Path to Smoke-Free

Innovation for a Healthier World

Continue Scrolling

Welcome to Path to Smoke-Free

We analyze global tobacco control policies through the lens of Sweden’s remarkable success becoming smoke-free. Our platform harnesses data from the Effective Anti-Smoking Policies Global Index, enhanced by We Are Innovation’s research and findings from surveys conducted by Ipsos among ex-smokers in Sweden.

With smoking rates of just 5.3% compared to the EU’s 24%, Sweden’s achievement goes beyond traditional tobacco control measures.

Sweden’s achievement goes beyond traditional tobacco control measures.

Our research reveals three key elements – the 3 As – that have proven crucial to Sweden’s comprehensive approach:

Accessibility

Ensuring a diverse range of alternative nicotine products is available through conventional and online retail channels, accompanied by comprehensive and relevant information for adult consumers.

Acceptability

Recognizing the importance of a variety of flavors and nicotine levels in alternative nicotine products to provide a compelling and realistic replacement for cigarettes.

Affordability

Keeping taxes to alternative nicotine products at a level that does not discourage adult consumers from choosing them over cigarettes because of their cost.

Path to Smoke-Free

Is your nation a leader or a follower?

Leading the Charge

Country Path to Smoke-Free Accessibility ranking Acceptability ranking Affordability
ranking
UK (England) 1 5 18 6
Slovakia 2 1 26 6
Switzerland 3 6 1 6
Czech Republic 4 2 37 6
Ireland 5 3 26 6
Spain 6 7 26 6
Lebanon 7 8 1 42
Greece 8 7 26 25
France 9 10 26 18
United States 10 9 40 44
New Zealand 11 19 23 16
Austria 12 17 26 6
Germany 13 14 41 37
Romania 14 15 26 25
Peru 15 25 1 14

Falling Behind

Country Path to Smoke-Free Accessibility
ranking		 Acceptability
ranking		 Affordability
ranking
Taiwan 57 57 58 63
Kazakhstan 58 66 58 63
Nicaragua 59 66 56 48
Brazil 60 66 60 53
Venezuela 61 66 60 53
Panama 62 66 60 57
Argentina 63 65 60 58
Norway 64 64 64 62
Mexico 65 63 64 59
India 66 62 66 63
Qatar 66 61 66 63
Thailand 66 60 66 63
Türkiye 66 59 66 63
Turkmenistan 66 58 66 63
Vietnam 66 57 66 63
Full Raking here

Country-by-Country Analysis

Path to Smoke-Free:
A Global Health Initiative

0

Countries analyzed, spanning diverse regions and economies.

0 BN

People covered, representing a majority of the world’s population.

0 %

Of global citizens included, making this the most comprehensive smoke-free study to date on smoke-free targets.

2024 | We Are Innovation | The Future Is Calling. And We Are Ready to Answer.

X-twitter Youtube Linkedin Tiktok Instagram
UK (England)

UK (England)

The United Kingdom has made significant strides in reducing smoking prevalence, achieving a rate of 12.3 percent. This success can be attributed to their embracing harm reduction strategies, especially regarding vaping. The UK scores exceptionally well in the 3As for vaping, with perfect scores in Accessibility (100), Acceptability (100), and Affordability (100). Their approach to other alternative nicotine products is more conservative, with lower scores for heated tobacco products and nicotine pouches. The UK’s evidence-based approach and public health messaging supporting vaping as a smoking cessation tool have been instrumental in their progress towards a smoke-free society.
1
Path to Smoke-Free Performance
5
Accessibility Performance
18
Acceptability Performance
6
Affordability Performance
12.3
Smoking Prevalence

Slovakia

Slovakia

Slovakia currently faces a high smoking prevalence of 27 percent, but its progressive regulatory approach to alternative nicotine products positions the country well for future reductions in smoking rates. The country achieves almost perfect scores in Accessibility, Acceptability, and Affordability for vaping, heated tobacco products, and nicotine pouches. This comprehensive approach to harm reduction provides adults in Slovakia with a wide range of alternatives to smoking, setting the stage for a significant decrease in smoking prevalence.
2
Path to Smoke-Free Performance
1
Accessibility Performance
25
Acceptability Performance
6
Affordability Performance
27
Smoking Prevalence

Switzerland

Switzerland

Switzerland’s regulatory approach to alternative nicotine products is relatively open across the board. In the case of vaping, Switzerland scores high in Accessibility (93.48), Acceptability (100), and Affordability (100). Regulation of heated tobacco products and snus is similarly open, while nicotine pouches face some restrictions. This comprehensive, progressive approach to harm reduction provides adults in Switzerland with a wide range of alternatives to smoking.
3
Path to Smoke-Free Performance
6
Accessibility Performance
1
Acceptability Performance
13
Affordability Performance
22.2
Smoking Prevalence

Czech Republic

Czech Republic

The Czech Republic’s approach to alternative nicotine products is relatively open, particularly in the case of vaping. The Czech Republic scores perfectly in Accessibility, Acceptability, and Affordability for vaping. Regulation of heated tobacco products is more restrictive, while snus and nicotine pouches face severe limitations. This policy landscape reflects the country’s efforts to embrace a harm-reduction approach, primarily through vaping.
4
Path to Smoke-Free Performance
2
Accessibility Performance
36
Acceptability Performance
6
Affordability Performance
25.6
Smoking Prevalence

Ireland

Ireland

Ireland has made significant progress, achieving a smoking prevalence of 17.8 percent. Their approach to alternative nicotine products is relatively open, and currently, Ireland scores perfectly in Accessibility, Acceptability, and Affordability in the case of vaping. However, restrictions on vaping flavors could be expected, which would have a significant impact on the acceptance of this alternative to smoking. Their approach to heated tobacco products is more restrictive, while snus is banned, and nicotine pouches face severe limitations. This policy landscape reflects a fragile embrace of vaping as a harm reduction tool, despite its role complementing strong traditional measures to eliminate smoking. Their moderate smoking rate, compared to the EU average, suggests some success but indicates that continued efforts, including the preservation of vaping flavors and a more comprehensive approach to all alternative nicotine products, may be needed to reduce smoking prevalence further and achieve a smoke-free Ireland.
5
Path to Smoke-Free Performance
3
Accessibility Performance
25
Acceptability Performance
6
Affordability Performance
17.8
Smoking Prevalence

Spain

Spain

Spain faces a high smoking prevalence of 26.6 percent, indicating significant room for improvement in their strategy to eliminate smoking. Their regulatory approach to alternative nicotine products is relatively open, particularly in the case of vaping. However, restrictions on vaping flavors could be expected, as well as additional restrictions for other alternatives to smoking. For now, Spain achieves perfect scores in Accessibility and Acceptability in the case of vaping, with the highest score also in Affordability. Regulation of heated tobacco products is more restrictive, while snus is banned, and nicotine pouches face severe limitations. The high smoking rate suggests that complementary measures and a more comprehensive approach to all alternative nicotine products may be needed to reduce smoking prevalence further and achieve a smoke-free Spain.
6
Path to Smoke-Free Performance
7
Accessibility Performance
25
Acceptability Performance
6
Affordability Performance
26.6
Smoking Prevalence

