Two Countries, the Same Evidence, and Two Very Different Ideas About Helping Smokers Quit

Australia and New Zealand are separated by a few thousand kilometres of ocean, yet we share medical research, similar health systems and decades of tobacco-control history. Cigarettes kill Australians and New Zealanders through the same biological mechanisms. Still, when it comes to helping an adult smoker move away from cigarettes, our two countries increasingly seem to be speaking different languages.

In August 2026, Health New Zealand published its updated New Zealand Guidelines for Helping People to Stop Smoking. These are national guidelines intended for GPs, nurses, midwives, pharmacists, hospital clinicians, allied health professionals and smoking-cessation services, and they explicitly incorporate current evidence on behavioural support, stop-smoking medicines, relapse prevention, digital interventions and, importantly, vaping to quit smoking.

In Australia, that is anything but ordinary. The contrast between the two countries exposes something much bigger than a disagreement about e-cigarettes. It reveals two different philosophies about nicotine, risk and what tobacco control is ultimately supposed to achieve.

New Zealand’s approach begins with the smoker. The person is smoking combustible tobacco, smoking is extraordinarily dangerous, and if that person cannot or does not want to stop using nicotine immediately, another question becomes important: can we help them stop inhaling cigarette smoke? That is harm reduction. It does not require anyone to pretend vaping is harmless, encourage people who have never smoked to vape or abandon youth protections. It simply requires recognising that stopping smoking and stopping nicotine are not necessarily the same objective.

Australia appears far less comfortable with that distinction. The Australian Government’s current cessation material says therapeutic vapes should only be considered if someone has been unable to quit smoking using other treatment options such as nicotine replacement therapy. It also says that someone using vaping to quit should have a plan eventually to quit both smoking and vaping and become nicotine-free.

Think about that contrast. On one side of the Tasman, vaping has been explicitly incorporated into updated national cessation guidelines. On the other, Australian smokers encounter a tightly controlled therapeutic model in which vaping is generally positioned behind conventional cessation treatments. The technology doesn’t change when it crosses the Tasman Sea. What changes is the philosophy surrounding it.

And this difference isn’t merely academic because it determines what happens when a smoker actually tries to act on the information they receive. In Australia, vapes can legally be sold only through pharmacies for smoking cessation or managing nicotine dependence. Adults can obtain qualifying therapeutic vapes without a prescription where state and territory laws allow, but they must use a participating pharmacy and meet the regulatory requirements. Stronger products require a prescription, flavours are tightly restricted and pharmacies aren’t obliged to stock therapeutic vapes.

Cigarettes require considerably less ceremony. A smoker can walk into thousands of ordinary retailers and purchase the combustible product responsible for enormous disease and premature mortality, yet accessing a lower-risk non-combustible alternative legally means entering a therapeutic system specifically created to control its availability. Australia has therefore constructed a nicotine marketplace in which the most dangerous delivery system remains remarkably convenient while a lower-risk alternative is treated as a therapeutic good.

There is nothing inherently wrong with wanting people to become nicotine-free. If somebody wants to stop smoking, stop vaping and stop nicotine altogether, they should receive every possible encouragement and support. But what if they can’t? What if somebody has smoked for thirty years, tried repeatedly to quit and discovers that switching completely to vaping finally allows them to stop smoking? Is their continued nicotine use really the public-health outcome we should be most concerned about?

Imagine two people who have smoked for thirty years. One stops smoking and stops nicotine completely, while the other stops smoking but continues using nicotine through a non-combustible product. The first outcome may be preferable in absolute terms, but the second is still radically different from continuing to smoke. This is where an excessive focus on abstinence can lose sight of harm reduction. People do not have to achieve the theoretically perfect outcome before we recognise a substantial reduction in harm.

New Zealand’s updated guidelines retain conventional smoking cessation, behavioural support, pharmacotherapy, professional advice and prevention while incorporating vaping into the cessation toolkit. That is what makes the comparison so important. Tobacco harm reduction doesn’t have to replace conventional tobacco control; it can complete it. Tax cigarettes appropriately, educate people about smoking, prevent youth initiation, provide cessation counselling, offer nicotine replacement therapy and medicines and maintain smoke-free environments. If an adult continues smoking despite all of that, give them another realistic route away from combustion.

Why wouldn’t we?

The Australian situation becomes even more difficult to understand because its regulatory framework doesn’t operate in a world where vaping simply disappears when legal access is restricted. People continue to vape, so the practical question isn’t merely whether Australia should “allow vaping”. Australia already has vaping. The more useful question is what sort of vaping market Australia wants: a regulated legal market capable of serving adult smokers, or a system in which tightly constrained legal access exists alongside substantial illicit supply.

There is another group easily forgotten in this discussion: smokers who haven’t switched. Some existing illicit vapers would undoubtedly move into a regulated legal market if access were expanded, and that movement alone wouldn’t necessarily reduce smoking because those people may already have stopped smoking. But a functioning regulated market would also become available to today’s smokers who don’t want to buy black-market disposables, don’t trust illicit products or simply refuse to participate in an illegal market. Those people matter because they are tomorrow’s potential ex-smokers.

