Nature Health Calls for “Smoke-Free 2040” Strategy Ahead of World No Tobacco Day
On the eve of World No Tobacco Day, Nature Health, a journal within the Nature series, published a commentary article suggesting that regulated non-combustible nicotine products could accelerate the global decline in smoking rates. The authors propose a “Smoke-Free 2040” goal and call for the establishment of a risk-proportionate regulatory framework that distinguishes between combustible cigarettes and lower-risk nicotine alternative products.
Key Highlights
- Publication in a Renowned Journal: On the eve of World No Tobacco Day, Nature Health published a commentary article proposing the more formal integration of non-combustible nicotine products such as e-cigarettes, nicotine pouches, and heated tobacco products into global tobacco control policies.
- The 2040 Goal: The authors propose a global “Smoke-Free 2040” goal aiming to reduce the daily smoking rate among adults to below 5% by 2040 and argue that existing tobacco control measures alone may be insufficient to achieve a decline at the necessary speed.
- Risk-Proportionate Regulation: The article advocates that public health policy should focus on the harms associated with combustible tobacco rather than on nicotine itself, and calls for the creation of a risk-proportionate regulatory framework that differentiates between cigarettes and non-combustible alternative products.
- Harm Reduction Pathways: The authors suggest that products such as e-cigarettes, nicotine pouches, heated tobacco products, snus (oral tobacco), and nicotine replacement therapies could, under strict regulation and with safeguards for youth protection, help adult smokers transition away from cigarettes.
- Global Divergence: The publication of this article coincides with the WHO’s release of its first global report on nicotine pouches; globally, discussions regarding nicotine policy are intensifying, centering on issues such as youth protection, adult transition, and the relative risks associated with different products.
Nature Health Commentary Proposes a “Smoke-Free 2040” Goal
May 20, 2026. Three global health experts have called for the more formal integration of “smoke-free nicotine products” into tobacco control policies. They argue that, within a regulatory framework, cigarette alternative products could help accelerate the global decline in smoking rates. In late April 2026, Robert Beaglehole, Ruth Bonita, and Tikki Pang published a commentary article online in Nature Health, a journal within the Nature series titled “Smoke-free nicotine products can accelerate the end of the smoking epidemic.” In this article, they proposed a global “Smoke-free 2040” goal: to reduce the daily smoking rate among adults to below 5% by the year 2040. The article was published on the eve of World No Tobacco Day, May 31.
About Nature Health and the Authors
Nature Health is a new health-focused journal launched by Nature Portfolio in January 2026. It focuses on public health, global health, and population health, emphasizing the impact of research on health policy and practice. Nature Portfolio features Nature as its flagship journal and encompasses numerous Nature-branded research journals.
Beaglehole and Bonita are affiliated with the University of Auckland in New Zealand. Pang served as Director of Research Policy and Cooperation at the World Health Organization (WHO) from 1999 to 2012 and is currently affiliated with the Center for Healthcare Policy and Reform Studies (CHAPTERS), based in Jakarta.
Why the Authors Believe Current Tobacco Control Measures Are Not Enough
The authors note that despite the progress achieved over the two decades since the implementation of the WHO Framework Convention on Tobacco Control (FCTC), smoking continues to cause over seven million deaths annually. They argue that existing tobacco control measures, including taxation, advertising restrictions, smoke-free public spaces, and cessation support, remain essential; however, relying solely on these measures may make it difficult to reduce smoking rates at a sufficiently rapid pace in many countries with a high burden of tobacco-related disease.
In the context of this article, “smoke-free nicotine products” refers to a category of nicotine-containing products that do not generate smoke through combustion. The products cited in the text include vapes, nicotine pouches, snus (oral tobacco), heated tobacco products, and nicotine replacement therapy products. This concept emphasizes not whether a product contains tobacco, but rather how it differs from combustible cigarettes in terms of usage method and the source of its associated risks.
The Focus Should Be on Combustion, Not Nicotine Itself
The core argument of the article is that public health policy should focus on eliminating the use of combustible tobacco, rather than on the use of nicotine itself. The authors write: “Decades of evidence indicate that it is exposure to smoke generated by combustion, not nicotine, that causes tobacco-related diseases.”
Based on this premise, the authors argue that smokeless nicotine products should not be regulated in the same manner as cigarettes.
A Risk-Proportionate Regulatory Framework
The authors do not claim that these products are “risk-free.” Rather, they contend that regulation should reflect the “continuum of risk” that exists among different nicotine products. The authors state that combustible tobacco products should be subject to the strictest restrictions and bear the highest excise taxes; conversely, smokeless alternative products should be regulated regarding product safety, youth protection, environmental impact, and marketing practices, while ensuring that their potential to serve as alternatives to smoking is not undermined.
This framework implies that for smokeless nicotine products to play a larger role in tobacco control policy. They must be coupled with product safety standards, restrictions on youth access, and evidence demonstrating their capacity to help adult smokers transition away from cigarettes.
Tobacco Harm Reduction Remains an Underutilized Strategy
The authors note that although Article 1(d) of the FCTC (Framework Convention on Tobacco Control) explicitly lists harm reduction as a component of comprehensive tobacco control. The implementation of tobacco harm reduction remains underdeveloped within global tobacco control policies.
They point out that, in practice, harm reduction is often treated as a peripheral issue within tobacco control or even perceived as conflicting with it. The authors argue that harm reduction should be viewed as a complementary strategy, particularly for adult smokers who have been unable to quit using traditional methods.