Lebanon

Lebanon

Lebanon’s regulatory approach to alternative nicotine products is relatively open across most categories. In the case of vaping, Lebanon scores very high in Accessibility (95.65) and perfectly in Acceptability (100) but low in Affordability (33.33). Their approach to heated tobacco products and snus is similar, while nicotine pouches have slightly lower scores. This open policy landscape could lead to an embrace of a harm reduction strategy.
7
Path to Smoke-Free Performance
8
Accessibility Performance
1
Acceptability Performance
41
Affordability Performance
26.8
Smoking Prevalence

Romania

Romania

Romania’s regulatory approach to alternative nicotine products is relatively open. Romania scores high in Accessibility (95.65) and Acceptability (100) in the case of vaping, with a moderate score in Affordability (66.67). Their approach to heated tobacco products is similar, while snus is banned and nicotine pouches face more severe restrictions. This policy landscape suggests an effort to provide alternatives to smoking, primarily vaping and heated tobacco products.
13
Path to Smoke-Free Performance
14
Accessibility Performance
25
Acceptability Performance
24
Affordability Performance
26.6
Smoking Prevalence

Greece

Greece

Greece has adopted a relatively open stance on alternative nicotine products, mainly vaping. In the case of vaping, Greece scores well in Accessibility (95.65) and Acceptability (100), with a moderate score in Affordability (66.67). Their approach to heated tobacco products is similar, while snus is banned and nicotine pouches face more severe restrictions. This mixed approach reflects Greece’s efforts to balance a harm-reduction strategy with traditional measures to eliminate smoking.
8
Path to Smoke-Free Performance
9
Accessibility Performance
25
Acceptability Performance
24
Affordability Performance
29.8
Smoking Prevalence

France

France

France has taken positive steps with its progressive stance on vaping, scoring well in Accessibility (95.65) and perfectly in Acceptability (100) and Affordability (100). However, France’s approach to other alternative nicotine products is more restrictive, with lower scores for heated tobacco products, a ban on snus, and severe limitations on nicotine pouches. To accelerate progress towards a smoke-free society, France would benefit from extending its progressive policies on vaping to other alternative nicotine products. Learning from countries like Sweden and the UK, France has the potential to dramatically reduce its smoking prevalence by embracing a broader spectrum of alternatives to smoking. A more comprehensive approach could be vital in overcoming France’s persistent smoking challenge.
9
Path to Smoke-Free Performance
12
Accessibility Performance
25
Acceptability Performance
18
Affordability Performance
31.2
Smoking Prevalence

New Zealand

New Zealand

New Zealand has made remarkable progress in reducing smoking prevalence, achieving a rate of 6.8 percent daily smoking. Their comprehensive strategy to eliminate smoking includes a progressive approach to alternative nicotine products, mainly vaping. New Zealand scores highly in the 3As for vaping, with solid scores in Accessibility (91.30) and Acceptability (100) and a perfect score in Affordability (100). In July 2024, they reduced the excise tax on heated tobacco products by 50%, which aligns with this harm-reduction strategy. Their approach to nicotine pouches remains conservative, but the government has been interested in examining the evidence more closely in 2025. New Zealand’s commitment to becoming smoke-free by 2025 is reflected in their balanced regulatory approach, which aims to make alternative nicotine products available to adults while taking robust measures to protect minors.
10
Path to Smoke-Free Performance
18
Accessibility Performance
22
Acceptability Performance
16
Affordability Performance
11.7
Smoking Prevalence

Germany

Germany

Germany’s regulatory approach to alternative nicotine products is relatively open, particularly for vaping. Germany scores well in Accessibility (95.65) and Acceptability (100) for vaping, with a moderate score in Affordability (66.67). Their approach to heated tobacco products is similar, while snus is banned, and policies on nicotine pouches are extremely restrictive. This balanced approach provides Germans with access to some alternatives, but the persistently high smoking rate suggests that a more comprehensive strategy may be necessary to accelerate progress toward a smoke-free Germany.
12
Path to Smoke-Free Performance
13
Accessibility Performance
39
Acceptability Performance
36
Affordability Performance
19.1
Smoking Prevalence

Austria

Austria

Austria’s regulatory approach to alternative nicotine products is relatively open, particularly for vaping. Austria scores high in Accessibility (89.13) and perfect in Acceptability (100) and Affordability (100) for vaping. Their approach to heated tobacco products is similar, while snus is banned and nicotine pouches face more restrictions. This open policy towards vaping and heated tobacco products suggests an effort to provide alternatives to smoking.
11
Path to Smoke-Free Performance
16
Accessibility Performance
25
Acceptability Performance
6
Affordability Performance
23.2
Smoking Prevalence

Italy

Italy

Italy’s approach to alternative nicotine products is relatively open, especially for vaping. Italy scores high in Accessibility (89.13) and Acceptability (100) for vaping, with a moderate score in Affordability (66.67). The regulatory landscape for heated tobacco products is similar, while snus is banned and nicotine pouches face more restrictions. Italy’s progressive approach provides smokers with access to alternative nicotine products.
23
Path to Smoke-Free Performance
23
Accessibility Performance
25
Acceptability Performance
29
Affordability Performance
21.8
Smoking Prevalence

Saudi Arabia

Saudi Arabia

Saudi Arabia has achieved relative success in reducing smoking, with a smoking prevalence of 10.7%. Their regulatory approach to alternative nicotine products is mixed. For vaping, Saudi Arabia scores very high in Accessibility (97.83) and moderately in Acceptability (64.71) but scores 0 in Affordability, where extremely punitive import duties and domestic excise taxes push much of the market towards untaxed illicit products. Their approach to heated tobacco products is more open, while snus and nicotine pouches have varying levels of regulation. The relatively low smoking rate suggests some success, but there is room for improvement, particularly in the Affordability of alternative nicotine products to further reduce smoking rates and help more smokers move and stay away from cigarettes.
15
Path to Smoke-Free Performance
4
Accessibility Performance
41
Acceptability Performance
49
Affordability Performance
10.7
Smoking Prevalence

Poland

Poland

Poland’s approach to alternative nicotine products is relatively open, especially for vaping. Poland scores high in Accessibility (91.30) and Acceptability (100) for vaping, with a moderate score in Affordability (66.67). The regulatory landscape for heated tobacco products is more restrictive, while snus is banned, and nicotine pouches face significant limitations. For now, Poland’s balanced approach provides smokers with access to alternative nicotine products, primarily vaping. However, the persistent high smoking rate suggests that more openness is necessary to significantly reduce smoking prevalence and move closer to a smoke-free Poland.
16
Path to Smoke-Free Performance
15
Accessibility Performance
25
Acceptability Performance
24
Affordability Performance
22
Smoking Prevalence

Croatia

Croatia

Croatia faces significant challenges in eliminating smoking, with a high smoking prevalence of 33.4 percent. Croatia has adopted a relatively open stance on alternative nicotine products, particularly vaping. For vaping, Croatia scores well in Accessibility (89.13) and perfectly in Acceptability (100), with a high score in Affordability (100). Their approach to heated tobacco products is similar, while snus is banned and nicotine pouches face more severe restrictions. This open approach to vaping and heated tobacco products reflects an effort to provide alternatives for smokers, which should be extended to other alternative nicotine products.

