In 1974, cigarettes were part of the fabric of British life. People lit up in offices, railway carriages and hospital waiting rooms, cigarettes were advertised almost everywhere and used by more than half of men and almost half of women in Great Britain.
Fifty years later, according to an Office for National Statistics survey, just nine in 100 British adults smoke. Few changes in public behaviour have been so pronounced. Fewer still have overturned a habit once considered an ordinary part of adult life.
Britain’s success began with measures familiar across Europe: advertising restrictions, steep excise duties, indoor smoking bans and services designed to help smokers quit. Every EU country has deployed some version of this playbook, several more aggressively than Britain. Yet roughly a quarter of adults across the bloc still smoke.
What set Britain apart was the alternative it offered smokers alongside the pressure to stop.
In 2015, Public Health England commissioned an independent evidence review, led by Professor Ann McNeill of King’s College London and Professor Peter Hajek of Queen Mary University of London. Its best estimate was that e-cigarettes are around 95 per cent less harmful than smoking. It found no evidence that vaping was acting as a route into smoking for children or non-smokers, but it did uncover another problem: close to half the public did not understand that vaping was substantially less harmful than cigarettes.
In April 2023, the Department of Health and Social Care launched Swap to Stop, a world first, offering a million smokers in England, nearly one in five of the total, a vape starter kit and behavioural support to go with it. Rather than demand abstinence from nicotine, using a ‘quit or die’ approach, it set out to separate nicotine from the far greater dangers of burning tobacco.
A harm reduction policy, backed by solid evidence in the UK has had an exceptionally positive effect. Action on Smoking and Health now estimates that 4.8 million British former smokers used vaping to quit, 2.5 million of them in the past five years alone.
Sweden got to the same place earlier, with a different product. Swedish smokers moved to snus and, more recently, to nicotine pouches, with daily smoking in Sweden at 5.3 per cent among adults in 2024, by far the lowest rate in the European Union. At the same time, Sweden has the lowest rate of tobacco-related death on the continent.
What both these cases show is that taxes, restrictions and public-health campaigns can make cigarettes less attractive, but less harmful alternatives give smokers a realistic way out.
The most up-to-date research only strengthens the case for vaping as a cessation tool. An ongoing Cochrane review has found high-certainty evidence that regulated nicotine e-cigarettes produce higher quit rates than traditional nicotine-replacement therapies such as patches and gum.
But, in the UK now, there is a clear danger that the distinction that brought so much of the progress towards a smokefree Britain will be erased. The UK government is now consulting on proposals that will severely restrict the packaging, appearance and retail display of vaping and nicotine products, alongside tobacco. Flavour descriptions are also under threat.
The difficulty is that regulation can create risks of its own. If vapes and other less harmful nicotine products are packaged, displayed and discussed as though they were as dangerous as cigarettes, smokers may reasonably infer that there is little benefit in switching. Public understanding of relative risk is already poor. Badly designed rules meant to deter young people from vaping could end up discouraging adults from giving up cigarettes.
Meanwhile, flavour variety in safer nicotine products is important because fruit, not tobacco, keeps most ex-smokers off cigarettes. Research by ASH, the UK’s leading voice on tobacco control, shows 60% of vapers prefer fruit flavour, while only 9% choose tobacco flavour. Strip away flavours, and ASH’s own research shows 15% of vapers expect to smoke more, while 14% expect to turn to the illegal market. A rule designed to protect children could instead send adults back to cigarettes, or into a black market with none of today’s safeguards.
The government’s current consultation and subsequent legislation should therefore be guided by two objectives. First, it should make nicotine products less attractive and less accessible to children. Second, it should also preserve an intelligible distinction between combustible tobacco and lower-risk alternatives intended for adults. The continued progress towards lower smoking rates may depend on whether ministers can regulate nicotine without forgetting that combustion is the principal killer.
The consultation is open to the public until 11.59 pm on 2 October, 2026. Responses can be submitted through the Department of Health and Social Care consultation.
