Safe types of tobacco and nicotine products do not exist

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REFUTATION

 

Counterarguments against the Tobacco Harm Reduction Strategy promoted  by the tobacco industry

 

In recent years, in Uzbekistan there were taken effective legislative measures to comply with the principles and recommendations of the World Health Organization Framework Convention on Tobacco Control (hereinafter the WHO FCTC). Specifically, there was imposed a ban on the circulation of:

non-smoking tobacco products, including nicotine-containing non-smoking products (except for nasvay), May 2023[1];

electronic nicotine delivery systems, along with electronic cigarettes (e-cigarettes), nicotine-containing and nicotine-free liquids for electronic cigarettes, November 2025.[2]

The Secretariate’s Report on the 2023 Conference of the Parties to the WHO FCTC highlighted progress in tobacco control legislation of a number member countries, including Uzbekistan.[3 ] In 2025, WHO recognized as successful the tobacco control legislation reforms of five countries in the world, with Uzbekistan among them.[4]

The adopted reforms have already produced the first impressive results: the ban on the turnover of smokeless tobacco and nicotine products (except for nasvay) resulted in considerable decrease in  their availability, particularly  for children and adolescents.

In response to progress in tobacco control policy, the tobacco industry has intensified efforts to weaken Uzbekistan legislation with a view to preserving and increasing the number of consumers of tobacco products.

Publishing the document «Report. Smoke Free Sweden. Tale of Two Nations Vol 7: A comparative study of how Uzbekistan and Sweden are faring in the fight against smoking» (hereinafter referred to as the Report)  on the Internet and social networks served as one of such steps. Its goal is to manipulate public opinion in order to protect the corporate interests of the tobacco industry.

The Report states that the greatest success in reducing smoking-related mortality can be achieved by countries applying the so-called «harm reduction» strategy. Instead of bans or strict restrictive measures, it proposes to encourage the consumption of «less harmful» tobacco and nicotine products such as snus, electronic cigarettes and heated tobacco products.

To refute the false policy of the tobacco industry, the counter-arguments to the Report are as follows:

  1. The reduction of smoking in Sweden is the result of a consistent state anti-smoking policy, rather than the application of the so-called «harm reduction» strategy.

The Report states that the success of Sweden is due to the use of a «harm reduction» strategy and provides data on the prevalence of daily smoking among men: 4.9% in Sweden versus 20.4% in Uzbekistan.

According to the WHO Global Report, in 2024 the prevalence of smoking at current time (daily and/or episodic during the last 30 days) among men over 15 years old was 12.0% in Sweden and 19.3% in Uzbekistan. In general, the prevalence of smoking among people aged 15 and over made 10.2% in Sweden and 10.1% in Uzbekistan, while the prevalence of all forms of tobacco consumption made 20.3% in Sweden and 16.3% in Uzbekistan.[5] 

According to the Public Health Agency of Sweden, the national tobacco control  policy of Sweden was launched in the 1960s. First national actions were aimed at:

  • reducing availability of tobacco products;
  • decreasing the demand for and social acceptance of smoking cigarettes;
  • increasing access to smoking cessation programs.[6]

Since the 1980s, stable reductions in the prevalence of daily cigarette smoking, coinciding with the implementation of large-scale preventive actions, have been observed in the country. Subsequent comprehensive measures – ban on tobacco advertising, tax regulation, setting an age limit, creating smoke-free spaces – resulted in a more significant decline in daily smoking prevalence. Thus, among the population aged 16-84 years, this figure dropped 16.4% in 2004 to 5.4% in 2024 (a decrease by 11 percentage points or about 67% from the baseline).[7]

Therefore, the Report conclusions on the effectiveness of substitution of smoking by snus consumption in Sweden are not proved: the country’s success is directly linked to a systemic government tobacco control policy rather than to the promotion of «less harmful» tobacco and nicotine products.

  1. In practice, the so-called “harm reduction” strategy leads to an increase in the consumption of “less harmful” tobacco and nicotine products. The Report omits to mention the increasing prevalence of snus and e-cigarettes consumption in Sweden, which is data manipulation.