17
Path to Smoke-Free Performance
20
Accessibility Performance
25
Acceptability Performance
6
Affordability Performance
33.4
Smoking Prevalence

Canada

Canada

Canada has achieved a smoking prevalence rate of 11.4 percent, demonstrating significant progress in smoking reduction. Their approach to alternative nicotine products is mixed, with a relatively open stance on vaping but more restrictive policies on other alternatives. In the case of vaping, Canada scores well in Accessibility (97.83) and Acceptability (100) but poorly in Affordability (0). Their scores for heated tobacco products, snus, and nicotine pouches are generally lower across the 3As. This approach reflects Canada’s cautious balancing act between providing alternatives to smoking for adults and protecting minors, though the low affordability score for vaping may hinder their potential as well.
18
Path to Smoke-Free Performance
11
Accessibility Performance
38
Acceptability Performance
57
Affordability Performance
11.4
Smoking Prevalence

Uzbekistan

Uzbekistan

Uzbekistan’s regulatory approach to alternative nicotine products reflects a tendency towards a prohibitive approach rather than a progressive policy solution like that of New Zealand and much of the European Union. For vaping, Uzbekistan currently scores well in Accessibility (89.13) and perfectly in Acceptability (100), with a moderate score in Affordability (66.67). Despite having regulated both vaping and heated tobacco in a reasonably open way in early 2024, there is currently proposed legislation seeking to completely ban both vaping and heated tobacco products, adding to the existing prohibition on snus and oral nicotine pouches. This mixed policy landscape is an aversion towards harm reduction, despite the potential benefits for their smoking and naswar (oral tobacco) consuming populations. There is significant room for improvement in adopting progressive regulation for other alternative nicotine products, particularly nicotine pouches. A recent expert report noted that a potential 464,000 lives could be saved by embracing such an approach.

19
Path to Smoke-Free Performance
21
Accessibility Performance
22
Acceptability Performance
32
Affordability Performance
9
Smoking Prevalence

Portugal

Portugal

Portugal grapples with a smoking prevalence of 22.9 percent, indicating ongoing challenges in their strategy to eliminate smoking. Their approach to alternative nicotine products is relatively open, especially for vaping. Portugal scores high in Accessibility (89.13) and Acceptability (100) for vaping but low in Affordability (33.33). The regulatory landscape for heated tobacco products is similar, while snus is banned and nicotine pouches face significant restrictions. Portugal’s approach provides smokers with access to some alternative nicotine products, but the low affordability score for vaping may hinder their potential. The persistent high smoking rate suggests that additional measures, including improving Affordability of alternative nicotine products, may be necessary to reduce smoking prevalence significantly.
21
Path to Smoke-Free Performance
17
Accessibility Performance
25
Acceptability Performance
38
Affordability Performance
22.9
Smoking Prevalence

Ukraine

Ukraine

The UAE provides reasonable Accessibility and Acceptability for both vaping and heated tobacco products. However, nicotine pouches are unavailable domestically, leading to a 0 score. Due to prohibitive taxes on vaping and heated tobacco products, the UAE scores 0 for Affordability in both cases. This approach reflects the UAE’s still limited efforts to embrace harm reduction options. There may be room for improvement in the Affordability of alternatives to smoking to further support smokers’ move and stay away from smoking, with expert public health reports noting the potential to save tens of thousands of lives in UAE and across the Middle East.
22
Path to Smoke-Free Performance
9
Accessibility Performance
44
Acceptability Performance
38
Affordability Performance
23.6
Smoking Prevalence

Latvia

Latvia

Latvia grapples with a high smoking prevalence of 27.4 percent, highlighting significant challenges in reducing its smoking prevalence. Their approach to alternative nicotine products is relatively open, especially for vaping. Latvia scores well in Accessibility (86.96) and Acceptability (100) for vaping, with a moderate score in Affordability (66.67). The regulatory landscape for heated tobacco products is similar, while snus is banned and nicotine pouches face more restrictions. Latvia’s approach provides access to alternative nicotine products, primarily vaping and heated tobacco products. However, the very high smoking rate suggests that additional measures, such as improved Affordability of alternatives to smoking, may be necessary to reduce smoking prevalence significantly.
36
Path to Smoke-Free Performance
26
Accessibility Performance
47
Acceptability Performance
32
Affordability Performance
27.4
Smoking Prevalence

Honduras

Honduras

Honduras’ approach to alternative nicotine products is relatively open, particularly for vaping. Honduras scores well in Accessibility (80.43) and perfectly in Acceptability (100) and Affordability (100) for vaping. Their approach to heated tobacco products and snus is similarly open, while nicotine pouches have slightly lower scores. This open policy landscape reflects an effort to provide alternatives for adults.
24
Path to Smoke-Free Performance
35
Accessibility Performance
1
Acceptability Performance
1
Affordability Performance
10.9
Smoking Prevalence

Belgium

Belgium

Belgium faces challenges in reducing its smoking prevalence, which stands at 23.2 percent. Their regulatory approach to alternative nicotine products is relatively open, particularly for vaping. Belgium scores well in Accessibility (84.78) and Acceptability (100) for vaping, with a perfect score in Affordability (100). Their approach to heated tobacco products is more restrictive, while snus and nicotine pouches are banned. The high smoking rate suggests that a more comprehensive approach may be necessary. By extending their stance on vaping to other alternative nicotine products, Belgium could provide adults with a wider range of alternatives to smoking. The country’s openness to vaping provides a foundation for expanding harm reduction strategies, potentially leading to significant reductions in smoking prevalence in the coming years.

28
Path to Smoke-Free Performance
33
Accessibility Performance
39
Acceptability Performance
5
Affordability Performance
23.2
Smoking Prevalence

Bolivia

Bolivia

Bolivia’s approach to alternative nicotine products is mixed, with a relatively open stance on vaping but more restrictive policies on other alternatives. For vaping, Bolivia scores well in Accessibility (86.96) and Acceptability (100) but low in Affordability (33.33). Their approach to heated tobacco products and snus is similar, while nicotine pouches have higher Accessibility. There may be room for improvement, particularly in the Affordability of alternative nicotine products, to further reduce smoking prevalence and help more smokers move and stay away from smoking.

25
Path to Smoke-Free Performance
30
Accessibility Performance
1
Acceptability Performance
40
Affordability Performance
10.4
Smoking Prevalence

Kazakhstan

Kazakhstan

Kazakhstan grapples with a smoking prevalence of 20.3 percent, indicating ongoing challenges in their strategy to eliminate smoking. Their approach to alternative nicotine products is hostile, with heated tobacco as the only legal product and broadly equated to cigarettes. Vaping was completely banned in June 2024, following on from a complete ban on nicotine pouches. The high smoking rate suggests that additional measures, including improved Accessibility and Affordability of alternative nicotine products, may be necessary to significantly reduce smoking prevalence. An expert report noted that adopting harm reduction could save an estimated 165,000 lives.

