'Smoking Declines And Public Health Improves In Countries Where Safer Nicotine Alternatives Are Allowed': Tholos Foundation Study

New Delhi: An international white paper by the Tholos Foundation demonstrates that countries adopting scientifically substantiated, safer nicotine alternatives are witnessing rapid and sustained declines in smoking rates and related diseases. The report, Safer Nicotine Works, shows that when adult smokers have access to regulated, less harmful nicotine products—alongside existing tobacco control policies—smoking prevalence drops faster and public health improves.

The report details how Japan and Sweden achieved dramatic reductions through consumer-driven switches to safer nicotine alternatives such as heated tobacco and oral nicotine products. In Japan, male smoking rates fell below 30% in 2020, for the first time after tobacco heating systems were introduced in 2016; reversing years of stagnation and contributed to a 32% decline in five years.  In Sweden, smoking prevalence dropped to 5.6% in 2023, nearing smoke free status, driven by the rapid uptake of snus and nicotine pouches that entered the market in 2016.

The decline occurred without prohibiting cigarettes; instead, it came from offering adult smokers regulated, sciencebacked alternatives that pose significantly lower harm. In India, however, the publichealth potential of harmreduction strategies remains untapped. The 2019 ban on Electronic Nicotine Delivery System (ENDS) also swept in heated tobacco products, despite both being distinct categories. No robust scientific assessment was conducted in India to differentiate these products, nor has India considered any extensive scientific and realworld evidence emerging from countries such as Japan, Sweden, the UK, USA and New Zealand among others.

As a result, adult smokers in India have no access to regulated, scientifically validated alternatives—depriving them of products with harmreduction benefits thereby restricting their freedom of choice. 

Commenting on the findings, Tholos Foundation Vice President Lorenzo Montanari said, ‘’Safer nicotine is, quite literally, saving lives around the world. The experience of Sweden and Japan, just as in the UK, Canada, New Zealand and France, proves that when people have access to safer products, they choose them in huge numbers. We now have the tools we need to fight harmful high smoking rates: governments around the world must now support their citizens to make a better choice.’’

With India facing one of the world’s highest burdens of tobaccorelated disease, reexamining the blanket ban on all reduced risk nicotine products could unlock substantial publichealth benefits. A science based framework that protects youth while offering adults safer alternatives can help India align with global best practices and reduce smoking harm.