Letter to UN General Assembly Delegates

Dear Sir/Madam,
We stand at a critical juncture for global public health. While smoking-related illnesses continue to kill more than 8 million people annually, we now have the proven capability to dramatically reduce that terrible toll.
By integrating Tobacco Harm Reduction (THR) practices into standard tobacco control measures, countries can significantly cut smoking-related deaths, potentially saving millions of lives.
Real-world evidence of this is indisputable. Sweden is on the cusp of becoming officially smoke-free and is a clear testament to the effectiveness of THR policies.
By encouraging smokers to switch to safer alternatives such as snus, nicotine pouches and vapes, Sweden has reduced its smoking rates by an astonishing 55% in the last decade.
Compared with the rest of the European Union, Sweden now has 44% fewer tobacco-related deaths, a cancer rate that is 41% lower, and 38% fewer deaths attributable to any cancer.
This remarkable achievement underscores that harm reduction works, saving lives and reducing healthcare burdens.
Sweden is not an isolated case. In 2019, New Zealand’s Ministry of Health endorsed vaping as a tool for smoking cessation. Since then, New Zealand has seen its smoking rates almost halve as it too nears smoke-free status, further affirming the potential of THR to help millions to quit harmful cigarettes. By promoting safer alternatives, New Zealand, like Sweden, is shaping a healthier future for its citizens.
Many other nations still grapple with alarmingly high smoking rates, including countries in Eastern Europe, the Middle East, parts of Asia and Africa. Evidence shows that millions of lives could be saved if these countries adopted progressive THR policies similar to those in Sweden and New Zealand. This week we learned that 280,000 lives could be saved in Czechia alone over the next four decades with the use of THR. This finding was a result of the latest study in a series of such analyses showing THR’s huge potential worldwide, from Brazil (1.4 million lives saved) to Bangladesh (920,000) and from South Africa (320,000) to Saudi Arabia (220,000).
Similar beneficial impacts could be replicated in every country across the globe. This is not about encouraging nicotine use; it is about offering safer choices to those who would otherwise continue to smoke.
It’s no exaggeration to say, therefore, that the world stands on the brink of a public health revolution. The evidence is clear: Tobacco Harm Reduction can drastically reduce smoking-related deaths and disease. However, this success depends on the will of governments. We urge the United Nations and global leaders to advocate for THR policies and to prioritise the health of their citizens.
The choice is stark. We can either embrace the path Sweden, New Zealand, and other progressive nations have forged, or we can turn away and condemn millions to harm and death. The decision should be easy. The time to act is now.
Yours sincerely,
Dr Delon Human
Smoke Free Sweden
Dr Derek Yach, US
MBChB MPH, Global Public Health Expert
Prof. Marewa Glover, New Zealand
Global Public Health Expert
Director, Centre of Research Excellence, Indigenous Sovereignty & Smoking