Despite more than a decade of growing scientific consensus that smoke-free nicotine products are far less harmful than cigarettes, governments across the world are accelerating bans on vaping, heated tobacco and other reduced-risk alternatives. From Southeast Asia to Latin America and Eastern Europe, policymakers are choosing prohibition over regulation—even as real-world data consistently show that access to safer nicotine products reduces smoking, disease and death.
The scientific foundation for tobacco harm reduction is no longer controversial among independent researchers. Combustion—not nicotine—is responsible for the overwhelming majority of smoking-related disease. Products that eliminate combustion, such as vapes, heated tobacco, snus and nicotine pouches, dramatically reduce exposure to toxicants. Public Health England, Cancer Research UK, the U.S. National Academies of Sciences and Engineering, and many other recognized health entities, have acknowledged this risk gradient. Yet many governments continue to treat all nicotine products as equally dangerous, or worse, treat safer alternatives as a greater threat than cigarettes themselves.
Protecting youth or the tobacco industry?
Vietnam offers one of the starkest recent examples. In December 2024, the National Assembly amended the country’s Investment Law to block all investment and commercial activity related to vaping and heated tobacco. This move reinforced a sweeping ban that took effect at the start of 2025 and extends beyond sales to include possession and personal use. The result is a total prohibition that leaves smokers with no legal harm-reduction options at all.
Naturally, the World Health Organization strongly supported Vietnam’s decision, urging the government to classify these products as prohibited businesses and warning against any exemptions. After the vote, the WHO publicly praised the policy and claimed it had already reduced youth use and hospital admissions, despite providing no supporting data. Harm-reduction experts have challenged those assertions, noting that a single year is far too short to assess the real consequences of prohibition, particularly given stockpiling, delayed behavioural change and the inevitable growth of illicit markets.
Vietnam’s case also highlights a recurring conflict of interest. The state-owned Vietnam National Tobacco Corporation controls roughly 60 percent of the domestic cigarette market, mirroring situations in India and Thailand where governments maintain deep financial ties to combustible tobacco while banning safer competitors. Smoking remains a major public-health burden in Vietnam, linked to more than 14 percent of all deaths in 2021. Critics argue that banning reduced-risk products while protecting cigarette monopolies is not health policy, it is market protection dressed up as prevention.
Sending safer alternatives underground where their safety is questionable
Similar dynamics are playing out elsewhere. Azerbaijan is moving toward a comprehensive prohibition on electronic cigarettes through amendments that would outlaw their manufacture, trade, storage, import, export and use. By redefining nicotine-containing e-cigarettes as tobacco products and removing them from excisable goods lists, lawmakers are effectively erasing them from the legal market. Advertising bans are also being expanded to cover non-nicotine devices, reflecting a policy approach that prioritises elimination over risk differentiation.
Mexico has taken an even more punitive path. New reforms to the General Health Law criminalise the production and sale of e-cigarettes, with penalties of up to eight years in prison and substantial fines. President Claudia Sheinbaum has explicitly rejected the idea that vaping can be a safer alternative to smoking. Yet enforcement realities tell a different story. Vapes remain widely available across Mexico City, sold openly and cheaply, raising serious doubts about whether criminalisation will reduce use, or simply entrench illegal supply chains. Critics warn that prohibition absolves the government of its responsibility to regulate product standards, age verification and quality control.
Costa Rica is now considering an outright ban on all electronic smoking devices, including non-nicotine products. The proposal follows reports of vape-related intoxications among youth and highly publicised medical cases. While concerns about underage use are legitimate, many experts argue that Costa Rica’s existing regulatory framework has not been given time to work. The current law governing e-cigarettes has been fully in force for less than a year and already includes taxation and controls. Abandoning regulation in favour of prohibition risks expanding black markets, particularly given weaknesses in customs enforcement and policing. Notably, illicit products are often more dangerous than regulated ones—a lesson learned repeatedly in drug and alcohol policy.
Choosing the wrong battle
Meanwhile, Malaysia illustrates how regulatory instability can undermine harm reduction even without a formal national ban. Although the Control of Smoking Products for Public Health Act 2024 initially promised clearer oversight, it has been followed by a cascade of state-level vape bans. Several states have outlawed vape retailing entirely, while the federal government signals that disposable vapes may be targeted next. At the same time, cigarette and heated tobacco taxes have risen, while vape taxes were conspicuously left unchanged—fueling speculation that the category is being positioned for prohibition rather than regulation.
The consequences are predictable. Illegal cigarettes already dominate more than half of Malaysia’s market. Industry groups warn that banning vapes will simply push consumers into unregulated channels, repeating patterns seen in other prohibitionist jurisdictions. Heated tobacco products are increasingly viewed as the only politically tolerable harm-reduction option, not because they are superior, but because they are less ideologically contested.
Banning harm reduction fights smoking cessation
Across all these cases, a common assumption underpins policy: that removing safer nicotine products will reduce overall nicotine use and protect public health. The evidence says otherwise. Multiple studies from the United States, Europe and Asia show that when access to lower-risk alternatives is restricted, many consumers substitute back to cigarettes. Flavour bans, sales bans and outright prohibitions consistently weaken smoking cessation and strengthen illicit trade.
By contrast, countries that regulate rather than ban—setting age limits, product standards, marketing controls and clear tax structures—have achieved the fastest declines in smoking. Sweden, Norway, Japan and New Zealand demonstrate that harm reduction works when smokers are offered appealing, affordable alternatives along a continuum of risk.
The global rush toward bans ignores this growing body of data. It also ignores human behaviour. Demand for nicotine does not disappear when products are outlawed; it simply moves into less visible, less controllable spaces. Prohibition has never eliminated consumption, it has only shifted who profits and who bears the risk.
Tobacco harm reduction does not require abandoning youth protection or public-health oversight. It requires acknowledging reality: cigarettes are uniquely deadly, and policies that make safer alternatives harder to access than combustible tobacco are fundamentally incoherent. As bans spread, the question is no longer whether the evidence is sufficient, it is whether governments are willing to follow it. Unless policymakers realign nicotine regulation with scientific risk, the world risks repeating decades of preventable harm, driven not by lack of knowledge, but by refusal to act on it.
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