56
Path to Smoke-Free Performance
56
Accessibility Performance
55
Acceptability Performance
61
Affordability Performance
20.3
Smoking Prevalence

El Salvador

El Salvador

El Salvador has made significant progress, achieving a low smoking prevalence of 7.7 percent. Their regulatory approach to alternative nicotine products is relatively open across most categories. For vaping, El Salvador scores well in Accessibility (80.43) and perfectly in Acceptability (100) and Affordability (100). Their approach to heated tobacco products and snus is more restrictive, while nicotine pouches have lower scores across the 3As. This mixed policy landscape reflects a haphazard approach to harm reduction, providing some alternatives to smoking but with limitations. There may be room for improvement in the regulation of other alternative nicotine products.
26
Path to Smoke-Free Performance
36
Accessibility Performance
1
Acceptability Performance
14
Affordability Performance
7.7
Smoking Prevalence

Estonia

Estonia

Estonia grapples with a smoking prevalence of 23.4 percent, indicating ongoing challenges in their strategy to eliminate smoking. Their approach to alternative nicotine products is mixed, with a relatively open stance on vaping, except concerning flavors, but more restrictive policies on other alternative nicotine products. Estonia scores well in Accessibility (86.96) for vaping but lower in Acceptability (64.71), with a moderate score in Affordability (66.67). Scores for heated tobacco products are similar, while snus and nicotine pouches face significant restrictions. The high smoking rate suggests that additional measures, including possibly a more comprehensive approach to alternative nicotine products, may be necessary to significantly reduce smoking prevalence.
27
Path to Smoke-Free Performance
19
Accessibility Performance
42
Acceptability Performance
30
Affordability Performance
23.4
Smoking Prevalence

Paraguay

Paraguay

Paraguay grapples with a relatively low smoking prevalence of 8.8 percent, indicating some success in their strategy to eliminate smoking. Their regulatory approach to alternative nicotine products is mixed. For vaping, Paraguay scores high in Accessibility (89.13) and Acceptability (100) but scores 0 in Affordability. Their approach to heated tobacco products and snus is more restrictive, while nicotine pouches have higher scores across the 3As. This varied policy landscape reflects an unclear approach to harm reduction, providing alternatives to smoking but with limitations. The low smoking rate suggests overall success, but the lack of Affordability for some alternatives to smoking may limit their potential impact. Paraguay may want to consider addressing the affordability issue and potentially opening up regulations for other alternative nicotine products to further support adults looking to move and stay away from smoking.
29
Path to Smoke-Free Performance
31
Accessibility Performance
1
Acceptability Performance
50
Affordability Performance
8.8
Smoking Prevalence

Ecuador

Ecuador

Ecuador demonstrates a relatively open approach to heated tobacco products. For heated tobacco products, Ecuador scores well in Accessibility (58.70) and perfectly in Acceptability (100), reflecting a progressive stance on this harm reduction option. However, the country scores 0 in Affordability for heated tobacco products, which may limit their potential impact. This mixed landscape, with a focus on heated tobacco products and similarly open policies for vaping, could reflect a cautious approach to harm reduction. While the low smoking rate suggests overall success, Ecuador could further capitalize on its open stance towards heated tobacco products by addressing the affordability issue. By making heated tobacco products and other safer alternatives more accessible and affordable, Ecuador could provide adults with an additional effective tool to move and stay away from smoking, potentially driving smoking rates even lower and accelerating the country’s progress towards becoming smoke-free.

30
Path to Smoke-Free Performance
32
Accessibility Performance
1
Acceptability Performance
51
Affordability Performance
8.8
Smoking Prevalence

Slovenia

Slovenia

Slovenia’s regulatory approach to alternative nicotine products is relatively open for vaping, with a limited range of flavors, but more restrictive for other products. Slovenia scores well in Accessibility (82.61) and Acceptability (100) [To be reviewed as, from this year, only tobacco flavors are allowed] for vaping, with a moderate score in Affordability (66.67). Their approach to heated tobacco products, snus, and nicotine pouches is more restrictive. This policy landscape reflects Slovenia’s overcautious approach to harm reduction, focusing primarily on vaping. While the smoking rate is lower than in many European countries, there may be room for improvement through a more comprehensive strategy to further reduce smoking prevalence and progress towards a smoke-free Slovenia.
37
Path to Smoke-Free Performance
27
Accessibility Performance
48
Acceptability Performance
24
Affordability Performance
18.8
Smoking Prevalence

Denmark

Denmark

Denmark’s approach to alternative nicotine products is not progressive, with significant restrictions on vaping favors and more restrictive policies on other alternatives to smoking. For vaping, Denmark scores well in Accessibility (80.43) but lower in Acceptability (64.71), with a moderate score in Affordability (66.67). Scores for heated tobacco products are similar, while snus is banned and nicotine pouches face more restrictions. This approach reflects Denmark’s effort to provide alternatives for adults while maintaining caution. There may be room for improvement in the Acceptability and Affordability of other options to further reduce smoking rates.

31
Path to Smoke-Free Performance
29
Accessibility Performance
42
Acceptability Performance
30
Affordability Performance
14.5
Smoking Prevalence

Lithuania

Lithuania

Lithuania faces challenges in reducing its smoking prevalence, which stands at 26.5 percent. Their regulatory approach to alternative nicotine products is mixed, with a relatively open stance on vaping but more restrictive policies on other alternatives. For vaping, Lithuania scores well in Accessibility (86.96) but lower in Acceptability (47.06), with a moderate score in Affordability (66.67). The high smoking rate suggests that a more comprehensive strategy, including a more open approach to alternatives to smoking, may be needed to accelerate progress toward becoming smoke-free.
32
Path to Smoke-Free Performance
25
Accessibility Performance
49
Acceptability Performance
32
Affordability Performance
26.5
Smoking Prevalence

Finland

Finland

Finland faces challenges in reducing its smoking prevalence, which stands at 15.2 percent. Their regulatory approach to alternative nicotine products is relatively restrictive compared to other European countries. Finland scores moderately in Accessibility (82.61) for vaping but lower in Acceptability (47.06) and Affordability (66.67). Their approach to other alternative nicotine products is even more restrictive. This cautious policy landscape reflects Finland’s traditionally narrow approach to tobacco control. While the smoking rate is lower than in many European countries, the restrictive approach to alternatives may limit options for adults looking to move and stay away from smoking. Finland may need to consider a comprehensive strategy to accelerate progress towards becoming smoke-free.
33
Path to Smoke-Free Performance
28
Accessibility Performance
46
Acceptability Performance
24
Affordability Performance
15.2
Smoking Prevalence