Firstly, according the Public Health Agency of Sweden, in 2018-2024 there was recorded a significant increase in daily consumption of tobacco and nicotine snus in Sweden: from 11.2% to 15.7% (an increase of 40% from baseline); the increase is particularly evident among women aged 16-29 years, where the proportion of daily users has risen from 3% to 18% (increase by 500%).[7]

Of particular concern is the increasing proportion of nicotine snus consumption among young people: females aged 16-29 years increased their daily consumption from 10% in 2022 to 15% in 2024, and males of the same age – from 5% to 11%. The increase was also observed among individuals aged 33-44 years and 45-64 years, though at a much lower level.[7]

Secondly, there is also increasing prevalence of e-cigarettes consumption in Sweden. In 2024, 4% of individuals aged 16-100 years reported using e-cigarettes, with about a quarter doing so daily. [7] The Survey, which was carried out in 2021-2022, showed that 18% of girls and 15% of boys aged 13 had ever used electronic cigarettes in their lives, with corresponding proportions of 34% and 29% among 15-year-olds respectively.[8]

This picture indicates that in Sweden the proportion of smoking of traditional tobacco products is decreasing, while the proportion of the consumption of “less harmful” tobacco and nicotine products is increasing. It should be emphasized: “less harmful” tobacco and nicotine products do not exist. All of them are harmful to health, and their widespread aggravates the situation, increasing the burden on both the health system and the economy as a whole.

Thus, the “harm reduction” strategy is essentially a tool for promoting and stimulating sales of new products of the tobacco industry, it is not a mean to protect the health of population.

 

  1. The tobacco industry uses false and distorted information to justify the effectiveness of the so-called “harm reduction” strategy.

First, the Report states: “Uzbekistan’s tobacco control policies are failing to achieve their core objective: stopping people smoking and thereby saving lives”.  Smoking rates in the country “have declined by less than a single percentage point in more than a decade”, with reference to a study funded under the grant from the Foundation for a Smoke-Free World, Inc.[9]

In 2017, WHO published a special Statements [10], which specified that the Foundation for a Smoke-Free World, Inc. had been established and was funded by the tobacco company Philip Morris International. Thus, the cited source reflects the commercial interests of the tobacco industry rather than the interests of public health.

According to WHO estimates, in Uzbekistan the prevalence of tobacco consumption among individuals aged 15 years and over has decreased from 21.2% in 2010 to 17.3% in 2020 (a decrease of 18% from baseline).[5] This is the evidence of significant progress, that completely disproves the tobacco industry’s statement about “lack of results of anti-smoking policy in Uzbekistan”.

Second, the Report states: “According to the Republican Institute of Health and Medical Statistics, about 30,000 people die each year in Uzbekistan due to smoking-related diseases”. However, the specified link in the Report leads to an inaccessible or non-working Web site. Moreover, the Republican Institute of Health and Medical Statistics itself did not exist during the period under review (2018-2021): in May 2017 it was reorganized into another institution.[11]

Third, the Report states: “…if Uzbekistan adopted tobacco harm reduction policies…, the country could prevent up to 464,000 smoking-related deaths by 2060.” This conclusion is groundless and misleading.

Foreign countries practice shows that aggressive advertising and promotion of new tobacco and nicotine products among young people is reflected in higher levels of their use. According to WHO, the global level of e-cigarette consumption among adolescents (13-15 years) is almost three times higher than that of adults, with a gap reaching the proportion of nine times or more in a number of countries [5]; as well as the dual use of these products is widespread- for example, up to two-thirds of consumers of heated tobacco products in Japan [12], and almost all consumers (96.2%) in the Republic of Korea continue to smoke cigarettes [13].

Thus, the conclusions of the Report are based on unreliable, distorted or non-existent data and cannot be considered as a reliable source of information for public health policy-making.

  1. Promotion of the «harm reduction» strategy as a form of misinformation.

The Report concludes: “Sweden’s success demonstrates that making safer nicotine alternatives accessible, affordable and socially acceptable is key to transitioning smokers away from combustible products”.

