From Tobacco Harm Reduction Leader to Laggard? The UK’s Legacy at Risk

by Peter lam September 29, 2025

Britain’s tobacco control strategy has proven that tobacco harm reduction works and that safer nicotine alternatives save lives. Another reason why the recent change in direction does notmake sense.

The UK has long been recognised as a global leader in tobacco harm reduction, with a record of success that few other countries can match. However, a new report from Smoke Free Sweden rightly warns that this progress could be derailed if policymakers allow regulatory overreach to undermine access to safer nicotine alternatives.

The report, “The Safer Nicotine Revolution: Global Lessons, Healthier Futures,” highlights the UK’s achievements to date, particularly its integration of vaping into NHS smoking-cessation services. Since 2011, smoking prevalence has dropped from 20.2% to 11.9%, with more than half of Britain’s 5.5 million vapers quitting cigarettes entirely, and projections suggest that, if current momentum is maintained, vaping could prevent 166,000 premature deaths by 2052.

More importrantly, the health benefits are clealy visible. Cardiovascular deaths have fallen by nearly a fifth, while cancer, COPD mortality, and smoking-related hospital admissions have all declined. Even short-term studies reinforce these gains—smokers who switch to vaping can experience measurable improvements, such as reduced blood pressure, within a month.

Real-world data show what works
Naturally, the UK’s trajectory is consistent with international examples of harm reduction. The most renowned is probably that of Sweden, where smoking has been slashed to just 5.3%—the lowest in Europe—driving lung cancer rates more than 60% below the EU average. Its success has been fuelled by long-standing access to snus and, more recently, nicotine pouches.

In Japan, cigarette sales have halved over the past decade following the introduction of heated tobacco products, while in New Zealand, smoking prevalence has been cut in half since 2018 thanks to widespread adoption of vaping and heated alternatives. In all these cases, hospitalisations and deaths linked to smoking have declined sharply, hence these examples strengthen the case that giving smokers safer choices delivers far greater public health benefits than blanket bans ever could.

Pouches offer unique advantages. They are tobacco-free, discreet, and smoke-free, releasing nicotine without combustion, vapour, or odour. Their appeal has grown particularly in the wake of the UK’s 2024 ban on disposable vapes, as many consumers transitioned directly from vapes to pouches. And Scandinavia offers a model: decades of widespread pouch and snus use coincide with some of Europe’s lowest smoking rates. Hence, advocates argue that the UK could accelerate its path to smoke-free status if policymakers embrace rather than restrict these alternatives.

Smarter options, not bans
The challenge now is to design regulation that protects youth while preserving harm reduction for adults. A recent study led by UCL and King’s College London provides one possible solution: standardized packaging.

Researchers tested how plain packs and limited flavour descriptors influenced perceptions of vaping among 2,770 young people and nearly 4,000 adults. The results were stark—53% of young people said their peers would be interested in branded vapes, but this dropped to 38% when shown plain packs. Crucially, adult interest in vaping as a cessation tool remained unchanged regardless of packaging.

The findings suggest that plain packaging reduces youth appeal without deterring adults. Hazel Cheeseman of Action on Smoking and Health (ASH) said the research illustrates how policymakers can “protect children without damaging [vapes] as a quitting aid for smokers.”

Such evidence-based measures stand in stark contrast to outright bans, which risk driving consumers back to smoking or into the hands of black-market suppliers. The ban on disposable vapes, for instance, while set with the intention of curbing youth uptake, is as expected also pushing consumers away from harm reduction altogether.

Keeping the Smoke-Free 2030 goal alive
The UK government has committed to making England smoke-free by 2030, and reaching that goal will require continued support for safer nicotine options. Vapes, heated tobacco, and nicotine pouches may not be entirely without risks, but they are certainly dramatically less harmful than cigarettes.

The evidence from the UK, Sweden, Japan, and New Zealand consistently underscores a simple truth: when smokers are given viable alternatives, smoking rates collapse and lives are saved. The opposite—banning or over-regulating safer products—only risks prolonging dependence on combustible tobacco, which remains the primary driver of preventable death worldwide.

As the Smoke Free Sweden report makes clear, the UK’s success story should not be taken for granted. Policymakers must resist the temptation of sweeping measures and instead double down on the strategy that has already delivered record-low smoking rates: harm reduction, as opposed to prohibition. The future of public health depends on it.