Pakistan

Pakistan

Pakistan’s regulatory approach to alternative nicotine products is relatively open across most categories. For vaping, Pakistan scores moderately in Accessibility (56.52) and perfectly in Acceptability (100) and Affordability (66.67). Their approach to heated tobacco products and snus is even more open, while nicotine pouches have perfect scores across all 3As. However, in its mid-2024 budget, the government increased excise on nicotine pouches for the first time, significantly impacting their Affordability for low and middle-income adults. This open policy landscape, while extremely positive for Pakistan’s large smoking population, is not yet the result of deliberate harm reduction-based regulation. Pakistan’s challenge lies in leveraging its open approach to alternatives to smoking through the adoption of progressive regulation, which promotes continued Accessibility, Acceptability, and Affordability – particularly in light of recent reports noting that 1.2 million Pakistani lives could be saved through such an approach.
34
Path to Smoke-Free Performance
40
Accessibility Performance
1
Acceptability Performance
22
Affordability Performance
10.7
Smoking Prevalence

Costa Rica

Costa Rica

Costa Rica’s approach to alternative nicotine products is mixed, with a risk of a more restrictive approach concerning vaping but more stringent policies on other alternatives to smoking. For vaping, Costa Rica scores well in Accessibility (76.09) and perfectly in Acceptability (100) but scores 0 in Affordability. Their approach to heated tobacco products is similar, while snus and nicotine pouches have lower scores across the 3As. This policy landscape reflects Costa Rica’s efforts to provide only some harm reduction options. There may be room for improvement in the Affordability of alternative nicotine products to further support adults looking to move and stay away from smoking.

35
Path to Smoke-Free Performance
38
Accessibility Performance
1
Acceptability Performance
48
Affordability Performance
7.9
Smoking Prevalence

Netherlands

Netherlands

The Netherlands’ approach to alternative nicotine products is negative. For vaping, the Netherlands scores well in Accessibility (82.61) and Affordability (100) but low in Acceptability (47.06). Scores for heated tobacco products are similar, while snus and nicotine pouches are banned. To further reduce smoking rates, the Netherlands need to consider a comprehensive strategy.
38
Path to Smoke-Free Performance
34
Accessibility Performance
49
Acceptability Performance
16
Affordability Performance
18.1
Smoking Prevalence

Guatemala

Guatemala

Guatemala’s scores perfectly in Acceptability (100) and Affordability (100) for vaping, there’s room for improvement in Accessibility (56.52). To further reduce smoking rates, Guatemala could focus on enhancing the availability and visibility of vaping in various retail channels, including online sales. For heated tobacco products and snus, which have similar open policies, Guatemala could consider targeted awareness campaigns to increase consumer knowledge about these alternatives to smoking. Regarding nicotine pouches, which have slightly lower scores, the country could work on reducing regulatory barriers to improve their Accessibility and Acceptability. By fine-tuning its already open policy landscape across all alternative nicotine products, Guatemala could leverage a harm reduction strategy more effectively. Combining these improvements with public health campaigns could significantly decrease smoking prevalence and set Guatemala on a faster path to becoming smoke-free.
40
Path to Smoke-Free Performance
44
Accessibility Performance
1
Acceptability Performance
1
Affordability Performance
10.3
Smoking Prevalence

Nigeria

Nigeria

Nigeria’s approach to alternative nicotine products is mixed. For vaping, Nigeria scores moderately in Accessibility (56.52) and perfectly in Acceptability (100), with a moderate score in Affordability (66.67). Their approach to heated tobacco products and snus is more restrictive, while nicotine pouches have lower scores across the 3As. This varied policy landscape reflects Nigeria’s narrow approach to harm reduction, providing some alternatives to smoking but with limitations.
42
Path to Smoke-Free Performance
43
Accessibility Performance
17
Acceptability Performance
23
Affordability Performance
2.5
Smoking Prevalence

Peru

Peru

Peru’s regulatory approach to alternative nicotine products is mixed, with a relatively open stance on vaping but more restrictive policies on other alternative nicotine products. For vaping, Peru scores moderately in Accessibility (56.52) and perfectly in Acceptability (100) and Affordability (100). Their approach to heated tobacco products is more restrictive, while snus and nicotine pouches have varying levels of regulation. This approach makes only some alternatives to smoking for adults. There may be room for improvement in the Accessibility of alternatives to smoking to further reduce smoking rates and by helping more smokers move and stay away from smoking.
14
Path to Smoke-Free Performance
24
Accessibility Performance
1
Acceptability Performance
14
Affordability Performance
6.5
Smoking Prevalence

Bangladesh

Bangladesh

Bangladesh has yet to adopt a regulatory framework for alternative nicotine products, however, the government is considering complete prohibition. While in the current scenario (in which alternative nicotine products are not regulated but are legal) Bangladesh scores well in Accessibility (52.17) and perfectly in Acceptability (100) for vaping, the government does not accept harm reduction as a viable approach to reduce smoking. Their approach to heated tobacco products and snus is similar, while nicotine pouches have slightly lower scores. Bangladesh should avoid a prohibitionist approach, including to import alternatives to smoking, particularly considering that country has one of the highest smoking rates in South Asia, and the expert public health reports state 920,000 lives could be saved by regulating alternative nicotine products in line with a harm reduction approach.

43
Path to Smoke-Free Performance
47
Accessibility Performance
1
Acceptability Performance
1
Affordability Performance
13.6
Smoking Prevalence

Indonesia

Indonesia

Indonesia grapples with a very high smoking prevalence of 33.2 percent, one of the highest in the world. Their regulatory approach to alternative nicotine products is mixed. For vaping, Indonesia scores moderately in Accessibility (56.52) and perfectly in Acceptability (100) but low in Affordability (33.33). Their approach to heated tobacco products is similar, while snus and nicotine pouches face more restrictions. Unfortunately, Indonesia’s policy landscape appears to be going backwards, with the recent regulation of September 2024 placing extreme restrictions on the availability of alternative nicotine products and proposing to introduce packaging measures that will not contribute to helping smokers move and stay away from smoking. High taxes also continue to pose a real barrier to the Affordability of alternative nicotine products for Indonesia’s large smoking population. This policy landscape reflects Indonesia’s overcautious steps towards harm reduction. The extremely high smoking rate indicates that much more robust measures are needed, including improved Accessibility, including awareness and information, and Affordability of alternatives to smoking, to accelerate progress towards reducing smoking prevalence.
44
Path to Smoke-Free Performance
42
Accessibility Performance
1
Acceptability Performance
44
Affordability Performance
33.2
Smoking Prevalence

Dominican Republic

Dominican Republic

The Dominican Republic’s regulatory approach to alternative nicotine products is relatively open across most alternative nicotine products. For vaping, the Dominican Republic scores moderately in Accessibility (52.17) and perfectly in Acceptability (100) and Affordability (100). Their approach to heated tobacco products is similar, while snus and nicotine pouches have varying levels of regulation. This open policy landscape suggests an acceptance of harm reduction. The low smoking rate suggests overall success, possibly due to a combination of traditional measures and the availability of alternatives to smoking. The Dominican Republic’s challenge now lies in maintaining this low rate while considering how to optimize its regulatory approach to alternative nicotine products to further reduce smoking and prevent uptake among non-smokers.