History shows that similar tactics have already been used: a few decades ago, the tobacco industry stimulated sales of so-called “light” and “soft” cigarettes, positioning them as less harmful alternatives, being fully aware that those products are no less harmful to health. Time has passed and the findings of studies have shown that morbidity and mortality among smokers has not decreased. Moreover, there has been revealed a direct link  between the spread of consumption of “light” cigarettes and an increase in the incidence of pulmonary adenocarcinoma.[14]

Currently, tobacco companies continue such misleading practice by promoting new tobacco and nicotine products for children in the form of gadgets, items associated with school things (pens, felt-tip pens and others), creating the illusion of “risk reduction”.[10]

However, the introduction of such products poses a serious threat to public health, in particular for children and adolescents: these products increase the risk of nicotine addiction, negatively affect brain development and contribute to switching to traditional smoking.[15,16]

Application of the “harm reduction” strategy to tobacco products is not acceptable, as regardless of manufacturing technologies or changes in characteristics, tobacco products remain to be harmful and dangerous.

  1. The Report cannot be considered as a source of independent scientific research data, since it was prepared by an organization and authors associated with the tobacco industry.

The Report has been  published by Smoke Free Sweden, which is affiliated with the Health Diplomats organization. Health Diplomats, for its part, declares cooperation with tobacco producers, including companies sponsoring the Global Tobacco and Nicotine Forum.[17] The Global Tobacco and Nicotine Forum comprises, among others, British American Tobacco, Philip Morris International, Imperial Brands and other tobacco companies.[18] 

Dr. Delon Human, the author of the Report, is a leader of the organization “Smoke Free Sweden”[19], and on repeated occasions he has cooperated with and acted as an adviser to the  British American Tobacco.[20]

Accordingly, the Report was developed by researchers whose activities were financed by tobacco companies.[21,22]

In summary, it is important to note that Uzbekistan tobacco control policy aims to create the country free of tobacco and nicotine. Replacing conventional cigarettes with “less harmful” alternative tobacco products does not solve the problem, because there are no safe types of tobacco and nicotine products, all kinds of such products are harmful to health.

Opinions of independent Swedish experts on tobacco control

In May 2024, Helen Stjerna, leader of the Swedish non-profit foundation, “A Non-Smoking Generation”, alarmingly warned: “There is a lot of talk about Sweden becoming smoke-free, but this is a narrative that has been created by the tobacco industry.”

“Despite a recent law in 2022, which banned advertising nicotine products on television and radio in Sweden, Helen says the tobacco industry still buys influence across social media and aggressively markets white snus, particularly at girls and young women.”[23]

“Snus use is spreading like an epidemic in schools here because students who are 18 can go and buy it and then sell it on to their younger friends who use it during school hours,” she says. “There are no laws to prevent this and it’s a huge problem in Sweden right now.”[23]

In November 2024, Ulrika Årehed Kågström, President of the Union for International Cancer Control (UICC) and Secretary-General of the Swedish Cancer Society Secretary-General of the Swedish Cancer Society, made the following announcement: “Smoking is one of the leading preventable causes of cancer, so it is great to see Sweden boast such low smoking rates, which is a testament to the effectiveness of proven public health strategies. It is alarming, however, that the tobacco industry is effectively misrepresenting this success to further its own commercial interests in selling smokeless products such as snus. It is equally disturbing that this narrative and the industry’s manipulation of science is being picked up by the media, with danger of influencing public opinion and health decisions.”[24]