Examples From Sweden, Japan, and New Zealand
The article cites several country-specific examples. In Sweden, the widespread use of snus is associated with lower smoking rates and a reduced burden of tobacco-related diseases.
Japan, cigarette sales experienced a significant decline following the market introduction of heated tobacco products in 2016. In New Zealand, smoking rates had undergone decades of gradual decline under FCTC-compliant tobacco control measures; however, after 2018, as access to regulated e-cigarette products expanded, the rate of decline accelerated.
The authors further observe that the most pronounced declines in smoking rates in New Zealand were observed among Māori and other vulnerable populations. This suggests that harm reduction strategies may contribute to narrowing health disparities. The article presents these national case studies as evidence that smokeless alternative products can drive population-level reductions in smoking rates at the same time. The authors emphasize that existing tobacco control measures remain crucial.
2040 Smoking Prevalence Target
The authors propose a goal to reduce the global prevalence of daily smoking among adults to below 5% by the year 2040.
The authors note that, as of 2024, approximately 16% of the global population aged 15 and older smokes; specifically, the smoking rate among men stands at about 28%, which is significantly higher than the rate of approximately 5% among women. If current trends persist, the global smoking rate is projected to decline to around 10% by 2040. The authors assert that achieving the target of less than 5% will require a significant acceleration in the current annual rate of decline in smoking prevalence.
Can Alternative Products Help Reach the Goal?
This objective shifts the focus of the discussion from tobacco reduction in a general sense to a more specific question: can daily smoking prevalence be reduced to low single-digit levels through a combination of established tobacco control measures and regulated, smoke-free alternative products?
The authors argue that implementing this strategy requires greater regulatory consistency. They point out that in many markets, cigarettes remain widely available, while lower-harm alternative products face stricter restrictions. The authors contend that this situation may result in the de facto protection of the most dangerous products, while simultaneously limiting adult smokers’ access to alternative options.
Youth Use, Dual Use, and Uncertainty
The article also addresses concerns surrounding youth use, the uncertainties regarding long-term health effects, and the dual use of both cigarettes and smoke-free products.
Concerns About Youth Access and Long-Term Effects
The authors acknowledge that the issue of youth use warrants serious attention, but argue that it should be evaluated in proportion to the proven harms associated with continued smoking. They note that some studies linking youth e-cigarette use to subsequent smoking may be confounded by shared risk factors, including sensation-seeking behavioral tendencies and social environments. At the population level, the authors observe that in countries where e-cigarette use has become more common, youth smoking rates have continued to decline.
Regarding long-term health effects. The authors state that ongoing monitoring and independent research remain necessary, particularly concerning newer products such as nicotine pouches. However, they maintain that, because they lack combustion, these products are, by their very nature, less harmful than cigarettes.
Understanding Dual Use Patterns
With respect to dual use, the authors point out that users do not constitute a homogeneous group. Some individuals may be making only partial or temporary changes, while others may be reducing their cigarette consumption as a transitional step before ultimately quitting smoking altogether. Citing biomarker studies, the article states that dual users, those who use both combustible tobacco and alternative products, exhibit lower levels of exposure to toxic substances compared to exclusive smokers.
Implications for Low- and Middle-Income Countries
The authors note that low- and middle-income countries face unique challenges, including tobacco remaining relatively affordable relative to income, limited access to cessation services, and uneven regulatory capacity.
Taxation and Regulatory Challenges
They argue that implementing risk-proportionate taxation, levying higher excise taxes on combustible tobacco while imposing lower tax burdens on smokeless alternative products, could encourage smokers to switch products, thereby maintaining government revenue while reducing long-term healthcare costs. The authors also point out that large nations have state-controlled tobacco industries, including China and Indonesia. These face particular challenges that require high-level government leadership.
The article suggests that, against this backdrop. The WHO could play a catalytic role in fostering the recognition of harm reduction as an integral component of comprehensive tobacco control.
The Broader Debate on the Eve of World No Tobacco Day
The publication of this article coincides with intensifying global discussions surrounding nicotine regulation, taking place just ahead of World No Tobacco Day.
WHO Releases First Global Report on Nicotine Pouches
On May 15, the WHO released its first global report on nicotine pouches, warning that the rapid growth of the nicotine pouch market, marketing targeting youth, and weak regulatory frameworks are converging to create a significant public health concern. The WHO reported that global retail sales of nicotine pouches exceeded 23 billion units in 2024, yet approximately 160 countries have not yet established specific regulations for this product category.
Tikki Pang’s Earlier Comments on Harm Reduction
Pang had expressed similar views in an interview with 2Firsts back in August 2025. In that interview, he noted that while the FCTC had achieved early successes through taxation, advertising bans, and age restrictions, it had failed to incorporate tobacco harm reduction into its cessation strategies. He further observed that Asia, home to 70% of the world’s smokers, faces significant political, economic, and regulatory hurdles regarding tobacco harm reduction.
A Continuing Global Policy Divide
This ongoing discussion reflects the persistent divergence within global nicotine policy: how governments should strike a balance between protecting youth, addressing the risks of nicotine addiction, facilitating product switching among adult smokers, and weighing the relative harms of combustible versus non-combustible tobacco products. Continue to monitor developments in global tobacco control, nicotine science, and tobacco harm reduction policies.
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