Another Day, Another Country—This Time South Korea—Fighting Nicotine Instead of Smoking

South Korea has made substantial progress against smoking over recent decades. Higher tobacco taxes, smoke-free laws, graphic warnings, public education and cessation programmes have all contributed to falling cigarette use. Yet smoking still causes a major burden of preventable disease, and the decline appears increasingly difficult to sustain. The debate is therefore no longer simply about whether South Korea needs stronger tobacco control. It is about which policies will actually reduce smoking fastest without creating damaging unintended consequences.

A new Smoke Free Sweden report, Tale of Two Nations: South Korea v Sweden, recently discussed by public health expert Marewa Glover, argues that South Korea could accelerate progress by embracing tobacco harm reduction. To put it simply, maintaining pressure on cigarettes while making lower-risk alternatives more accessible and affordable to adults who smoke would do the job. And as governments worldwide consider increasingly restrictive nicotine policies, considering such strategies is becoming particularly important. Prohibition may sound decisive, but public health should ultimately be judged by outcomes: smoking prevalence, disease, deaths, illicit trade and successful switching.

An example cited all too often: Sweden has pursued many conventional tobacco-control policies, but it has also allowed cigarettes to compete with non-combustible alternatives and achieved historic successes as a result. The Smoke Free Sweden report places South Korean daily smoking at around 15.3%, compared with 5.3% in Sweden. Differences in surveys and definitions may mean international comparisons require caution, but the gap remains striking.

Sweden’s experience does not necessarily indicate that snus and nicotine pouches alone caused its low smoking prevalence. Culture, taxation and conventional tobacco-control measures matter too. Nevertheless, Sweden demonstrates something highly relevant to South Korea: widespread use of nicotine does not necessarily require widespread cigarette smoking.

New Zealand offers another useful comparison. Government data shows that the percentage of adults who smoke daily decreased from 12.9% in 2018/19 to 6.9% in 2023/24, while daily vaping increased from 3.3% to 11.1%. A study published in The Lancet Regional Health – Western Pacific in 2026 revealed a significant acceleration in the decline of adult smoking beginning in 2018/19, which aligned with a rise in vaping following regulatory changes and government backing for vaping as a smoking cessation tool. The researchers found that New Zealand’s experience suggests harm reduction strategies can work alongside traditional tobacco control measures.

Still, this doesn’t completely address concerns about youth vaping. Other research conducted in New Zealand has pointed out issues regarding adolescent vaping patterns, emphasising the necessity for strong age limits and targeted protections for young individuals. The lesson is not unrestricted nicotine access. It is risk-proportionate regulation.

This distinction was central to discussions at the recent GFN  conference examining “prohibition in public health.” Ondrej Koumal argued that regulation can be thought of as a U-shaped curve: completely unrestricted markets can create substantial harm, but prohibition can too. The objective should therefore be finding a regulatory “sweet spot” between the two.

Applied to nicotine, Koumal highlighted an obvious contradiction: cigarettes remain legally available while products expected to pose considerably lower risks are sometimes prohibited or heavily restricted. That matters because prohibition does not necessarily eliminate demand.

People used nicotine long before today’s multinational tobacco companies existed, and expecting nicotine consumption simply to disappear may be unrealistic. A more practical policy question is therefore who supplies that demand and under what conditions: regulated businesses subject to manufacturing standards, age controls and taxation, or criminal and informal sellers operating outside those safeguards?

Evidence suggests this is more than a theoretical concern. Euromonitor 2025 estimated the global illicit e-vapour market at approximately US$47 billion, with illicit products representing more than 76% of global e-vapour volume. Crucially, 71% of illicit volumes were reportedly sold in markets where vaping was regulated rather than completely unregulated. That should encourage governments considering prohibition to pause.

This is particularly relevant to South Korea’s treatment of newer nicotine products. South Korea already has substantial experience with alternatives to cigarettes, especially heated tobacco products. But regulation should increasingly distinguish products by their likely health risks and encourage complete substitution, rather than prolonged dual use.

South Korea could establish strict age restrictions, require retail licenses, set ingredient and manufacturing standards, impose nicotine limits where needed, enforce child-resistant packaging, uphold responsible marketing practices, and implement real penalties for unlawful sales. At the same time, it could ensure smokers receive accurate information about relative risks.

This balanced approach aligns with Koumal’s “sweet spot”: not a completely hands-off market or outright prohibition but a regulated environment focused on measurable health outcomes. Additionally, South Korea should keep assessing whether these interventions are effective. If tighter restrictions lead to more illegal purchases or higher rates of smoking relapse or cigarette use, regulators ought to be ready to make adjustments instead of measuring success just by how many legal nicotine products are sold.

The key takeaway from Sweden and New Zealand isn’t that South Korea should replicate either country’s model exactly. It’s that reducing smoking rates can really pick up speed when adults have viable alternatives to cigarettes.

No problem, smokers who want and can handle complete nicotine abstinence should receive counselling, NRT and cessation medicines. But those unable or unwilling to quit nicotine should have accurate information and regulated pathways towards substantially lower-risk products.

The critical public-health objective should remain reducing exposure to combustible tobacco. Prohibition may make for a powerful political message, but eliminating a legal product does not necessarily eliminate its consumers. If excessive restrictions simply transfer nicotine sales to illicit suppliers—or leave smokers using cigarettes—the policy has succeeded on paper while failing in practice.

South Korea has shown the positive outcomes that traditional tobacco control can bring. The next step forward might hinge on blending these policies with harm reduction strategies, striking a balance in regulation: being strict on cigarettes, cracking down on illegal sellers, safeguarding young people, while also being supportive of adults who are trying to quit smoking.

https://www.vapingpost.com/2026/07/16/foreign-influence-sweeping-vape-bans-and-nrt-restrictions-sounding-the-alarm-for-asia/