45
Path to Smoke-Free Performance
46
Accessibility Performance
24
Acceptability Performance
1
Affordability Performance
6.8
Smoking Prevalence

UAE

UAE

The UAE provides reasonable Accessibility and Acceptability for both vaping and heated tobacco products. However, nicotine pouches are unavailable domestically, leading to a 0 score. Due to prohibitive taxes on vaping and heated tobacco products, the UAE scores 0 for Affordability in both cases. This approach reflects the UAE’s still limited efforts to embrace harm reduction options. There may be room for improvement in the Affordability of alternatives to smoking to further support smokers’ move and stay away from smoking, with expert public health reports noting the potential to save tens of thousands of lives in UAE and across the Middle East.
46
Path to Smoke-Free Performance
45
Accessibility Performance
18
Acceptability Performance
54
Affordability Performance
6.4
Smoking Prevalence

Colombia

Colombia

Colombia’s approach to alternative nicotine products is mixed, with a relatively open stance on vaping but a less open stance to other alternatives. For vaping, Colombia scores moderately in Accessibility (54.35) and perfectly in Acceptability (100) and Affordability (100). Their approach to heated tobacco products is similar, while snus and nicotine pouches face some restrictions. This approach reflects Colombia’s limited effort to provide alternatives to smoking. There may be room for improvement in the Accessibility of alternative nicotine products to further reduce smoking rates and help more smokers move and stay away from smoking.

47
Path to Smoke-Free Performance
50
Accessibility Performance
20
Acceptability Performance
20
Affordability Performance
7.1
Smoking Prevalence

South Africa

South Africa

South Africa faces essential challenges, with a smoking prevalence of 16.8 percent. Their approach to alternative nicotine products is mixed, with moderate openness towards vaping but more restrictive policies on other alternatives. For vaping, South Africa scores moderately in Accessibility (56.52) and perfectly in Acceptability (100) but low in Affordability (33.33). Their approach to heated tobacco products is more restrictive, while snus and nicotine pouches have varying levels of regulation. South Africa should introduce differentiated regulation for alternative nicotine products in the forthcoming Tobacco Control Amendment Bill, which currently proposes to regulate them similarly to smoked tobacco products to include improved Accessibility and Affordability of alternatives to smoking to further reduce smoking prevalence.
48
Path to Smoke-Free Performance
48
Accessibility Performance
16
Acceptability Performance
42
Affordability Performance
16.8
Smoking Prevalence

China

China

China faces significant challenges, with a high smoking prevalence of 23.3 percent. Their regulatory approach to alternative nicotine products is mixed and relatively restrictive. For vaping, China scores high in Accessibility (89.13) but low in Acceptability (47.06) and Affordability (0). Their approach to heated tobacco products is more restrictive, while snus and nicotine pouches face severe limitations. This cautious policy landscape reflects China’s traditionally strict approach to reducing smoking and to alternative nicotine products. The high smoking rate suggests that a more comprehensive approach, including more progressive alternatives to smoking, may be necessary to significantly reduce smoking prevalence in the world’s largest tobacco market.
49
Path to Smoke-Free Performance
39
Accessibility Performance
51
Acceptability Performance
57
Affordability Performance
23.3
Smoking Prevalence

Malaysia

Malaysia

Malaysia faces challenges in tobacco control, with a smoking prevalence of 30 percent. Their regulatory approach to alternative nicotine products is restrictive. For vaping, Malaysia scores moderately in Accessibility (56.52) and perfectly in Acceptability (100), but low in Affordability (66.67). Their approach to heated tobacco products is more restrictive, while snus and nicotine pouches face severe limitations. This cautious policy landscape reflects Malaysia’s uber-conservative approach to harm reduction. Consequently, this restrictive approach to alternatives to smoking limits options for smokers looking to move and stay away from smoking. Malaysia may need to consider a more open harm reduction strategy to further reduce smoking prevalence and progress towards a smoke-free future.
50
Path to Smoke-Free Performance
49
Accessibility Performance
20
Acceptability Performance
35
Affordability Performance
17.6
Smoking Prevalence

South Korea

South Korea

South Korea has a smoking prevalence of 18.9 percent. Their approach to alternative nicotine products is restrictive, particularly for vaping. South Korea scores low in Accessibility (30.43) and moderately in Acceptability (76.47) for vaping, with no score for Affordability. Their approach to heated tobacco products is slightly more open, while snus and nicotine pouches face severe restrictions. This cautious policy landscape is hindered by an antiquated policy on nicotine resulting in extremely low Acceptability and reflects South Korea’s narrow approach to harm reduction. South Korea’s high smoking rate indicates significant challenges, exacerbated by their restrictive approach to alternative nicotine products. This limiting approach severely reduces options for smokers looking to move and stay away from smoking, potentially hindering progress in reducing smoking prevalence. To accelerate their journey towards becoming smoke-free, South Korea urgently needs to consider adopting a more progressive and comprehensive harm reduction strategy that embraces a wider range of alternative nicotine products and better Affordability (tax).
52
Path to Smoke-Free Performance
52
Accessibility Performance
37
Acceptability Performance
61
Affordability Performance
18.9
Smoking Prevalence

Kenya

Kenya

Kenya’s regulatory approach to alternative nicotine products is mixed, with varying degrees of openness across different categories. For vaping, Kenya scores moderately in Accessibility (56.52), perfectly in Acceptability (100) but low in Affordability (33.33). Their approach to heated tobacco products and snus is more open, while nicotine pouches have perfect scores in Accessibility and Acceptability. There may be room for improvement, particularly in the Affordability of alternatives, to further reduce smoking rates by helping more smokers move and stay away from smoking.
41
Path to Smoke-Free Performance
41
Accessibility Performance
1
Acceptability Performance
37
Affordability Performance
7.2
Smoking Prevalence

Japan

Japan

Japan presents a unique case in the global tobacco landscape, with a smoking prevalence of 18.5 percent. Their approach to alternative nicotine products is distinctive, focusing heavily on heated tobacco products while being restrictive towards other alternatives to smoking. Japan scores very low across all 3As for vaping but exceptionally high for heated tobacco products, with near-perfect scores in Accessibility (93.48) and Acceptability (100) and a moderate score in Affordability (66.67). This focused approach to heated tobacco products has led to a rapid decline in cigarette sales. While the smoking rate is lower than in many developed countries, Japan’s restrictive approach to other alternatives may limit options for smokers who do not find heated tobacco products acceptable. A more comprehensive harm reduction strategy, including Accessibility of nicotine-containing vaping, might help Japan further reduce its smoking prevalence.
53
Path to Smoke-Free Performance
53
Accessibility Performance
53
Acceptability Performance
47
Affordability Performance
18.5
Smoking Prevalence

Uruguay

Uruguay

Uruguay’s approach to alternative nicotine products is highly restrictive. Uruguay scores 0 across all 3As for vaping, reflecting a ban on these products. They score slightly higher for heated tobacco products, snus, and nicotine pouches in Accessibility and Acceptability but generally low in Affordability. This restrictive approach reflects Uruguay’s traditionally strict stance about reducing smoking rates, prioritizing precaution over harm reduction. While the smoking rate of 19 percent is lower than in many countries in the region, the restrictive approach to alternatives may limit options for smokers looking to move and stay away from smoking. Uruguay may need to consider a more progressive harm reduction strategy and potentially accelerate its progress toward becoming smoke-free.
54
Path to Smoke-Free Performance
54
Accessibility Performance
52
Acceptability Performance
45
Affordability Performance
19
Smoking Prevalence

