Tobacco harm reduction in real-world action

Real-world evidence is increasingly demonstrating tobacco harm reduction (THR) in action, so why do many public health bodies and regulators remain sceptical? Joe Thompson, Group Science & Regulatory Affairs Director at Imperial Brands, builds on his panel contribution at the World Nicotine Congress to examine the arguments.

Increasingly, it’s real-world data – not just laboratory and clinical testing – that’s complementing the existing evidence base and helping fill critical gaps in understanding how next-generation products (NGP), including vapes and nicotine pouches, are used by consumers, and the impact they have on smoking behaviour and THR.

Traditional emissions testing and clinical studies remain essential tolls in our scientific substantiation. However, as consumer behaviour, product innovation, and the wider harm reduction debate evolve rapidly, these approaches alone cannot answer every question.

That’s why longitudinal, observational research, like our ‘actual use’ studies, can provide a close-to-real-world picture of how individuals who smoke use NGP to help them transition away from cigarettes.

The elephants in the room

However, despite mounting evidence, THR is still not universally endorsed or accepted.

For instance, misconceptions about the absolute risk of NGP – and nicotine – are still abound. Concerns are also raised about the lack of long-term epidemiological data on health impacts, while studies presented by industry are often dismissed out of hand. Finally, there are fears that NGP will become an ‘on-ramp’ to regular nicotine use and potentially future cigarette smoking for youth.

All these concerns are understandable and worthy of debate, but it’s also important they are considered against the ever-increasing weight of scientific evidence. Take nicotine, for example. To date, expert health organisations have concluded that nicotine, by itself, has not been established to cause cancer – yet this myth continues to endure.

Or consider the idea of the NGP on-ramp. In-market data[i] consistently shows that the off-ramp from cigarettes to NGP among adults who smoke is significantly larger than any on-ramp among never smokers, including youth.

While it’s vital to safeguard vulnerable populations, fears around NGP as a ‘gateway’ to cigarette smoking lack credence in terms of scientific data – and panels at the World Nicotine Congress broadly agreed that banning NGP on this basis would be an own goal for public health.

Bringing real-world evidence to the table

The most compelling insights come from nations whose NGP regulation have embraced THR strategies, and are beginning to generate meaningful data.

For example, Sweden has generated lots of epidemiological evidence. It’s on the cusp of becoming the world’s first smoke-free country, driven by decades of access to potentially harm reduced smoke-free alternatives like snus and, more recently, tobacco-free nicotine pouches. This report by Dr David Sundén highlights the impact of Sweden’s approach, reporting the number of daily smokers in the country being roughly only one third of the average numbers reported across the broader European Union.

Another notable example is New Zealand, where the daily smoking rate has reduced by around 58% since 2011/12[ii] following the promotion of vaping and heated tobacco as impactful cigarette alternatives.

Evidence-driven regulation

Nobody is suggesting NGP are risk-free, which is why responsible manufacturers  market them towards adults who smoke only.

But to dismiss them out-of-hand, or regulate them as harshly as cigarettes, ignores the growing weight of scientific and real-world evidence. More concerningly, it also risks pushing former adults who smoke back to cigarettes, or even worse into criminal illicit markets – as is reportedly happening in the Netherlands according to this article in the Brussels Times.

With major regulatory milestones approaching, including the latest revision of the European Union Tobacco Product Directive, it’s essential that policymakers recognise the continuum of risk and regulate accordingly. To either ignore – or cherry-pick –  scientific data when making vital decisions around tobacco control policy is potentially damaging to future public health outcomes.

Read Joe’s blog here. To find out more about Imperial Brands' consumer-centric, data-driven approach to tobacco harm reduction, visit their science website.

[i] NHS 2024; NYTS data; OFDT, 2025

[ii] New Zealand Health Survey, 2022/23