobacco Control
The WHO Framework Convention on Tobacco Control isn't working. Here we use the key messages from the latest Global State of Tobacco Harm Reduction report, Fighting the Last War, to argue why tobacco harm reduction must be adopted urgently by the WHO.
The UK and tobacco: successful elements of a harm reduction strategy and the chance to influence the international response to smoking
The UK is a world leader in tobacco harm reduction (THR), but it can still do more. Here, we argue COP9 presents the UK with the perfect opportunity to both display its THR credentials on the global stage and to champion the benefits of safer nicotine products.
The Framework Convention on Tobacco Control (FCTC) Conference of the Parties (COP): an explainer (2021)
With the Ninth Meeting of the Conference of the Parties (COP) to the Framework Convention on Tobacco Control (FCTC) taking place from 8 - 13 November 2021, here's our guide to explain how the meeting works.
Tobacco harm reduction consumer advocacy organisations
Tobacco harm reduction consumer advocacy organisations play a vital role in maintaining access to safer nicotine products around the world. Here we explore the development, role and importance of these grassroots groups.
Tobacco harm reduction and people experiencing homelessness – a UK perspective
With such high smoking rates among people who experience homelessness or rough sleeping in the UK, this Briefing Paper looks at the potential for tobacco harm reduction to help reduce the health inequalities seen in this vulnerable population.
Cigarette sales halved: heated tobacco products and the Japanese experience
In the ten years following the introduction of heated tobacco products to Japan, sales of cigarettes have fallen by 52% in Japan. This Briefing Paper explores some of the factors that have helped bring about this startling decline alongside the rapid growth of heated tobacco products.
Smoking and vulnerable populations: supporting smoking cessation and tobacco harm reduction in social work
Social workers build relationships with individuals who are often from marginalised or vulnerable communities where smoking rates are disproportionately high. This Briefing Paper calls for tobacco harm reduction to become more integrated into their work to reduce the harms from smoking.
A smokefree UK? How research, policy and vapes have cut smoking rates
The number of people who vape in the United Kingdom is soon set to exceed the number who smoke for the first time. This Briefing Paper explores the United Kingdom’s progress towards becoming smokefree, highlighting both the successes and the challenges.
How snus is replacing smoking in Norway: a revolution led by consumers and product innovation
While Sweden recently became the first smokefree country, its neighbour, Norway, is also experiencing plummeting smoking rates. This Briefing Paper explores why so many Norwegians have switched from deadly cigarettes to much safer snus.
Pro-consumer laws and an endorsement for vaping: why smoking is disappearing in Aotearoa New Zealand
Pro-consumer laws and an endorsement for vaping: why smoking is disappearing in Aotearoa New Zealand
This Briefing Paper tells the story of Aotearoa New Zealand's rapid and growing embrace of vaping, providing another important case study showcasing the potential of tobacco harm reduction to help bring down smoking rates.
Safer nicotine product taxation and optimal strategies for public health
This Briefing Paper examines the current global situation regarding the taxation of safer nicotine products and how this relates to product accessibility, before offering evidence-based policy recommendations for optimal taxation strategies in support of harm reduction goals and public health.
Dead ends - the tobacco industry's quest for a ‘safe’ combustible cigarette
Tobacco companies spent decades denying any link between smoking and disease, while also trying to develop a ‘safe’ cigarette. This Briefing Paper sets out to tell the story of this quest, looking at the roles played both by those within and outside of the tobacco industry.
The Global State of Tobacco Harm Reduction 2024: A Situation Report
This Briefing Paper summarises The Global State of Tobacco Harm Reduction 2024: A Situation Report, which 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.
Why is tobacco harm reduction needed and what is the evidence it works?
Our latest Briefing Paper explains the importance of tobacco harm reduction as well as providing a range of country case studies demonstrating the power of safer nicotine products to bring down rates of smoking.
From cigarettes to snuff to nicotine pouches: the unusual Icelandic model for tobacco harm reduction
From cigarettes to snuff to nicotine pouches: the unusual Icelandic model for tobacco harm reduction
While snus has provided an increasingly popular off-ramp for those looking to switch away from smoking in Sweden and Norway, Icelanders have taken to a different selection of safer nicotine products, and this Briefing Paper uncovers the story of their rise.
Tobacco harm reduction and the FCTC: issues and challenges at COP11
From 17th – 22nd November 2025, COP11 is taking place in Geneva. This Briefing Paper explores the efficacy of the FCTC in reducing smoking, and considers the challenges posed by COP11 to consumer access to safer nicotine products and tobacco harm reduction progress.
The Framework Convention on Tobacco Control (FCTC) and the Conference of the Parties (COP): an explainer (updated September 2025)
The Eleventh Meeting of the Conference of the Parties (COP) to the Framework Convention on Tobacco Control (FCTC) is taking place from 17th – 22nd November 2025. This updated guide for COP11 explains what COP meetings are, how they work, and why they are important.
Nicotine and medical research – a background
Despite misconceptions about nicotine, due to its association with smoking, this Briefing Paper explains why researchers are increasingly interested in the therapeutic potential of nicotine with respect to Parkinson’s disease, Alzheimer’s disease and mental health.