Taiwan

Taiwan

Taiwan faces challenges, with a smoking prevalence of 14 percent. Their regulatory approach to alternative nicotine products is highly restrictive across all categories. Taiwan scores 0s across most of the 3As for vaping, heated tobacco products, snus, and nicotine pouches, reflecting a ban or near-ban on these products. This prohibitive approach reflects Taiwan’s anti-innovation stance on alternative nicotine products. This restrictive approach to alternatives to smoking limits options for smokers looking to move and stay away from smoking. Taiwan may need to consider a more comprehensive approach, certainly including a more progressive view of harm reduction, to accelerate progress toward becoming smoke-free.
55
Path to Smoke-Free Performance
55
Accessibility Performance
55
Acceptability Performance
61
Affordability Performance
14
Smoking Prevalence

Nicaragua

Nicaragua

Nicaragua faces challenges, with a smoking prevalence of 13 percent. Their regulatory approach to alternative nicotine products is highly restrictive. Nicaragua scores 0s across most of the 3As for vaping, reflecting a ban or near-ban on these alternatives to smoking. They score slightly higher for heated tobacco products, snus, and nicotine pouches in Accessibility and Acceptability but generally low in Affordability. This prohibitive approach reflects Nicaragua’s anti-innovation stance on alternative nicotine products. The country’s smoking rate suggests that this restrictive strategy may be limiting progress in reducing smoking prevalence. Nicaragua may need to consider a more comprehensive approach, including a more progressive view of harm reduction, to accelerate progress toward becoming smoke-free.
57
Path to Smoke-Free Performance
57
Accessibility Performance
53
Acceptability Performance
46
Affordability Performance
13
Smoking Prevalence

Chile

Chile

Chile faces significant challenges -with a high smoking prevalence of 26.5 percent- Chile’s regulatory approach to alternative nicotine products used to be highly restrictive. Until now, Chile scored 0 across all 3As for vaping. They were already scoring slightly higher for heated tobacco products in Accessibility (39.13) and Acceptability (100) but low in Affordability (0). Snus and nicotine pouches face similar restrictions. The high smoking rate suggests that this restrictive strategy was limiting progress in reducing smoking prevalence, something that should be addressed by the recently approved progressive regulatory framework for vaping (pending entry into force), which may contribute to accelerating progress toward becoming smoke-free.
39
Path to Smoke-Free Performance
37
Accessibility Performance
45
Acceptability Performance
19
Affordability Performance
26.5
Smoking Prevalence

Brazil

Brazil

Brazil’s approach to alternative nicotine products is highly restrictive. Brazil scores very low across all 3As for vaping and heated tobacco products, reflecting their ban on these products. Interestingly, they score slightly higher for snus and nicotine pouches in terms of Accessibility (55.81) and Acceptability (100) but low in Affordability (100). This restrictive approach reflects Brazil’s uber-precautionary stance on innovative alternatives to smoking. A public consultation to determine whether or not the current ban on vaping and heated tobacco products would be lifted received more than 20,000 responses advocating for regulation. Still, the regulatory agency has maintained the ban so far. Naturally, this strategy has been criticized for not providing help to smokers to move and stay away from smoking.

58
Path to Smoke-Free Performance
58
Accessibility Performance
58
Acceptability Performance
51
Affordability Performance
10.9
Smoking Prevalence

Venezuela

Venezuela

Venezuela faces challenges, with a smoking prevalence of 17 percent. Their regulatory approach to alternative nicotine products is highly restrictive. Venezuela scores 0 across all 3As for vaping and heated tobacco products, reflecting a ban or near-ban on these products. They score slightly higher for snus and nicotine pouches in Accessibility and Acceptability but low in Affordability. This prohibitive approach reflects Venezuela’s anti-innovation stance on alternative nicotine products. The high smoking rate suggests that this restrictive strategy limits progress in reducing smoking prevalence. Venezuela must consider a more comprehensive approach, including a more progressive view of harm reduction alternatives, to accelerate progress toward becoming smoke-free.

59
Path to Smoke-Free Performance
59
Accessibility Performance
58
Acceptability Performance
51
Affordability Performance
17
Smoking Prevalence

Panama

Panama

Panama’s regulatory approach to alternative nicotine products is highly restrictive. Panama scores 0 across all 3As for vaping and heated tobacco products, reflecting a ban on these products. They score slightly higher for snus and nicotine pouches in Accessibility and Acceptability but low in Affordability. This prohibitive approach reflects Panama’s extremely precautionary stance on alternatives to smoking. This strategy has been criticized for potentially denying smokers help to move and stay away from cigarettes.
60
Path to Smoke-Free Performance
60
Accessibility Performance
58
Acceptability Performance
55
Affordability Performance
4.3
Smoking Prevalence

Argentina

Argentina

Argentina grapples with a high smoking prevalence of 21.7 percent. Their regulatory approach to alternative nicotine products is highly restrictive across all categories. Argentina scores 0 across all 3As for vaping, heated tobacco products, and snus. They score slightly higher for nicotine pouches in Accessibility (56.52) and Acceptability (100). This prohibitive approach reflects Argentina’s non-evidence-based stance on alternative nicotine products. The high smoking rate suggests that this restrictive strategy limits progress in reducing smoking prevalence. Argentina may need to consider a more comprehensive approach, including a more balanced approach to alternatives to smoking, to accelerate progress toward becoming smoke-free.
61
Path to Smoke-Free Performance
61
Accessibility Performance
58
Acceptability Performance
56
Affordability Performance
21.7
Smoking Prevalence

Norway

Norway

Norway’s approach to alternative nicotine products is one of the most restrictive among developed countries. Norway scores very low across all 3As for vaping, heated tobacco products, and nicotine pouches. Interestingly, they have a more open approach to snus, with high scores in Accessibility (88.37) and Acceptability (100) but lower in Affordability (33.33). This unique policy landscape, focusing on snus while restricting other alternatives, has indeed contributed to Norway’s low smoking rates. However, the restrictive approach to other products may not help smokers who do not find snus acceptable, potentially slowing further progress towards a smoke-free society.
62
Path to Smoke-Free Performance
62
Accessibility Performance
62
Acceptability Performance
60
Affordability Performance
10.9
Smoking Prevalence

Mexico

Mexico

Mexico faces challenges, with a smoking prevalence of 13.7 percent. Their regulatory approach to alternative nicotine products is highly restrictive. Mexico scores 0 across all 3As for vaping, heated tobacco products, and snus, reflecting a ban or near-ban on these products. They score slightly higher for nicotine pouches in Accessibility (46.51) and Acceptability (100). This prohibitive approach reflects Mexico’s anti-innovation stance on alternative nicotine products. While the smoking rate is lower than in many countries, the restrictive approach to alternatives to smoking limits the help to smokers looking to move and stay away from smoking. Mexico may need to consider a more progressive harm reduction strategy to further reduce smoking prevalence.
63
Path to Smoke-Free Performance
63
Accessibility Performance
62
Acceptability Performance
57
Affordability Performance
13.7
Smoking Prevalence

Türkiye

Türkiye

Türkiye faces challenges, with a high smoking prevalence of 28.9 percent. However, their regulatory approach to alternative nicotine products remains stubbornly highly restrictive across all categories. Türkiye scores 0 across all 3As for vaping, heated tobacco products, snus, and nicotine pouches, reflecting a ban or near-ban on these products. This prohibitive approach reflects Türkiye’s anti-innovation stance on alternative nicotine products. The high smoking rate suggests that this restrictive strategy limits progress in reducing smoking prevalence. Türkiye may need to consider a more comprehensive approach, including a more progressive view of harm reduction alternatives, to accelerate progress towards becoming smoke-free.

