Global tobacco control at a crossroads: a battle between ideology and evidence

Core insight: Global tobacco control is at a critical turning point. The traditional prohibitionism ideology represented by the World Health Organization’s Framework Convention on Tobacco Control (FCTC) is increasingly in conflict with real-world evidence centered around “Tobacco Harm Reduction” (THR). The contradiction between outdated theories and pragmatic data not only weakens the decision-making credibility of the convention, but also indicates that the global public health strategy may face a profound paradigm shift.

Driving factors:

• Technological disruption and outdated regulatory framework: The emergence of non-combustible products such as electronic cigarettes, nicotine pouches, and heated tobacco has completely changed the pattern of nicotine consumption. However, the FCTC framework, born 20 years ago, was designed to address traditional cigarettes, and its structural flaws make it difficult to adapt to and effectively regulate these new products with vastly different levels of risk.
• The paradox between empirical evidence and policy behavior: Data from countries such as Sweden, Japan, and New Zealand clearly indicate a historic decline in smoking rates after the widespread adoption of safer nicotine alternatives. The most ironic thing is Denmark, whose domestic research shows that the sharp decline in adolescent smoking rates coincides with the shift to non-combustible products. However, its representative went against the trend at COP11 and pushed for a comprehensive ban, highlighting the serious contradiction between ideology and scientific evidence in policy-making.
• The confrontation between closed decision-making and external pressure: The FCTC Conference (COP11) has been criticized for its opacity and exclusiveness (excluding consumer representatives and independent scientists). This closed decision-making model results in the inability to access key real-world data such as black market and user conversion behavior. In contrast, parallel conferences such as “Good COP” and external pressure from various advocacy organizations are constantly challenging its legitimacy, forcing it to face calls for scientific debate and public participation.
• The instrumentalization of the issue of “protecting teenagers”: Although protecting teenagers from the effects of nicotine is a universal consensus, this goal is being used by prohibitionists as a political tool to implement comprehensive restrictions, deliberately creating a false opposition between “protecting teenagers” and “helping adult smokers reduce harm”, and ignoring balanced and pragmatic regulatory strategies.

Key evidence:

• The stark contrast of Danish data: The Danish study “UngMap 2025” found that the daily smoking rate among young people aged 15 to 25 has decreased from 15.4% in 2014 to only 2.7%. The report clearly states that this decline is occurring in parallel with the increased use of alternatives such as snuff, electronic cigarettes, and nicotine pouches. However, the Danish representative pushed for a ban on electronic cigarette products and nicotine pouches within the European Union at COP11.
• The wavering stance of the EU: The EU’s negotiating position draft initially leaned towards a “broad ban on alternative nicotine products,” but after widespread criticism, the final version softened to support “proportional regulation” and “evidence-based decision-making.” This indicates that science and public pressure can influence policies, but also reflects the fragility of internal consensus.
• Successful precedents of harm reduction strategies: The article explicitly states that “smoking rates in countries such as Sweden, Norway, New Zealand, and Japan have significantly collapsed after safer alternatives gained market appeal,” providing strong practical evidence for the effectiveness of “tobacco harm reduction” strategies.
• The negative effects of the ban: The conference report pointed out that after implementing strict bans or high taxes, “several contracting parties reported a significant increase in sales of illegal tobacco and unregulated nicotine.” This confirms that radical restrictive measures can foster a dangerous black market and weaken public health protection.

Strategic insights:

The core controversy of COP11 is no longer about technical details, but about the fundamental path of global public health strategies. The success or failure of tobacco control in the next twenty years depends on whether FCTC can evolve from a rigid ideology based on “abstinence” to a modern governance framework that embraces science, acknowledges risk differences, and adopts pragmatic harm reduction strategies. If the ban continues to be enforced, it will not only fail to eradicate nicotine use, but also push millions of adult smokers seeking safer alternatives into unregulated danger zones, missing the huge historical opportunity to end smoking-related diseases. Therefore, the focus of strategy must shift from “prevention” to “pragmatism”, establishing a new regulatory paradigm that distinguishes risks and encourages innovation, which is the truly responsible path for the future.