Consider the practical incentives facing them. Cigarettes are familiar, widely available and don’t require locating a participating pharmacy or entering a therapeutic pathway. Then we wonder why some people continue smoking.

For decades, tobacco control has understood that behaviour is shaped by the environment. We changed cigarette prices, advertising, packaging, social acceptability and where people could smoke because we understood that people don’t make choices in a vacuum. Yet when it comes to switching away from cigarettes, Australia has created an environment in which the combustible product can remain easier to obtain legally than its non-combustible competitor. That seems to work against the very behavioural principles tobacco control spent decades establishing.

None of this means New Zealand has discovered the perfect regulatory model. It hasn’t. Vaping carries risks, youth uptake matters, product standards matter, nicotine dependence matters, long-term surveillance matters and marketing rules matter. Nor should we look at New Zealand’s smoking prevalence and simply declare that vaping caused its decline. Smoking prevalence is complicated, with taxation, education, generational change, fewer young people starting, migration, socioeconomic conditions, cessation services, medical treatment, vaping and cultural attitudes all interacting over decades. Taking a national smoking-prevalence number and awarding all the credit to whichever policy we favour is poor analysis, whether the favoured intervention is taxation, plain packaging, vaping or anything else.

But we can observe something much simpler. New Zealand’s national health authorities have reviewed contemporary evidence and explicitly included vaping to quit smoking in their updated cessation guidelines, while Australia’s legal and clinical framework remains considerably more restrictive.

Perhaps that points towards the larger question Australia needs to confront: what exactly is the endpoint of tobacco control? Is success a society in which nobody consumes nicotine, or is the overriding objective a society in which almost nobody smokes combustible tobacco? Ideally, perhaps we achieve both, but when those objectives come into conflict, public health needs to decide which matters most.

If somebody who otherwise would have smoked for another twenty years instead uses a substantially lower-risk nicotine product for those twenty years, should we primarily regard that as a failure because the person remains dependent on nicotine? I struggle to see how. The cigarette isn’t uniquely catastrophic simply because it delivers nicotine. Its extraordinary danger comes overwhelmingly from repeatedly inhaling the products of combustion, and that distinction should sit at the centre of tobacco policy.

Again, there is nothing wrong with becoming nicotine-free. For somebody who wants that, fantastic. But nicotine abstinence and smoke abstinence should not become conceptually interchangeable. A smoker who quits cigarettes and nicotine completely has achieved an excellent outcome, while a smoker who completely replaces cigarettes with a substantially lower-risk nicotine product has achieved something different but also profoundly important: they are no longer continually inhaling cigarette smoke. Neither outcome should be confused with continuing to smoke.

This is why I find New Zealand’s new guidelines so important. They don’t require us to throw away everything tobacco control achieved; they invite us to add another layer to it. The traditional tobacco-control question was how we make people stop smoking. Harm reduction adds another: if someone cannot or will not stop using nicotine, how do we make continuing to smoke the least attractive option?

That opens the door to a much more ambitious approach: not vaping instead of cessation, but vaping as a route to cessation for some people; not harm reduction instead of prevention, but harm reduction alongside prevention; not nicotine products without regulation, but regulation proportionate to risk.

And perhaps eventually not vaping alone either. If credible evidence demonstrates that other non-combustible nicotine products can displace cigarettes at substantially lower risk, they too should be assessed according to their evidence and risks rather than rejected simply because they contain nicotine.

Different smokers may need different exits. Some will quit unaided, some will use patches or gum, some will use medicines, some will vape, some may prefer other non-combustible nicotine products, and some will move through several approaches before finally leaving cigarettes behind. The destination matters more than insisting everybody take the same road.

That is ultimately what I take from the comparison between Australia and New Zealand. Both countries say they want fewer people smoking, both say they follow evidence and both say they care about public health, but New Zealand’s 2026 guidelines appear more willing to accept something Australia still struggles to embrace fully: sometimes the most practical route away from the most dangerous behaviour isn’t demanding that people give up everything. It is giving them something substantially less dangerous to move towards.

Australia doesn’t need to copy New Zealand blindly. It should study it, challenge it, measure it, learn from its mistakes, learn from its successes and, most importantly, be willing to change course when evidence warrants it. Tobacco control should never become a monument to policies that worked yesterday. Its purpose is to prevent tomorrow’s disease and death.

If a smoker moves away from combustible tobacco because we gave them a regulated, affordable and acceptable alternative, public health shouldn’t regard their continued nicotine use primarily as a failure. It should first recognise what has disappeared: the smoke.

Perhaps that is the philosophical difference Australia most urgently needs to confront. The ultimate measure of tobacco control should not be how successfully we eliminate nicotine from people’s lives. It should be how successfully we eliminate the death and disease caused by smoking.