64
Path to Smoke-Free Performance
64
Accessibility Performance
64
Acceptability Performance
61
Affordability Performance
28.9
Smoking Prevalence

Vietnam

Vietnam

Vietnam faces challenges, with a smoking prevalence of 16.4 percent. Their regulatory approach to alternative nicotine products is highly restrictive across all categories. Vietnam scores 0 across all 3As for vaping, heated tobacco products, snus, and nicotine pouches, reflecting a ban or near-ban on these products. This prohibitive approach reflects Vietnam’s anti-innovation stance on alternative nicotine products. The relatively high smoking rate suggests that the restrictive approach to alternatives to smoking may be limiting help to smokers looking to move and stay away from smoking. Vietnam needs to consider a more comprehensive approach, including a more progressive view of harm reduction, to accelerate progress toward reducing smoking prevalence and becoming smoke-free.

64
Path to Smoke-Free Performance
8
Accessibility Performance
64
Acceptability Performance
61
Affordability Performance
16.4
Smoking Prevalence

Turkmenistan

Turkmenistan

Turkmenistan is not transparent in relation to smoking prevalence. Their regulatory approach to alternative nicotine products is highly restrictive across all categories. Turkmenistan scores 0 across all 3As for vaping, heated tobacco products, snus, and nicotine pouches, reflecting a ban or near-ban on these products. This prohibitive and strictly coercive approach reflects Turkmenistan’s non-evidence-based stance on alternatives to smoking. Such an approach limits help for smokers looking to move and stay away from smoking. Turkmenistan needs to consider a more comprehensive approach to make progress towards becoming smoke-free.
64
Path to Smoke-Free Performance
64
Accessibility Performance
64
Acceptability Performance
61
Affordability Performance
4.7
Smoking Prevalence

Thailand

Thailand

Thailand’s approach to alternative nicotine products is one of the most restrictive globally. Thailand scores 0 across all 3As for all alternative products, including vaping, heated tobacco products, snus, and nicotine pouches. This prohibitive approach reflects Thailand’s anti-innovation stance on alternative nicotine products. The smoking rate remains stubbornly high, and their restrictive strategy has been criticized for not helping smokers move and stay away from smoking. Thailand must reconsider its approach and explore a more progressive view of harm reduction to accelerate progress toward becoming smoke-free.
64
Path to Smoke-Free Performance
64
Accessibility Performance
64
Acceptability Performance
61
Affordability Performance
18
Smoking Prevalence

Qatar

Qatar

Qatar’s regulatory approach to alternative nicotine products is highly restrictive. Qatar scores 0 across all 3As for vaping, heated tobacco products, snus, and nicotine pouches. This prohibitive approach reflects Qatar’s cautious stance on alternatives to smoking. Without smoking prevalence data, it is difficult to assess the impact of these policies. However, such a restrictive approach may limit help for smokers looking to move and stay away from smoking. Qatar may need to consider a more comprehensive approach, potentially including a more progressive view of harm reduction, to make progress towards becoming smoke-free.
64
Path to Smoke-Free Performance
64
Accessibility Performance
64
Acceptability Performance
61
Affordability Performance
9.2
Smoking Prevalence

India

India

India’s approach to alternative nicotine products is highly restrictive, with vaping and heated tobacco products being banned. This results in scores of 0 across all 3As for all alternatives to smoking. This prohibitive approach reflects India’s unjustified concerns about the potential for alternative nicotine products to undermine its efforts to eliminate smoking. The restrictive view of harm reduction limits help for smokers who are looking to move and stay away from smoking.
64
Path to Smoke-Free Performance
64
Accessibility Performance
64
Acceptability Performance
61
Affordability Performance
4.6
Smoking Prevalence

Australia

Australia

Australia still wrestles with a smoking prevalence of 10.6 percent despite some of the stringent measures. Their approach to alternative nicotine products is one of the most restrictive worldwide, whereby heated tobacco products and nicotine pouches are banned, and vaping is only available with a prescription or over the counter in a pharmacy. This highly regulated approach has failed, with over 90% of adult vapers sourcing their products from the illicit market. Australia scores very low across all 3As for all alternatives to smoking, including vaping, heated tobacco products, snus, and nicotine pouches. This restrictive approach reflects Australia’s anti-innovation stance on alternative nicotine products. Naturally, this strategy has been criticized for potentially denying smokers help to move and stay away from smoking.
51
Path to Smoke-Free Performance
51
Accessibility Performance
57
Acceptability Performance
20
Affordability Performance
10.6
Smoking Prevalence

Sri Lanka

Sri Lanka

Sri Lanka has a high smoking rate, and efforts to reduce it are further undermined by a small,unfiltered tobacco product, hand-rolled on a tendu leaf and tied with a string called ‘beedi.’ ‘Beedi’ does not comply with any regulatory or tax frameworks applicable to tobacco products, but accounts for around 30% of the cigarette market. There are no regulatory frameworks for alternative nicotine products, but heated tobacco products and snus are banned. Smuggled
vaping has become increasingly available, which strengthens the call for the government to pursue policies that help smokers move and stay away from cigarettes, to alternatives such as nicotine pouches.

52
Path to Smoke-Free Performance
53
Accessibility Performance
43
Acceptability Performance
18
Affordability Performance
5.9
Smoking Prevalence

 

United States

United States

The United States ranks tenth with a global index score of 86.75, demonstrating a solid but still developing approach to tobacco harm reduction. The country shows strong performance in Accessibility (92.08) but faces more significant challenges in Acceptability (81.24) and particularly in Affordability (28.83). While the US maintains a relatively high position among evaluated countries, there remains substantial room for improvement, especially when compared to leading nations like the UK (94.78), Slovakia (94.57), and Switzerland (94.50). These results suggest that while the United States has established a rather functional framework for innovative nicotine products, further policy refinements could help close the gap with top-performing countries.
*Methodological Note: The US assessment incorporates a sophisticated state-by-state approach, recognizing that regulations impacting product categories often vary at the state level. Each state’s score is weighted according to its population to determine the national index, ensuring the final results accurately reflect the complex federal regulatory landscape.

10
Path to Smoke-Free Performance
9
Accessibility Performance
40
Acceptability Performance
44
Affordability Performance
16.4
Smoking Prevalence