New Zealand reduced adult smoking rates from nearly 40 per cent in the mid-20th century to less than 7 per cent by 2022-23 in a new study published in The Lancet Regional Health – Western Pacific, which offers some insights into tobacco-control methods. The country’s greatest reduction in smoking was achieved by the integration of traditional anti-smoking policies with regulated, lower-risk nicotine alternatives, particularly as vaping products.
The findings have reignited tobacco harm reduction discussions, especially in countries that have a large number of smokers, like India, which is one of the world’s largest populations of smokers.
The decline of smoking has intensified over the last 10 years
The research, titled “New Zealand's Accelerating Smoking Decline: Lessons for Tobacco Harm Reduction,” used joinpoint regression to study national smoking trends over several years.
By 2011 and 2018, adult smoking rates in New Zealand were already declining by an average of 3.5 per cent per year, thanks to strong tobacco-control measures.
However, after the government formally recognised regulated vaping products as smoking cessation aids during 2018-19, the annual decline in smoking accelerated dramatically to 17.9%, a five-fold increase in the pace of reduction.
The change occurred at the time of the introduction of a regulated system for vaping products, rather than in a replacement of the tobacco-control laws.
Traditional tobacco control remained strong
The study makes clear that New Zealand did not abandon conventional anti-smoking measures. Rather, it continued to implement policies based on the World Health Organization Framework Convention on Tobacco Control (WHO FCTC).
These measures included:
- Significant increases in tobacco taxes.
- Plain packaging of cigarette packs.
- Graphic health warnings.
- Comprehensive smoke-free public policies.
- Government-supported smoking cessation programmes.
Researchers found that these efforts reduced smoking persistently for years, and the addition of regulated vaping products seemed to accelerate the decline among adult smokers.
Strict rules for vaping products
The Lancet paper also notes that New Zealand introduced vaping products alongside strict regulatory safeguards to prevent youth access and misuse.
The regulations include:
- Minimum purchasing age of 18 years. Restrictions on flavours.
- Nicotine concentration limits.
- Ban on disposable vaping devices.
- Licensing requirements for retailers.
- Strict advertising and marketing controls.
Researchers found that although youth vaping was initially high as vaping products became more prevalent, adolescent smoking remained relatively low, and youth vaping later began to decline in the wake of tighter regulations.
India is in a different situation
India is currently taking a different policy approach.
The Prohibition of Electronic Cigarettes Act, 2019, bans the manufacture, import, sale, distribution, and advertisement of electronic cigarettes. Conventional cigarettes, however, are still subject to separate laws.
According to government estimates, about 135 million Indians smoke, and tobacco use contributes to around 1.35 million deaths annually, making it one of the country's leading preventable causes of death.
Debate on tobacco harm reduction continues
Supporters of tobacco harm reduction believe New Zealand’s experience suggests regulated lower-risk nicotine alternatives may help adult smokers move away from combustible tobacco.
They also note that nicotine replacement therapies such as nicotine gums and patches are already recognised as smoking cessation tools and are included in the WHO Model List of Essential Medicines.
But many public health experts in India are still cautious. They cite concerns including:
- Youth nicotine addiction.
- Dual use of cigarettes and vaping products.
- Aggressive marketing practices.
- Limited long-term evidence regarding vaping safety.
Expert opinions
Commenting on the study, Dr. Saurabh Tomar, Consultant Pulmonologist at Aakash Healthcare, stated that the findings reflect what many clinicians see in practice.
According to him, most smoking-related diseases, from lung cancer to chronic obstructive pulmonary disease (COPD) and cardiovascular disease, are primarily caused by the toxic chemicals released when tobacco is burned rather than nicotine itself. He said this distinction needs to be taken into account when developing public health policies.
Similarly, Dr. Satish Kumar, Senior Consultant in Internal Medicine at Pacific One Health Hospital, said New Zealand's experience indicates that traditional tobacco-control measures and regulated harm-reduction strategies may complement one another rather than compete.
At the same time, he warned that India and New Zealand have different healthcare systems, demographics, and tobacco-use patterns. Any future policy decisions, he said, should be guided by strong scientific evidence while balancing public health priorities.
A continuing public health debate
The Lancet study doesn’t prescribe a universal policy but shows that New Zealand’s combination of strong tobacco-control measures and tightly regulated nicotine alternatives coincided with a significant reduction in smoking prevalence.
If such strategies can still achieve similar results in India, the scientific and policy debate is ongoing as to what effect on India's public health must be on the same lines. Public health experts agree that any future policy decisions should take into account not only the benefits for adult smokers but also the need to protect young people from nicotine addiction in the future.
