The worldwide tobacco control landscape is increasingly characterized by a dichotomy — on one side, evidence-based harm reduction, and on the other, prohibitionist policymaking. Nowhere is this tension clearer than in the dramatic regulatory push taking shape from Turkey, juxtaposed with increasing criticism of the European Union’s direction of travel. Taken together, these developments raise pressing questions about whether policymakers are actually focusing on the fundamental cause of smoking-related disease at all — combustion.
Turkey’s proposed tobacco legislation represents one of the most draconian anti-nicotine frameworks to date. By proposing a complete ban on tobacco products, including their production, sale, and consumption by 2040, Ankara is putting the finishing touches on its prohibitionist endgame. The proposal is critical in that it does not draw a distinction between combustible cigarettes and reduced-risk alternatives. Instead, it broadens the concept of “tobacco products,” including e-cigarettes and heated tobacco as well as all systems that contain nicotine.
Ignoring different risk levels
Nicotine, although addictive, is not classified as a carcinogen by major authorities and is of minor importance in cancer causation.
From a harm reduction standpoint, the most impactful piece is not these restrictions on particular products, but rather the slapping of similar regulation onto all nicotine products, irrespective of their level of risk. By treating combustible cigarettes and non-combustible alternatives the same, the policy ignores a central finding of decades of research: it is combustion — not nicotine — that causes the vast majority of smoking-related cancers.A wide body of toxicological and epidemiological literature has long shown that the carcinogenic properties of smoking derive from combustion byproducts—tar, carbon monoxide, and thousands of toxicants produced when tobacco is burned. While nicotine, although addictive, is not classified as a carcinogen by major authorities and is of minor importance in cancer causation.
And while there is still a lot we don’t know about the effects of inhaling vapour, comparative exposure studies have found that, although some toxins are present in vapes, they typically deliver only a small fraction of the toxicants found in cigarette smoke (with many carcinogens absent or at very low levels). This is one reason that comprehensive public health reviews, including one by the Royal College of Physicians (RCP), have repeatedly found that vaping is greatly less harmful than smoking and can be a powerful quit tool.
But frameworks such as the one proposed in Turkey’s draft law obliterate these distinctions, building regulatory environments in which less harmful products are regulated with the same strictness as the most dangerous ones. This could sabotage one of the biggest levers to help reduce smoking-related disease: substitution.
An unfortunate global pattern — from Seoul to Hawaii
Turkey is not alone. In Seoul, recent regulatory changes have now banned smoking and imposed fines for all nicotine products, including vapes. Framing this as filling enforcement gaps, the policy once more makes it seem, at a glance, that there are no meaningful risk differentials between combustible and non-combustible products.
In Hawaii, too, lawmakers have moved to ban disposable e-cigarettes due to youth uptake and environmental concerns. The United Kingdom currently has its own version of the ban in place. And although these interventions are frequently justified on narrower grounds (e.g., protecting youth, preventing waste), the overall trend is clear — greater restrictions on reduced-risk products without proportional acknowledgment of their role in smoking cessation.
A fork in the road for Bangladesh?
By contrast, Bangladesh is now reviewing its planned 2025 ban on vaping and other new nicotine products. Advocacy groups such as the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), say this review is an opportunity to adopt a more pragmatic, risk-proportionate framework. Their stance reflects a commonly held view among harm reduction experts: it is possible to engage in effective tobacco control without forcing a choice between protecting youth and reducing harm for adults. Both can be accomplished through targeted regulation — strict age limits, product standards, and enforcement against illicit sales — while keeping access to safer alternatives for smokers.
That debate is also playing out at the supranational level. The European Union’s current process for reviewing its Tobacco Products Directive has been criticized for a similar failure to integrate comparative risk into its policy-making. By threatening to impose the same kind of restrictions on reduced-risk products that are commonplace with combustible products — from flavour bans to disproportionately punitive tax structures — the EU is in danger of duplicating policy mistakes that are now becoming apparent elsewhere, including Turkey.
The proliferation of such approaches was flagged by groups such as Prohibition Does Not Work (PDNW) and the Observatory for Harm Reduction in Medicine, which decried them as unscientific and inconsistent with reality. Demand doesn’t disappear; it moves, based on data from jurisdictions that have enacted restrictive policies. In the Netherlands, for instance, where flavour restrictions were introduced a few years earlier, a large proportion of users continue to consume outlawed products through the black market or cross-border access following these laws.
So what actually reduces smoking in the real world?
As prohibitionist policies multiply, real-world evidence continues to show the opposite. Countries that have embraced harm reduction — most famously Sweden but also the U.K. and others — have delivered some of the steepest declines in smoking prevalence on record. Sweden has, of course, been declared smoke-free. And now, in the UK, vaping has surpassed smoking for the first time, with 95% of vapers being current or former smokers.
These results reinforce an important lesson: when smokers are given the opportunity to transition to attractive, lower-risk alternatives, many will do so. By contrast, when such alternatives are limited or stigmatized, smoking reductions slow and even reverse.
Turkey’s proposed law reflects a wider dilemma worldwide. Policymakers can choose effective nicotine elimination strategies that penalize all products uniformly, or proceed with risk-proportional measures informed by available science.
The distinction matters. If cancer risk is primarily a product of combustion, then policies modeled on smoke- and smokeless-tobacco alike can protect the most dangerous products while restricting access to those least harmful.
