A Position Statement by SCOHRE and Allied Associations

Introduction

Over recent decades, tobacco control has saved millions of lives. Yet, despite significant global progress, the world continues to face an enduring smoking epidemic. The time has come to complement established strategies with science-based harm reduction approaches — not as a replacement, but as an essential evolution in global tobacco control.

The Continuing Challenge

The  Framework Convention on Tobacco Control (FCTC) — the first global health treaty negotiated under the auspices of the World Health Organization (WHO) — was established in response to the globalization of the tobacco epidemic. Its implementation has led to substantial progress in tobacco control worldwide, yet systemic barriers remain in many countries.

 

Despite decades of effort, population growth has meant that the absolute number of smokers continues to increase. More than one billion people around the world still smoke — 80% of them in low- and middle-income countries — and tobacco use causes roughly eight million premature deaths each year.

The Role of Nicotine and the Need for Change

Nicotine is addictive, but it plays a negligible role in smoking-related morbidity and mortality. In fact, it is safely used in Nicotine Replacement Therapies (NRTs) to help people quit smoking. Medically assisted smoking cessation, one of the most cost-effective interventions in medicine, remains the ideal pathway for smokers. Yet, it has not been sufficient to end the global smoking epidemic.
We believe that tobacco control strategies must be reshaped to include harm reduction, and that lower-risk alternatives should be actively encouraged alongside cessation and prevention measures.

Evidence and Opportunity

There is mounting scientific evidence supporting Tobacco Harm Reduction (THR), yet resistance to incorporating this strategy persists. New approaches continue to emerge, offering less harmful alternatives to cigarettes for smokers who, for various reasons, are unable or unwilling to quit smoking by themselves or with medical support. Encouraging smokers to switch to these lower-risk products can have a profoundly positive impact on individual and public health alike.

Evidence demonstrates that countries adopting more holistic and pragmatic approaches to tobacco control have achieved greater success in reducing smoking rates — including the United Kingdom, Sweden, Japan, Greece, and the Czech Republic. Their progress stems from embracing harm reduction strategies, ensuring access to lower-risk alternatives, and empowering smokers to make informed choices.
The Swedish experience with snus — and the successful adaptation of similar models elsewhere — provides compelling proof that integrating less harmful nicotine alternatives can accelerate declines in smoking without compromising public health objectives.

A Call to the WHO and Global Policymakers

Article 1(d) of the WHO Framework Convention on Tobacco Control (FCTC) explicitly defines tobacco control as “a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke.”
Yet, despite this clear definition, the WHO continues to oppose tobacco harm reduction (THR).

 

The Eleventh Session of the Conference of the Parties (COP11) to the WHO FCTC, scheduled for November 2025 in Geneva, will address how governments should regulate novel and emerging tobacco and nicotine products. It is vital that COP11 discussions acknowledge the growing body of scientific evidence supporting harm reduction and include these products as essential components of a comprehensive, evidence-based approach to tobacco control.

Empowering People Through Knowledge

We must strengthen the knowledge that empowers people to take control of their health, in alignment with the 1986 Ottawa Charter for Health Promotion. This means expanding access to education, smoking cessation support, and harm reduction strategies.
Better-informed patients achieve better health outcomes. Better-informed doctors and public health officials create better-informed patients. And better-informed policymakers deliver more effective public policies. Regulators and decision-makers must ensure that every choice they make is grounded in evidence and guided by science.

Science Over Stigma

We believe that promoting the idea that all nicotine products are equally harmful as cigarettes is deeply misleading. Public health authorities have a duty to provide truthful, evidence-based information about the significantly lower risks posed by newer nicotine products compared to the unquestionably lethal effects of smoking.
Withholding such information — and failing to encourage smokers to switch to less harmful alternatives — is not only a violation of consumer rights, but also a serious act of public health negligence.

Conclusion and Call to Action

SCOHRE, together with allied associations, calls for an urgent reform of tobacco control policies — grounded in science, transparency, and the protection of public health.
The upcoming Conference of the Parties (COP) to the FCTC represents a unique opportunity to update and adapt global tobacco control strategies, moving beyond dogma and embracing evidence-based solutions that save lives.