Japan’s success in fight against smoking is an example for the world

By Dr. Hiroya Kumamaru 

Over the past decade, Japan has achieved one of the most significant public health shifts in the world. The introduction of heated tobacco products has transformed smoking patterns and placed Japan among the leaders in harm reduction.

The figures are striking. Since heated tobacco was introduced in 2014, cigarette sales have dropped by more than half, the steepest decline in the nation’s history.[1] Smoking prevalence has fallen from 21% to 16% in less than 10 years.[2] Millions of Japanese smokers have chosen heated tobacco in place of cigarettes, leading to a measurable reduction in exposure to harmful toxicants.[3]

Health modelling suggests that if only half of Japan’s remaining smokers made the switch, as many as 12 million cases of smoking-related disease – including lung cancer, COPD, stroke and heart disease – could be prevented in the future.[4]

Biomarker studies already show that people who switch record significantly lower levels of harmful substances in their bodies and reduced markers of inflammation, offering tangible evidence of health benefits.[5]

Japan’s progress is highlighted in a new international report which I have co-authored with Smoke Free Sweden. The Safer Nicotine Revolution: Global Lessons, Healthier Futures documents how Japan, alongside Sweden, the United Kingdom and New Zealand, is showing that harm reduction is reducing smoking and saving lives.

In Sweden, smoking rates have fallen to just 5.3%,[6] the lowest in Europe, and lung cancer death rates among men are 61% below the EU average.[7]

In the UK, integrating vaping into NHS quit-smoking services has halved smoking rates since 2011[8] and is projected to prevent 166,000 premature deaths by 2052.[9] In New Zealand, smoking halved in just six years after vaping and heated products were promoted,[10] with COPD hospitalisation falling by nearly 30% and smoking-related cardiovascular deaths by 20%.[11]

Together with Japan, these countries demonstrate that safer nicotine alternatives deliver rapid declines in smoking and real health gains at the population level.

This recent phenomenon of tobacco harm reduction in Japan proves that technology and innovation can accelerate the decline of smoking and reduce the enormous health burden caused by tobacco. It also shows that culturally appropriate solutions, adapted to national contexts, can work at scale.

Japan should defend this achievement on the world stage. With smoking still a leading cause of disease and death worldwide, our experience provides a valuable model for other countries.

Japan has already shown extraordinary results by allowing millions of smokers to choose a less harmful option. The challenge now is to safeguard that progress, share the evidence with the world and ensure that harm reduction remains central to future tobacco policy.

• Hiroya Kumamaru is a cardiovascular surgeon and vice director of AOI International Hospital in Kawasaki, Japan.

[1] Global State of Tobacco Harm Reduction. Cigarette sales halved: Heated tobacco products and the Japanese experience [Internet]. 2024 May [cited 2025 Aug 27]. Available from: https://gsthr.org/resources/briefing-papers/cigarette-sales-halved-heated-tobacco-products-and-the-japanese-experience/

[2] World Health Organisation. WHO report on the global tobacco epidemic, 2025: Warning about the dangers of tobacco [Internet]. 2025 Jun 23. [cited 2025 Aug 27]. Available from: https://www.who.int/publications/i/item/9789240112063

[3] Odani S, Tabuchi T. Tobacco usage in the home: A cross-sectional analysis of heated tobacco product (HTP) use and combustible tobacco smoking in Japan, 2023. Environ Health Prev Med [serial online]. 2024 Mar 5 [cited 2028 Aug 19]; 29:11. Available from: https://pubmed.ncbi. nlm.nih.gov/38447971

[4] Mahlich J, Kamae I. Switching from Cigarettes to Heated Tobacco Products in Japan—Potential Impact on Health Outcomes and Associated Health Care Costs. Healthcare [serial online] 2024 Sep 27 [cited 2025 Sep 3]; 12(19):1937. Available from: https://www.mdpi.com/2227- 9032/12/19/1937

[5] Sakaguchi C, et al. Differences in Levels of Biomarkers of Potential Harm Among Users of a Heat-Not-Burn Tobacco Product, Cigarette Smokers, and Never-Smokers in Japan: A Post-Marketing Observational Study. Nicotine and Tobacco Research [serial online] 2021 Jul [cited 2025 Sep 3]; 23(7):1143-1152. Available from: https://academic.oup.com/ntr/article/23/7/1143/6121436

[6] Public Health Agency of Sweden. Use of tobacco and nicotine products [Internet]. 2024 Dec 12 [cited 2025 Aug 3]. Available from: https:// www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/living-conditions-and-lifestyle/andtg/tobacco/use-of-tobacco-and-nicotine-products/

[7] Institute for Health Metrics and Evaluation. Global burden of disease results [Internet]. 2021 [cited 2025 Aug 3]. Available from: https://vizhub.healthdata.org/gbd-results/

[8] Office for National Statistics (ONS). Adult smoking habits in the UK: 2023 [Internet]. 2024 Oct 1.[cited 2025 Aug 12]. Available from: https:// www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2023

[9] Levy D.T, et al. England SimSmoke: the impact of nicotine vaping on smoking prevalence and smoking-attributable deaths in England. Addiction [serial online] 2022 Aug 10 [cited 2025 Aug 31]; 116(5): 1196-1211. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9364758/

[10] Ministry of Health. Smoking status of daily vapers: New Zealand Health Survey 2017/18 to 2021/22 [Internet]. 2023 [cited 2025 Aug 3]. Available from: https://www.health.govt.nz/system/files/2023-05/smoking_status_of_daily_vapers.pdf

[11] Institute for Health Metrics and Evaluation. Global burden of disease results [Internet]. 2021 [cited 2025 Aug 3]. Available from: https://vizhub.healthdata.org/gbd-results/