An Open Letter to Tobacco Control Academics: When Will You Look Abroad?

Dear Tobacco Control Academics,

Australia has long seen itself and been seen by others as a global leader in tobacco control. Plain packaging, graphic health warnings, and sustained taxation policy. These interventions helped drive smoking prevalence down from around 24 % of adults in 1991 to an estimated 8.3 % in 2022–23. The proportion of people who have never smoked continues to rise, now at about 65 % of Australians aged 14 and older. These are not small achievements, and they are rightly celebrated.

But leadership carries an obligation: to remain open to evidence from outside our borders, especially where that evidence challenges our assumptions, informs better design, or highlights unintended consequences.

On vaping and tobacco harm reduction, an expanding body of real-world international experience is already available. Yet in Australia, this evidence is often sidelined, reframed, or treated as irrelevant to our own policy debates.

In the United Kingdom, for example, recent official statistics show smoking prevalence falling to historic lows. In 2024, just 9.1 % of adults aged 18+ reported smoking cigarettes, the lowest level since records began in 1974. Meanwhile, an estimated 10 % of adults now vape, about 5.4 million people, which for the first time outnumbers the 4.9 million adult smokers.

That shift in more adults vaping than smoking is not just symbolic. It suggests that non-combustible nicotine products are displacing smoked tobacco at the population level. Among young adults (16–24), around 13 % reported vaping in 2024 (down slightly from 15.8 % in 2023), even as smoking among that age group declined sharply over the past decade.

These are the sorts of trends many Australian tobacco control debates claim not to believe can happen. Yet here they are documented by the UK’s own national statistics agency.

Look also at New Zealand. New Zealand deliberately incorporated vaping into its Smokefree 2025 strategy, permitting regulated retail access and encouraging smokers to switch to less-harmful alternatives. In the years leading up to 2025, daily smoking declined faster than many projections had anticipated, especially in populations with historically high tobacco use. At the same time, lifetime vaping experimentation among young adults reached substantial proportions, without a corresponding reversal in youth smoking. Unlike Australia’s current approach, New Zealand did not criminalise adult access, nor did it constrain flavours to the point of near non-availability.

Then consider Sweden, a case often overlooked in Australian discourse. Sweden is widely regarded as on track to become the first European country to be effectively “smoke-free.” It achieved this not by eliminating nicotine but by reducing combustion through widespread use of snus and other non-burning nicotine products. Today, Sweden’s smoking prevalence sits among the lowest in Europe, around 8 % overall according to EU data and significantly lower than the EU average of ~24 %. This has translated into one of the lowest smoking-related disease burdens on the continent.

France’s national health and safety agency, ANSES, has delivered one of the clearest statements yet from a major European health body that vaping is less harmful than smoking.

None of these countries is the perfect analogue, regulatory frameworks differ, cultures differ, and health systems differ. But they are high-income democracies with sophisticated public health institutions whose experiences are highly relevant to our own policy choices.

Meanwhile, in Australia, the recent policy trajectory has been very different. Retail availability of most vaping products has been restricted. Flavours that appeal to adult smokers are effectively banned. Enforcement and penalties have intensified. Public messaging overwhelmingly emphasises youth risks, often without a clear articulation of the relative risk for adult smokers seeking to quit.

Unsurprisingly, e–cigarette use in Australia has increased in recent years, with lifetime vape experimentation reported by around 49 % of 18-24-year-olds and 28 % of 14-17-year-olds in 2022–23, although daily use remains lower than in places like the UK. Smoking among adults is at historically low levels by long-term Australian standards, around 8.3 % daily smokers — yet the dynamics among young adults are complex. Some recent data reported in the media suggests that smoking among Australians aged 18–24 increased by around 36 % within a year following the vaping reforms, with more than 10 % of this age group now smoking, and combined smoking/vaping prevalence approaching 28 %.

The context in which this happened, against tightened vape access and a thriving black market, is often not meaningfully engaged with in academic commentary.

If the UK shows that adult vaping prevalence can exceed smoking prevalence while smoking continues to fall, if New Zealand shows accelerated smoking decline in the context of regulated adult vape access, if Sweden’s smoke-free progress reflects harm reduction rather than nicotine abolition, at what point does ignoring that evidence become ideological rather than scientific?

Some Australian tobacco control scholars argue that these findings are culturally or methodologically inapplicable that somehow our context is unique. Yet this position is rarely articulated with clear criteria for falsification. What would international evidence look like that would change minds? What set of outcomes abroad would persuade sceptics that harm-reduction policies deserve genuine consideration?

Australia’s tobacco control community has accomplished extraordinary things over the decades. But past success does not immunise any field from blind spots. Science and policy alike flourish when confronted with new data, especially when it unsettles established priors.

This letter is not an attack. It is an invitation and a challenge.

Look abroad seriously, rigorously, and in good faith. Engage with the UK’s experience of declining smoking and rising adult vaping. Scrutinise New Zealand’s accelerated decline. Analyse Sweden’s displacement of combustion. Acknowledge these real-world outcomes as data, not anomalies.

Public health is strengthened, not weakened, by confronting uncomfortable evidence. Australia deserves a policy built on the full international record, not a curated subset of it.

Respectfully,

Alan Gor