Countries page


For now, smoking remains a global problem. But a smoke-free future is possible.


In the past, the world’s adult smokers had two options: Quit, or continue to smoke, and accept all the harm that comes with doing so. The obvious right answer has always been to quit tobacco and nicotine altogether, but in any given year, more than 9 out of 10 don’t. These men and women who would otherwise continue to smoke deserve access to and information about better alternatives to smoking.


Now, scientific advances and innovation provide new cause for optimism. Without question, quitting completely remains the best option, but by eliminating the burning, scientifically substantiated smoke-free alternatives give those who would otherwise continue to smoke far better ways of enjoying tobacco and/or nicotine, with significantly reduced exposure to toxicants.


Of course, for these smokers to be able to switch to better alternatives, they first need to have access to, and accurate information about them. It’s therefore encouraging to see countries across the world updating their regulation to embrace the opportunities presented by smoke-free alternatives.

Waking up to the opportunity of smoke-free alternatives 


One such country is the United States. The Food and Drug Administration (FDA) has a comprehensive multi-year plan for tobacco and nicotine regulation which includes a science-based review of new tobacco and nicotine products. Part of that roadmap involves increasing restrictions on cigarettes, while allowing greater flexibility and accessibility for non-combustible products that potentially represent a less harmful form of nicotine delivery. The FDA also carefully weighs evidence regarding innovative products, like e-cigarettes, HTPs and snus.

Its framework acknowledges that tobacco and nicotine products exist on a “continuum of risk” and that nicotine—while addictive—“is most harmful when delivered through smoke particles in combustible cigarettes.”

FDA believes that the inhalation of nicotine (i.e. nicotine without the products of combustion) is of less risk to the user than the inhalation of nicotine delivered by smoke from combusted tobacco products.

Processes for substantiating new products are clearly outlined with the FDA Modified Risk Tobacco Product Application process, which sets a clear pathway for the scientific assessment of and communication about novel tobacco and/or nicotine-containing products that can be a better choice for adults who would otherwise continue to smoke.

In 2019, eight varieties of one particular snus product were the first of their kind authorized for sale as ‘modified risk tobacco products’ by the FDA—meaning the FDA determined, among other things, that the products, as actually used by consumers, will benefit the health of the population as a whole. More recently, in July 2020, the FDA authorized the marketing of a tobacco heating system as a modified risk tobacco product with reduced exposure information.

Progress can be seen across the Pacific too, with Japan demonstrating the potential smoke-free alternatives have to reduce cigarette sales. After the introduction of heated tobacco products in the country, cigarette sales dropped five-times faster than they had been prior to introduction.  Another study confirms that the accelerated decline in cigarette only sales coincided with the introduction and growth of the sales of HTPs.

The accelerated decline in cigarette only sales in Japan since 2016 corresponds to the introduction and growth in the sales of HTPs.
K. Michael Cummings, Georges J. Nahhas and Professor David Sweanor

At the same time overall decline of tobacco use has continued. This indicates that people are switching completely from cigarettes to HTPs rather than supplementing cigarette use or initiating use with HTPs. These are encouraging data which demonstrate that where smoke-free alternatives are made available to adult smokers, they are switching at scale to smoke-free products which can significantly reduce their exposure to risk.

These are just two examples where the availability of—and information about—smoke-free alternatives is starting to make a difference. A growing number of countries are beginning to embrace risk-proportionate regulation for smoke-free alternatives and recognizing their role in addressing a major global public health problem. If other countries follow in the footsteps of these countries, engage in open and informed dialogue, and let science and evidence guide their decision making, it’s no longer difficult to imagine a future in which cigarettes have been completely eradicated. That’s worth talking about.

Countries page






Sources for this page:

1. U.S. Food and Drug Administration, FDA News Release: FDA Announces Comprehensive Regulatory Plan to Shift Trajectory of Tobacco-Related Disease, Death (July 27, 2017), 

2. U.S. Food and Drug Administration, Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Restrictions on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products, (2016),

3. Stoklosa M, Cahn Z, Liber A, et al., “Effect of IQOS introduction on cigarette sales: evidence of decline and replacement”, British Medical Journal, June 2019, https://   

4. Cummings K, Nahhas G, Sweanor D, “What Is Accounting for the Rapid Decline in Cigarette Sales in Japan?”, Int. J. Environ. Res. Public Health, May 2020.