The Global State of Tobacco Harm Reduction 2024

Report highlights:

• SNPs are increasingly substituting for cigarettes, with inflation-adjusted combustible tobacco sales in decline and SNP sales increasing six-fold since 2015
• Analysis shows strong evidence of association between the rise in SNP use and a corresponding decrease in smoking in many countries, at rates far exceeding those achieved by tobacco control measures alone; market data from many countries adds further evidence for substitution
• More than two-thirds of the world's population – in nearly 130 countries – can currently access at least one form of SNP legally – while 100% can still buy cigarettes
• Governments must recognise and seize the opportunity SNPs offer to drive down smoking rates, with risk-proportionate regulations to enable people to quit smoking and switch

The report’s authors say that the extent to which SNP are replacing and substituting for combustible and risky oral tobacco products is the report’s central theme. Co-authored by experts in harm reduction, data science and economics, GSTHR 2024 considers what is driving these changes, how different regulatory environments have developed, and the complex interplay between products, consumers, and policy and regulation.

The opening section, ‘A Global Perspective’, uses the latest evidence and new data projections to assess the current global THR situation and its potential to rapidly reduce tobacco-related disease and mortality. The latest market data shows that while sales of combustible tobacco remain significantly higher than sales of SNP, two key shifts are occurring in the tobacco and nicotine market: firstly, the total market share of SNP is increasing, and secondly, inflation-adjusted combustible tobacco sales are declining, while SNP sales are experiencing rapid growth.

Although the nominal value of combustible tobacco sales increased from $752 billion in 2015 to over $1 trillion in 2024, when adjusted for inflation (and assuming a constant currency value), combustible tobacco sales actually decreased to $685 billion in 2024 - an 8.9% decline. Meanwhile, inflation-adjusted SNP sales grew nearly sixfold from 2015, reaching, in non-adjusted terms, $96 billion in 2024.

Further analysis shows, however, that Chinese data skews these figures. China’s tobacco market accounts for an astonishing $344 billion of the $1 trillion global combustible tobacco market. Despite being the global centre of production for nicotine vapes, the Chinese market for all SNP is extremely small, at less than 1.2% of its market for combustibles. GSTHR analysis removing China from the calculations reveals the true scale of the acceleration in the global SNP market: it has reached 12.3% of the total tobacco and nicotine market in 2024, up from virtually zero in 2004.

Adding weight to the substitution argument, analysis of prevalence data shows there is strong evidence of an association between the rise in SNP use and a corresponding decrease in smoking prevalence in the following countries: Sweden, Norway, New Zealand, the UK, the US, Ireland, Luxembourg and the Philippines, and to a lesser extent, Austria and Lithuania. The rates of reduction in many countries far exceeds those achieved by tobacco control measures alone. Market data also show that as the popularity of heated tobacco products (HTP) accelerates in numerous markets, there is a coincidental decline in cigarette sales, again suggestive of a substitution effect. In Kazakhstan, Lithuania and Portugal, cigarette sales have been dropping but more slowly than HTP sales have increased. However, in Hungary, South Korea, Italy and Germany, there has been approximately a one-to-one substitution of HTP sticks for cigarettes, and in Slovakia, Czechia, Russia, Japan and Greece, cigarette sales have dropped faster than HTP sales have increased.

Legal access to a range of SNP will be essential for the billion people who smoke worldwide to benefit from THR. Research undertaken for GSTHR 2024 shows that more than two-thirds of the world's adult population – in nearly 130 countries – can now legally access at least one form of SNP. Access to combustible tobacco products, known to kill up to half of all users, remains legal for 100% of the world’s adult population. The report also reveals, in an update to previous GSTHR research, that the global number of vapers has increased from 58 million in 2018, to reach an estimated 114 million in 2023. With 30 million people using other safer nicotine products, this means the GSTHR estimates there are now around 144 million users of SNP worldwide.

The authors say the World Health Organization continues to deny any potential health benefits of switching from cigarettes to SNP. The organisation and its allies have sought to encourage countries to introduce regulatory frameworks at least as restrictive as those for cigarettes, and in some cases more so. In several countries, the result is that safer products have been banned while cigarettes remain universally available. But there are signs of hope. At the 2024 Conference of the Parties (COP) to the Framework Convention on Tobacco Control in Panama, some Parties signalled that they are uncomfortable with the current position on tobacco harm reduction. The next COP meeting a year from now, in November 2025, will be one to watch.

Harry Shapiro, Executive Editor and Lead Author of The Global State of Tobacco Harm Reduction 2024: A Situation Report said: “People talk about a war on smoking, a war on nicotine or a war on vapes. But you don’t conduct a war against inanimate objects. This is a war against people. Those against tobacco harm reduction don't want people to use safer nicotine products. They're putting everything in their path to stop them, to the detriment of public health. And keeping people smoking just keeps more profits flowing to the tobacco industry.

“Despite the many barriers, we estimate that 140 million people around the world are using safer nicotine products. Many countries are showing significant reductions in smoking or falls in cigarette sales as SNP use increases, far faster than tobacco control has achieved alone. Safer nicotine products are here to stay. Let’s hope they are allowed to stub out the cigarette for good.”

Professor Gerry Stimson, co-founder of K∙A∙C which runs the GSTHR project, added: “The safer nicotine products available in 2024 offer what could be considered a classic harm reduction opportunity. The cigarette is a dirty delivery system, but it became the dominant route of nicotine administration, with the attendant risks of combustion and smoke inhalation leading to disease, disability and millions of deaths every year. But people can now consume nicotine without burning tobacco, by switching to significantly safer alternatives like vapes, heated tobacco products, snus and nicotine pouches.

“Harm reduction is often thought about as policies and strategies, driven by public health. But it isn’t only this. It’s also what people do themselves to reduce risks and improve their own health. Governments and both international and national health organisations, need to help create an environment in which people can be informed and empowered to make those safer choices. And the evidence from this report shows that – when safer products are appropriate, acceptable, accessible and affordable – people will switch, in fact are already switching, in their millions.”

Giorgi Mzhavanadze, GSTHR Economist, continued: “Growing evidence suggests that SNPs hold significant potential in reducing smoking prevalence, smoking-related mortality, and life-years lost from smoking. There seems little doubt that they are already making a positive impact on public health. However, fully realising the potential offered by these products as substitutes for cigarettes depends on the pace and scale of the transition. This will largely be dictated by national regulations and control measures, which, unfortunately, so often hinder rather than support these goals.”

Tomasz Jerzyński, GSTHR Data Scientist, concluded: “Monitoring smoking and SNP use is important; it allows us to understand the extent to which safer alternatives are replacing combustible tobacco. To observe and quantify this process, the dynamics of smoking and SNP use must be monitored over time. At the moment, data has to be drawn from multiple sources. These include official prevalence estimates, national or smaller scale population surveys and, where available, market data. The resulting figures are comparable only with the application of numerous assumptions, and cannot be taken as evidence, only insights. We hope more countries will adopt better monitoring practices over time.”

References:

• The Global State of Tobacco Harm Reduction 2024 report - https://gsthr.org/resources/thr-reports/the-global-state-of-tobacco-harm-reduction-2024-a-situation-report/
• Knowledge∙Action∙Change - https://kachange.eu/ 

Dave Cross

Journalist at POTV

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Dave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous start-ups to develop content for their websites.