Nicotine should be regulated proportionately to its risks and in a manner that accelerates the decline of combustible smoking. It should not be governed through sweeping “endgame” narratives that treat all nicotine products as though they occupy the same place on the risk spectrum.
Recent interventions from both The Guardian and the Government of Palau illustrate a growing shift in nicotine policy debates. While framed as public health initiatives, both approaches risk collapsing critical distinctions between combustible tobacco and lower-risk nicotine products. In doing so, they raise important questions about whether nicotine governance is becoming increasingly focused on nicotine itself rather than on the products responsible for the overwhelming burden of smoking-related disease.
This distinction matters because public health success should ultimately be measured by reductions in disease, death, and exposure to harmful toxicants, not simply by reductions in nicotine use regardless of how that nicotine is delivered.
The Guardian’s False Choice
The Guardian is correct to reject an outright global ban on nicotine. However, its editorial largely presents the policy debate as a choice between easy availability and increasingly restrictive controls. Missing from this framing is a third pathway: risk-proportionate regulation.
By focusing on the idea that “addiction without harm” is a contradiction, the editorial risks conflating dependence with disease. Nicotine is addictive, but addiction alone does not explain the vast burden of smoking-related mortality. The principal drivers of tobacco-related disease are the thousands of toxicants produced through combustion.
This distinction has informed decades of tobacco-control science and increasingly underpins modern regulatory discussions. Yet it receives surprisingly little attention in a debate that seeks to justify stronger controls on all forms of nicotine.
The result is a policy conversation that risks treating nicotine replacement therapies, nicotine pouches, vaping products, heated tobacco products, and combustible cigarettes as though they pose broadly similar public health concerns when growing evidence suggests otherwise.
A more balanced approach would recognise both realities simultaneously: nicotine products require regulation, but regulation should reflect relative risk.
The Problem With Endgame Thinking
The language of “endgame” strategies is politically appealing. Few policymakers wish to appear anything other than ambitious when discussing public health.
The difficulty emerges when the objective subtly shifts from reducing smoking to eliminating nicotine itself.
A smoke-free society and a nicotine-free society are not necessarily the same thing.
When public discourse treats all nicotine products as morally or medically equivalent, lower-risk alternatives risk becoming collateral damage in a broader campaign against nicotine. This can create a paradox in which products responsible for the greatest burden of disease remain legally available while less harmful alternatives face increasingly restrictive treatment.
The question should not be whether society wishes to minimise youth uptake and dependence. It should. The question is whether those objectives can be achieved without undermining pathways that may help adult smokers move away from combustible tobacco.
What Palau Gets Wrong
Palau’s proposal to explore international drug-control scheduling for nicotine rests on a powerful but potentially misleading narrative: that nicotine is the molecule behind more than seven million tobacco-related deaths annually.
The reality is more complex.
The overwhelming majority of tobacco-related mortality is driven by combustion and smoke exposure rather than nicotine itself. Tar, carbon monoxide, particulate matter, and thousands of combustion-derived toxicants account for the diseases most commonly associated with smoking.
This distinction is not a technicality. It is fundamental to understanding risk.
By conflating nicotine with the entire burden of smoking-related disease, policymakers risk overlooking one of the central developments in tobacco control over the past two decades: the emergence of non-combustible products that may substantially reduce toxicant exposure for adults who would otherwise continue smoking.
The proposal therefore raises an important question. Should products that occupy very different positions on the risk continuum be governed through the same international framework?
Increasingly, the evidence suggests they should not.
Why Drug-Control Frameworks May Be the Wrong Tool
International narcotics conventions were designed primarily for substances whose risks arise largely from the substances themselves.
Nicotine presents a different challenge.
Existing global tobacco-control architecture already exists through the WHO Framework Convention on Tobacco Control. The question is not whether nicotine should be regulated internationally, but whether moving nicotine into a narcotics-style governance model would improve public health outcomes.
Such a move could create uncertainty around nicotine replacement therapies, complicate regulatory pathways for reduced-risk products, and encourage increasingly restrictive approaches that fail to differentiate between combustible and non-combustible products.
At a minimum, these potential consequences deserve far greater scrutiny than they have received thus far.
Lessons From Quebec
The experience of Quebec illustrates some of the challenges associated with universal restriction models.
The province’s flavour restrictions were introduced primarily to reduce youth vaping. While the objective is understandable, the policy also raises broader questions about unintended consequences.
When adult consumers lose access to products that helped them move away from smoking, some may return to combustible tobacco while others may seek products through informal channels.
The policy debate therefore cannot end with the question of whether restrictions reduce legal availability. It must also consider how consumers respond once those restrictions are in place.
This is particularly relevant when restrictions apply to lower-risk products while combustible cigarettes remain widely available.
Australia and the Limits of Prohibition-Leaning Models
Australia offers another important case study.
Over recent years, policymakers adopted increasingly restrictive approaches to nicotine vaping products, including prescription-based access pathways and tighter import controls.
Supporters argued these measures would strengthen public health protections. Critics argued they would create barriers for adult smokers seeking alternatives.
The resulting debate highlights a broader policy lesson. When access pathways become too complex or disconnected from consumer behaviour, demand does not necessarily disappear. Instead, it may migrate toward informal or illicit channels.
This is not an argument against regulation. It is an argument for regulation that remains grounded in how consumers actually behave.
The IMF and the Risk Continuum
Recent analysis from the International Monetary Fund adds another important dimension to this discussion.
Drawing on toxicological evidence, IMF economists highlighted substantial differences in risk across nicotine products and reinforced the principle that taxation and regulation should reflect relative harm rather than treating all products as equivalent.
This is significant because it demonstrates that recognition of the risk continuum is no longer confined to harm-reduction advocates or industry stakeholders. Increasingly, it is being acknowledged by institutions examining broader questions of economics, taxation, and public policy.
If regulation is to remain evidence-based, these distinctions cannot simply be ignored.
The Unfinished MPOWER Agenda
Perhaps the most important question raised by both The Guardian editorial and the Palau proposal is one of priorities.
Many countries have yet to fully implement core MPOWER measures aimed at reducing combustible tobacco use. Smoking cessation services remain uneven. Enforcement gaps persist. Smoke-free environments remain incomplete in many regions.
Against this backdrop, it is reasonable to ask whether global public health efforts are focusing on the interventions most likely to reduce smoking-related disease and mortality.
Strengthening implementation of existing tobacco-control measures while maintaining appropriate regulation of lower-risk alternatives may offer greater public health returns than pursuing a global nicotine scheduling initiative.
The Goal Should Be Fewer Smoking Deaths
The central challenge for policymakers is not whether nicotine should be regulated. It should.
The challenge is designing regulatory systems that recognise differences in risk, protect young people, support adult smokers seeking alternatives, and remain focused on the outcomes that matter most.
A nicotine-free society may be an appealing slogan. A smoke-free society is a measurable public health objective.
As debates over endgame strategies, flavour restrictions, international scheduling, and nicotine governance continue to evolve, policymakers should remain focused on the question that matters most: which approaches are most likely to reduce disease, death, and inequality caused by smoking?
For GINN, the answer lies not in treating all nicotine products as equivalent, but in building regulatory frameworks that are evidence-based, proportionate, and firmly anchored in relative risk.
Sources
The Guardian view on nicotine: we shouldn’t buy the idea of addiction without harm
Palau Makes Historic Call for UN Nicotine Control Ahead of Pacific Leaders’ Forum https://islandtimes.org/palau-makes-historic-call-for-un-nicotine-control-ahead-of-pacific-leaders-forum/