The Statistics Relating to Smoking-Related Mortality and Morbidity Across the World
- No Fire, No Smoke: The Global State of Tobacco Harm Reduction
There are large differences between countries in the overall levels of smoking, and in the levels of smoking between men and women. According to WHO data for 2015, in 26 countries the prevalence of daily smoking amongst men is above 40 percent: in Indonesia, a staggering 65 percent of adult males smoke; 61 percent in East Timor; 57 percent in Tunisia; 51 percent in the Russian Federation and in Kiribati; 48 percent in Syria; 46 percent in Georgia and Armenia, 45 percent in Laos, Greece and Latvia; 44 percent in the Maldives and Egypt; 43 percent in the Solomon Islands and Ukraine; 42 percent in China, Papua New Guinea and Cyprus; 42 percent in Lesotho; 41 percent in Albania and Mongolia; and 40 percent in Bosnia and Herzegovina, Montenegro, Bangladesh, Belarus and Micronesia.
These high levels persist despite major global initiatives led by the WHO to reduce smoking, and despite the investment of billions of dollars in tobacco control to reduce demand and supply.
That smoking has been in decline in much of the developed world is to be welcomed. But the fact that the steep drops since the 1970s have begun to level out in some countries demonstrates that despite all the efforts of tobacco control, even in the West, there are still millions of people who continue to smoke, most notably among the poorest and most vulnerable.
The situation is even more serious in LMIC, where most smoking deaths occur and where population growth is set to increase rather than decrease the smoking population. And it is precisely these poorer countries that simply do not have the resources to make serious inroads into their smoking problem. Overall, at the current levels, the WHO estimated in 2008 that by the end of the century, a billion people would have died from smoking at an annual cost to the global economy of US$1 trillion amounting to a projected total of US$92 trillion by 2100.
Yet there is now a proof of concept which offers a way for governments to tackle smoking-related deaths and disease and move towards the aspirations of the Sustainable Development Agenda, with no drain on national finances. Current safer nicotine products have the potential to replace and eradicate smoking. The history, development and growth in use of these products is the subject of the next chapter.
See also p. 17 of the report: No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018 — Global State of Tobacco Harm Reduction (gsthr.org)
Global E-Cigarette Regulation as of July 2018
Harry Shapiro - No Fire, No Smoke: The Global State of Tobacco Harm Reduction
It may come as a surprise to both those in tobacco control and those advocating for tobacco harm reduction that at present most countries do not have any specific law regulation regarding e-cigarettes: 101 countries have no specific law on e-cigarettes. It is possible that if it came to a government or court decision, it might be that in some of these countries e-cigarettes would be found to be covered by tobacco control legislation. However, this has yet to be determined in many countries. This includes many LMIC, where it is likely that e-cigarettes are not yet available or are only used by a minority.
At the other end of the spectrum there are 39 countries where the sale of e-cigarettes or nicotine liquids is banned. It is worth noting that rather like the failure of bans on recreational drugs to be effective, e-cigarettes are known to be available in at least 14 of these 39 countries. For example, e-cigarettes and nicotine are widely available and used in Australia. Some of the banning countries had pre-existing laws in which e-cigarettes and nicotine liquids were caught up – as again for example in Australia where the poisons regulations under the jurisdiction of the Therapeutic Goods Administration (TGA) prohibit the unauthorised sale, possession and use of nicotine (see box). Several countries have a legal and regulatory framework for e-cigarettes, and this is generally a mix of a legal framework – often within the context of tobacco control legislation (as in the USA and Europe), plus product standards and legal or voluntary control over access to the products by young people. The most usual legislative route is to regard them as tobacco products, and/or as consumer products.
In most jurisdictions manufacturers are only allowed to promote e-cigarettes as safer than cigarettes and as aids to quitting if they are registered as medicinal products, similar to the regulations governing nicotine replacement therapies. In ten countries there is provision for medically regulated products.
See also p. 84 of the report: No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018 — Global State of Tobacco Harm Reduction (gsthr.org)
Tobacco Harm Reduction - Origins
- Burning Issues: The Global State of Tobacco Harm Reduction 2020
“The case is advanced for selected nicotine replacement products to be made as palatable and acceptable as possible and actively promoted on the open market to enable them to compete with tobacco products. There will also need to be health authority endorsement, tax advantages and support from the anti-smoking movement if tobacco use is to be gradually phased out altogether. It is essential for policymakers to understand and accept that people would not use tobacco unless it contained nicotine and that they are more likely to give it up if a reasonably pleasant and less harmful alternative source of nicotine is available. It is nicotine that people cannot easily do without, not tobacco. It will be assumed … our main concern is to reduce tobacco-related diseases and that moral objections to the recreational and even addictive use of the drug can be discounted providing it is not physically, psychologically or socially harmful to the users or to others.”
- Professor Michael Russell – consultant psychiatrist, Institute of Psychiatry, London.
See also p.24 of the report: Burning Issues: The Global State of Tobacco Harm Reduction 2020
Tobacco Smoking Prevalence
- Burning Issues: The Global State of Tobacco Harm Reduction 2020
Historically, most countries have seen a rise and then a decline in smoking. A general decline in rates of smoking is apparent across all global regions, and for both sexes. This has been especially marked in many higher-income countries. Rates of smoking have fallen for both men and women largely due to greater public awareness of the importance of a healthier lifestyle, as well as the introduction of various tobacco control measures including advertising bans, smoke-free environments, and higher taxation. Nevertheless, reduction in smoking prevalence tends to start plateauing at around 20% of a population, suggesting diminishing returns on tobacco control interventions.
What these data show is that millions of people are still smoking, many of whom will want to, but have been unable, to quit. We discuss this in later chapters, where we consider the limits of tobacco control interventions and the need to adopt harm reduction measures for people who don’t want to smoke but want to continue using nicotine.
See also p.32 of the report: Burning Issues: The Global State of Tobacco Harm Reduction 2020