The global nicotine market is undergoing a profound transformation, with millions of smokers moving away from combustible tobacco and towards safer nicotine products. Yet while consumers are increasingly embracing tobacco harm reduction, governments are often moving in the opposite direction.
The
Global State of Tobacco Harm Reduction (GSTHR) 2026 Situation Report estimates that around 200 million people worldwide now use safer nicotine products (SNPs), including vapes, heated tobacco products, snus and nicotine pouches. That figure represents roughly one-fifth to one-quarter of the world’s approximately one billion smokers. The report’s central message is striking: the question may no longer be whether tobacco harm reduction will become a major force in nicotine use, but when policymakers will fully recognise it.
Where safer nicotine use goes up, smoking goes down
GSTHR analysis found that increasing use of safer nicotine products has coincided with declining smoking prevalence across 28 countries. In several nations—including Sweden, Norway, Iceland, New Zealand and the UK—use of safer nicotine products has already overtaken smoking.
Sweden, of course, still provides the most compelling example. High levels of snus and nicotine-pouch use have developed alongside exceptionally low smoking rates. GSTHR reports that daily smoking among Swedes aged 16–84 was 5.4% in 2024, while daily snus use stood at 15.7%. Among 16- to 29-year-olds, daily smoking had fallen to just 2%.
Nevertheless, the international pattern provides strong evidence that consumers can substitute lower-risk nicotine products for cigarettes when those alternatives are accessible and acceptable. The scale of this transition is now difficult to dismiss. GSTHR’s peer-reviewed estimates indicate that approximately 129 million people vaped in 2025, while around 78 million used heated tobacco products in 2024, in addition to tens of millions using snus and nicotine pouches.
The evidence for vaping as a cessation tool is undeniable
Vaping is not risk-free, but the relevant public-health comparison for an adult smoker is generally not vaping versus doing nothing. It is vaping versus continuing to inhale cigarette smoke. Reliable evidence increasingly supports that distinction. The latest Cochrane living systematic review included 104 studies involving 30,366 adults who smoke and found that nicotine e-cigarettes help more people quit smoking for at least six months than nicotine replacement therapy. For every 100 people using nicotine e-cigarettes, approximately eight to 11 may stop smoking, compared with around six using NRT.
Recent research is also adding to the evidence on toxicant exposure. A randomised clinical trial published in JAMA Network Open found that adults who switched from cigarettes to a nicotine pod-based e-cigarette experienced reductions in certain biomarkers associated with cigarette smoke exposure. The study concluded that effective nicotine delivery may help facilitate both smoking cessation and reductions in toxicant exposure.
Prohibition has never decreased demand
One of the report’s most important warnings concerns the growing disconnect between consumer behaviour and government policy. GSTHR found that restrictive measures targeting safer nicotine products vastly outnumbered policies expanding access during the period examined. By March 2026, it estimated that 109 countries—around one-third of the world’s population—had banned safer nicotine products outright.
But prohibition does not necessarily eliminate demand. The US provides a useful illustration. Research published in the American Journal of Preventive Medicine found that the amount of nicotine contained in e-cigarettes sold monthly increased by 249.2% between February 2020 and June 2024, while standardised unit sales rose by only 34.7%. Disposable products accounted for much of this expansion.
The lesson is that consumer demand for nicotine alternatives remains substantial even when regulators attempt to restrict particular products. Excessively restrictive policies can therefore create opportunities for illicit suppliers while removing regulated products from legitimate businesses.
The inequality problem
Perhaps the biggest missed opportunity lies in low- and middle-income countries, where most of the world’s smokers live. GSTHR reports that safer nicotine products remain disproportionately accessible in high-income countries. In many lower-income markets, cigarettes remain the cheapest nicotine product, while alternatives carry a significant price premium.
That creates a particularly troubling policy contradiction. The people who could potentially gain the most from switching away from combustible tobacco are often those facing the greatest financial barriers to doing so. Tobacco harm reduction should therefore not simply mean allowing safer products to exist. They need to be affordable, appropriately regulated and realistically accessible to adult smokers.
Change is already underway. Will lawmakers choose to keep up?
Smoking remains one of the world’s largest preventable causes of death, responsible for millions of deaths every year. The economic consequences are similarly enormous, including healthcare expenditure, lost productivity and premature mortality. Yet tobacco control policy frequently focuses on reducing nicotine use rather than prioritising the elimination of the most dangerous form of nicotine consumption: combustible tobacco. Emerging evidence suggests these objectives should not be confused.
The 2026 GSTHR report describes a world in which consumers are already conducting a vast, largely uncoordinated experiment in substitution. Around 200 million people have chosen safer nicotine products, while smoking continues to decline in many countries where those products are available. For policymakers, the opportunity is clear. Rather than treating every nicotine product as equivalent, regulation can distinguish between levels of risk, protect young people and non-smokers, maintain product standards and give adult smokers credible alternatives to cigarettes.
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