References

  1. Article 37 of the Law of the Republic of Uzbekistan dated May 24, 2023 No. 844 “On restricting the distribution and consumption of alcohol and tobacco products”. https://lex.uz/docs/6472104?ONDATE=01.03.2026.
  2. Article 4 of the Law of the Republic of Uzbekistan dated November 27, 2025 No. 1098 “On Amendments and Additions to Certain Legislative Acts of the Republic of Uzbekistan aimed at further strengthening the requirements for the turnover of certain types of tobacco products, tobacco and nicotine devices.” https://lex.uz/docs/7869890.
  3. 2023 Global Progress Report on Implementation of the WHO Framework Convention on Tobacco Control, World Health Organization 2023. https://fctc.who.int/resources/publications/m/item/2023-global-progress-report.
  4. WHO report on the global tobacco epidemic, 2025: warning about the dangers of tobacco. Fresh and alive MPOWER, World Health Organization, 2025. https://www.who.int/publications/i/item/9789240112063.
  5. WHO global report on trends in prevalence of tobacco use 2000–2024 and projections 2025–2030. World Health Organization 2025. https://www.who.int/publications/i/item/9789240116276.
  6. The Public Health Agency of Sweden. Towards a smoke-free Sweden. https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/living-conditions-and-lifestyle/andtg/tobacco/towards-a-smoke-free-sweden/.
  7. The Public Health Agency of Sweden. Use of tobacco and nicotine products. https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/living-conditions-and-lifestyle/andtg/tobacco/use-of-tobacco-and-nicotine-products/
  8. Health Behaviour in School-aged Children (HBSC), results for Sweden in the 2021/22 WHO study. Nationella resultat. Folkhälsomyndigheten, 2023. https://hbsc.org/unveiling-the-state-of-youth-health-and-behaviour-in-sweden-insights-from-the-latest-hbsc-study/
  9. «Ubekistan Country Report. Prepared by Healthy Initiatives. December 2021» https://globalactiontoendsmoking.org/wp-ontent/uploads/2024/02/Uzbekistan_country_report_3.21.22.pdf.
  10. WHO Statement on Philip Morris funded Foundation for a Smoke-Free World. 28 September 2017. https://www.who.int/news/item/28-09-2017-who-statement-on-philip-morris-funded-foundation-for-a-smoke-free-world/.
  11. Resolution of the Cabinet of Ministers of the Republic of Uzbekistan of May 10, 2017 No. 266 “On the organization of activities of the Research Institution of Public Health and the Organization of Healthcare”. The Act became invalid on 04/26/2019. https://lex.uz/docs/3199756.
  12. Edward Sutanto et al. Prevalence, Use Behaviors, and Preferences amongsers of Heated Tobacco Products: Findings from the 2018 ITC Japan Survey. Int. J. Environ. Res. Public Health 2019, 16, 4630; doi:10.3390/ijerph16234630. https://www.mdpi.com/1660-4601/16/23/4630.
  13. Jinyoung Kim,Hyunjae Yu, Sungkyu Lee, Yu-Jin Paek. Awareness, experience and prevalence of heated tobacco product, IQOS, among young Korean adults. Tob Control. 2018 Aug 29;27(Suppl 1):s74–s77. doi: 10.1136/tobaccocontrol-2018-054390. https://pmc.ncbi.nlm.nih.gov/articles/PMC6252497/.
  14. Fred Charatan. US judge allows class action over light cigarettes. BMJ. 2006 Oct 7;333(7571):722.doi: 10.1136/bmj.333.7571.722, https://pmc.ncbi.nlm.nih.gov/articles/PMC1592382/.
  15. Technical note on the call to action on electronic cigarettes. World Health Organization 4 December 2023. https://www.who.int/publications/m/item/technical-note-on-call-to-action-on-electronic-cigarettes.
  16. Heated tobacco products: summary of research and evidence of health impacts. World Health Organization 2023. https://www.who.int/publications/i/item/9789240042490.
  17. The Global Tobacco and Nicotine Forum. https://healthdiplomats.com/disclosure/.
  18. The Global Tobacco and Nicotine Forum. https://www.gtnf.org/sponsors).
  19. Smoke Free Sweden. News & Articles. https://smokefreesweden.org/news/.
  20. Tobacco tactics from the University of Bath (United Kingdom). Delon Human/ Last edited on 20 November 2024. https://www.tobaccotactics.org/article/delon-human//.
  21. Tobacco tactics from the University of Bath (United Kingdom). Centre for Research Excellence: Indigenous Sovereignty and Smoking (COREISS). Last edited on 16 June 2022, https://www.tobaccotactics.org/article/coreiss.
  22. Tobacco tactics from the University of Bath (United Kingdom). Quit Like Sweden. Last edited on 02 July 2025. https://www.tobaccotactics.org/article/quit-like-sweden/.
  23. Have you heard of white snus? A Swedish tobacco control activist rings the alarm. 29 May 2024. https://www.who.int/europe/news-room/feature-stories/item/have-you-heard-of-white-snus–a-swedish-tobacco-control-activist-rings-the-alarm.
  24. Announcement. The misleading and industry-friendly narrative of Sweden’s ‘smoke-free’ status. 27 November 2024. Last update. 03 December 2024. https://www.uicc.org/news-and-updates/announcements/misleading-and-industry-friendly-narrative-swedens-smoke-free-status.

Shukurov Shukhrat – Chief Specialist of the Institute of Health and Strategic Development of the Ministry of Health of the Republic of Uzbekistan.

January 20, 2026