The Global Nicotine Transition: A Progress Report From the Front Lines

The global nicotine transition—from combustible cigarettes to non-combustible alternatives—is not happening uniformly. It's unfolding at different speeds, through different products, shaped by different regulatory environments, in different cultural contexts. The transition looks radically different in Stockholm (where snus has been the dominant nicotine product for decades), in London (where vaping is integrated into the public health system), in Tokyo (where heated tobacco dominates), in Shenzhen (where the products are manufactured), in Nairobi (where cigarettes are still growing), and in São Paulo (where the tobacco industry is fighting a rearguard action against regulation). A global tour of the nicotine transition reveals both the diversity of experience and the common challenges that unite them.

Stockholm is the past and the future of the nicotine transition. Sweden's experience with snus—a centuries-old oral tobacco product that replaced cigarettes among Swedish men over the latter half of the 20th century—is the longest-running real-world experiment in nicotine harm reduction. The results—the lowest smoking rate and lowest tobacco-related mortality in Europe—are the strongest evidence that the transition works. The Swedish model is not replicable everywhere—snus is culturally specific, and the transition occurred over decades through consumer behavior rather than policy intervention—but the principle it demonstrates is universal: when non-combustible nicotine products are cheaper, more accessible, and more socially acceptable than cigarettes, smokers switch.

London represents the policy-led transition. The UK's explicit embrace of vaping as a harm-reduction tool—through Public Health England's communications, the NHS 'swap to stop' program, and risk-proportionate regulation—has accelerated smoking decline beyond what would have been expected from conventional tobacco control alone. The UK model demonstrates that governments can actively promote the transition, not just permit it. The UK experience also demonstrates that harm-reduction policies don't inevitably produce youth vaping epidemics: the UK's youth vaping rate, while a concern, is lower than the U.S. rate despite more permissive policies. The lesson is not that UK policy is perfect but that proactive harm reduction, combined with strong youth-access enforcement, can achieve both adult smoking reduction and youth protection.

Tokyo represents the accidental transition. Japan did not set out to embrace heated tobacco. The regulatory environment—nicotine e-liquid is effectively banned under pharmaceutical law—should have prevented any non-combustible nicotine transition. But IQOS, launched in 2014, exploited a regulatory gap: it heated tobacco rather than vaporizing nicotine liquid, and it wasn't classified as a pharmaceutical. The result was the fastest smoking decline ever recorded in a major market—cigarette sales fell by over 40% in seven years—driven not by policy but by consumer substitution. The Japanese experience is both encouraging (the transition can happen rapidly when a satisfying alternative is available) and cautionary (heated tobacco is almost certainly more harmful than vaping, and Japan's regulatory framework prevented the lowest-risk products from competing).

Shenzhen is where the products are made—and increasingly, where the regulatory framework is being written. China's 2022 regulatory intervention transformed the global vaping supply chain: thousands of small manufacturers closed or consolidated, production standards improved, and the global market for vaping hardware became more concentrated and more compliant. The Shenzhen experience demonstrates both the power and the limits of manufacturing-based regulation. China can control what's produced in its factories, but it can't control what's sold in other countries' markets—and the products that are banned for domestic Chinese sale continue to be manufactured for export. The global nicotine transition depends on Shenzhen, but Shenzhen is not accountable to the global consumers who depend on its products.

Nairobi represents the transition that hasn't happened yet. Smoking rates in many African countries are still rising, driven by population growth, rising incomes, and aggressive industry marketing. The non-combustible products that are transforming nicotine use in high-income countries are largely unavailable, unaffordable, or unknown to African smokers. The tobacco industry's 'smoke-free' narrative, so prominent in its Western communications, is largely absent from its African operations. The result is a bifurcated global transition: accelerating in rich countries, not yet begun in many poor ones. The equity dimension of this bifurcation—the populations that would benefit most from the transition are the ones being denied it—is the most urgent and least addressed challenge in global nicotine policy.

São Paulo represents the contested transition—the battle between tobacco control and the tobacco industry that's playing out across Latin America and much of the developing world. Brazil's tobacco control framework is among the strongest in the developing world, and its smoking rates have declined substantially. But the industry continues to fight every regulatory advance—through litigation, farmer mobilization, and the same arguments about jobs and illicit trade that have been effective globally. The Brazilian experience demonstrates that the nicotine transition is not just a matter of making reduced-risk products available. It's a political battle against an industry that has no interest in transitioning away from its most profitable product.

The global tour reveals that the nicotine transition is neither inevitable nor impossible. It's happening, unevenly and incompletely, driven by a combination of consumer behavior, technological innovation, regulatory action, and industry strategy. The transition can be accelerated (through risk-proportionate regulation, honest communication, and international cooperation) or obstructed (through prohibitionist policies, precautionary paralysis, and industry capture of the regulatory process). The speed and equity of the global nicotine transition will be determined by the choices made in the next decade. The transition is underway. The question is whether it will reach the populations that need it most.