Harm Reduction or Harm Creation? Rethinking Global Tobacco Policy

A report by CAPHRA calls for evidence-based reform, highlighting why prohibition fails, and urging evidence-based harm reduction to truly protect health and save lives.

The Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA) recently released a powerful report, “The Right to Health and Public Health Policy,” authored by C.Y. Virgino and N.E. Loucas, which exposes a disheartening contradiction. While governments invoke the human right to health—enshrined in Article 25 of the Universal Declaration of Human Rights and Article 12 of the International Covenant on Economic, Social and Cultural Rights—they continue to lean on heavy taxation of combustible cigarettes (thus sustaining government revenue), while suppressing safer alternatives like vapes and nicotine pouches.

At its core, CAPHRA asserts that the right to health is anchored in four pillars: adequate healthcare availability, nondiscriminatory access, cultural and scientific appropriateness, and quality grounded in evidence. Sadly, the report finds governments falling short on all counts: public health systems remain chronically under-funded, preventive care is subordinated to reactive policies, and even the COVID-19 pandemic revealed systems poorly designed for resilience or equity. Instead of prioritizing evidence-based, preventive strategies, too many policies serve political or financial interests—or what the authors label a “pay for play” public health economy that reinforces harm in vulnerable communities.

The right to health betrayed
Tobacco harm reduction groups have consistently insisted that protecting the right to health should not be optional. Governments and international bodies must commit to accountability, transparency, and evidence-based harm reduction—or risk deepening global health inequalities and wasting countless lives. Sadly, the latter is more often the case.

Their message lands with particular force when considering Australia’s tobacco policy fiasco. Despite levying some of the world’s steepest cigarette taxes—with packs costing up to A$50—Australia’s smoking rates have stubbornly clung around 11 percent since 2019. Far from reducing harm, these punitive policies have fueled a booming illicit tobacco economy worth A$6.3 billion, empowering criminal networks.

The breakdown has been violent: over 125 fire bombings since 2023, widespread community disruption, and a staggering A$156 million poured into enforcement—yet the violence continues. Experts have been warning that Australia’s approach isn’t just a public health failure; it’s a global warning that prohibitionist, ideology-driven policies can empower organized crime while leaving adult smokers with fewer, not safer, choices.

Contrast that with New Zealand, which embraced harm-reduction pragmatism. By offering widespread access to safer nicotine alternatives, adult smoking rates plunged from 15.1 percent in 2018 to just 6.9 percent by 2024. It is a testament to what science-driven, consumer-focused policy can achieve when ideology yields to results.

Breaking the closed bubble
At the Asia Forum on Nicotine (AFN25), scheduled for August 27, 2025, CAPHRA will spotlight these contrasts. Moderated by Loucas, the forum brings together regional harm-reduction experts in a region home to over half of the world’s 1.1 billion smokers. A central focus will be how consumer advocacy groups remain shut out of global policymaking—including the WHO’s FCTC, which permits far fewer NGO observers than the UN Climate Convention. This “closed bubble” approach stifles diverse perspectives, leading the WHO to double down on anti-vaping positions—even as countries like Sweden, Japan, and the UK demonstrate clearly that access to safer nicotine alternatives accelerates smoking declines.

Adding even more urgency to the forum’s agenda are the unintended consequences seen in Canada and Australia’s “pharmacy-only” models. In Canada (as of July 2025), nicotine pouches and low-strength vapes are available solely through pharmacies. Pharmacists defend this as necessary for age verification and customer safety. While since October 2024, Australia allows low-strength vapes via pharmacies (with ID checks and monthly limits), but stronger nicotine still needs a prescription.

Prohibition fuels harm and crime
In practice, these systems have failed. Many pharmacies opt out, citing the burden, many uneducated doctors are unwilling to prescribe the products, and legal sales remain negligible—while illicit markets flourish, and organized crime profits expand. This dynamic reinforces the reality: restricting safer products to pharmacies may feel prudent, but it creates barriers for adult smokers, drives illegal sales (often easier for youth to access), and undermines harm-reduction goals.

Prohibition isn’t new and its lessons are clear. One review of menthol cigarette prohibition in Massachusetts found hardly any drop in smoking rates but substantial illegal market activity—and disproportionate enforcement impacts on minority communities. While lessons from alcohol prohibition in the U.S. remain instructive: while alcohol consumption initially dropped, organized crime surged, toxic unregulated products proliferated, and crime and violence rose significantly. Similarly, stringent tobacco bans have historically produced illicit trade and corrupt enforcement.

The World Bank and other global institutions reinforce this perspective: illicit trade frequently thrives alongside prohibition and weak enforcement, especially where governance gaps and governance fragmentation exist. Cigarettes can fall into illicit supply lines rife with contaminants—research has documented illicit tobacco containing lead, cadmium, mold, even human waste. These products compound health risks and worsen inequalities.

Ideology vs. evidence: why harm reduction must take over
So what should the path forward look like? For CAPHRA and harm-reduction advocates, the answer is clear: policy should prioritize adult smokers by expanding access to safer alternatives, regulating them responsibly—not banning them outright or locking consumers out via pharmacy restrictions. Governments must fund health systems adequately, invest in preventive care, include consumer voices in policymaking, and design regulation based on real-world outcomes—not moral panic. AFN25 offers a platform for such change.

In line with real-world data, CAPHRA’s report indicated that ideology-driven prohibition doesn’t reduce harm—it reroutes it into criminal networks and entrenches inequality. By contrast, pragmatic harm reduction can halve smoking in a few years. The path ahead demands courage: to reject hollow symbolism, center consumer experiences, and ensure policies uphold the right to health in practice—not just in principle. Governments must choose: double down on failed dogma, or embrace the science and human rights that save lives.