Health experts are urging policymakers to explore safer nicotine alternatives alongside traditional tobacco-control strategies, pointing to a study showing New Zealand’s smoking rates plummeted after adopting harm-reduction aids. Published in The Lancet Regional Health Western Pacific, the research shows daily smoking fell below 7% by 2023.
Researchers used joinpoint regression analysis to assess New Zealand’s smoking trends. They reported that the annual rate of decline quickened nearly five-fold once regulated vaping products were formally recognized as cessation aids in 2018-19. This drop occurred despite New Zealand already having strict conventional measures in place, such as plain packaging, graphic health warnings, and high taxes.
| Policy Phase (New Zealand) | Annual Rate of Smoking Decline |
|---|---|
| Pre-2018 (Conventional Measures Only) | 3.5% |
| Post-2018 (With Regulated Nicotine Alternatives) | 17.9% (Nearly 5-fold increase) |
Dr. Saurabh Tomar, an interventional pulmonologist at Aakash Healthcare, noted that conventional tobacco-control interventions eventually reach a limit. “Despite New Zealand implementing measures such as plain packaging, graphic health warnings and repeated tax increases, smoking declined only gradually,” Tomar said. “The sharper fall came after regulated, substantially less harmful nicotine alternatives were recognized as cessation tools and made available to adults.”
Tomar explained that scientific evidence differentiates the health risks of tobacco combustion from those of nicotine. “It is the combustion of tobacco that generates thousands of toxic chemicals responsible for lung cancer, chronic obstructive pulmonary disease and cardiovascular disease,” he said.
To prevent youth uptake, New Zealand paired its harm-reduction strategy with strict regulations. The country enforced age restrictions, restricted flavors, capped nicotine concentrations, and banned disposable vapes. Consequently, smoking among 14-to-15-year-olds fell to historic lows, even as youth vaping rates rose.
These findings carry weight for India, which has 135 million smokers and suffers 1.35 million tobacco-related deaths annually. Dr. Satish Kumar, senior consultant of internal medicine at Pacific One Health Hospital, observed that while India and New Zealand differ in demographics, tobacco dependence follows identical biological principles.
Kumar stated that traditional demand-reduction measures are necessary but insufficient for rapid declines, particularly among socio-economically vulnerable groups. He suggested that regulated access to safer alternatives could complement existing efforts.
The World Health Organization has included nicotine replacement therapies on its Essential Medicines List since 2009, and India’s Drugs Technical Advisory Board exempts 2 mg nicotine gum from certain restrictions, acknowledging its cessation benefits. Experts suggest India’s low unassisted quit rates could be improved by studying New Zealand’s model while maintaining strict youth protections.
