WHO spurns the world’s most successful anti-smoking story

by Dr Delon Human, leader of Smoke Free Sweden

The World Health Organization’s (WHO) latest report on nicotine pouches claims to expose the marketing tactics behind the global rise of smoke-free nicotine products. Across 156 pages, the focus falls heavily on flavours, branding, youth appeal and industry behaviour. 

But what’s missing from the discussion is the most important public health question of all: what happens when adult smokers have access to safer nicotine alternatives in a properly regulated environment?

The answer already exists. It is called Sweden.

Sweden receives only a brief mention in the report as the country with the world’s highest per-capita use of nicotine pouches. Yet Sweden is also on the brink of becoming the first officially smoke-free nation in the world and has the lowest rates of tobacco-related disease in Europe.

Sweden’s progress has been driven by adult smokers moving away from cigarettes towards smoke-free alternatives such as snus, nicotine pouches and vapes. 

Policymakers supported that transition by ensuring these products remained accessible, acceptable and affordable.

WHO officials launching its report urged countries not to follow Sweden’s example, arguing its success stems mainly from traditional tobacco control measures. 

Yet conventional policies have been in place across Europe for decades – and smoking rates across the continent remain roughly four times higher than Sweden’s.

Sweden stands apart because smokers have widely adopted lower-risk alternatives to cigarettes.

Nor is Sweden an isolated case tied to Nordic culture or habits. Similar results are emerging in countries that have also embraced harm reduction approaches.

The United Kingdom integrated vaping into smoking cessation services and saw smoking rates fall from 20.2% in 2011 to 11.9% in 2023 – a 41% reduction.

New Zealand halved its smoking rate between 2018 and 2024 while actively promoting vaping as a less harmful option for smokers. 

In Japan, the arrival of heated tobacco products in 2014-15 coincided with the fastest decline in smoking in the country’s modern history, with prevalence falling from 21% in 2015 to 16% in 2023.

These examples show that different societies have reached remarkably similar outcomes when smokers are encouraged to move away from combustible cigarettes.

Despite this evidence, WHO repeatedly frames nicotine pouches as a danger to public health. Its report warns they could “threaten to undermine decades of progress in tobacco control”. 

Yet Sweden’s experience points in the opposite direction. As the use of smoke-free nicotine products increased, smoking rates and tobacco-related disease continued to fall.

WHO also wants to ban claims that products are “safer” or “less harmful”. But smokers deserve accurate information about relative risk.

People smoke for nicotine, but the overwhelming harm comes from inhaling toxic smoke produced by burning tobacco.

International evidence consistently shows that smokeless nicotine products are substantially less harmful than cigarettes. No nicotine product is entirely risk-free, but equating all nicotine products with smoking ignores the scientific evidence and creates confusion among smokers seeking alternatives.

Clear communication matters because smokers are more likely to switch when they understand the relative risks. 

WHO already recognises this principle when endorsing nicotine replacement therapies, such as gum or patches, for smoking cessation. The same logic should apply to smoke-free consumer alternatives.

The report also supports high taxes and flavour bans aimed at reducing the appeal of nicotine pouches. 

Experience from other countries suggests these policies can have damaging unintended consequences. Higher costs and fewer product choices reduce switching among smokers, encourage illicit trade and risk pushing former smokers back towards cigarettes.

Flavours are particularly important for many adults trying to quit smoking. Research from Yale found that adults using non-tobacco flavours were more likely to stop smoking successfully. Denmark’s restrictions on e-cigarette flavours have meanwhile coincided with rising youth vaping and expanding illicit markets for banned products.

Demand for nicotine does not disappear when safer alternatives are restricted. The danger is that cigarettes remain the easiest and most familiar option.

Sweden has shown the world what can happen when policymakers focus on reducing smoking-related harm rather than opposing every form of nicotine use. That evidence deserves serious attention.