By Dr Gan Quan, Senior Vice-President, Vital Strategies, and Advisory Board Chair, World Conference on Tobacco Control 2025
When the modern e-cigarette first appeared in Shenzhen two decades ago, its inventor, Hon Lik, imagined a cleaner route out of combustible tobacco. This vision has persisted, with current health guidelines across the world listing nicotine vaping as one of the most effective tools for quitting smoking compared to traditional nicotine-replacement therapy.
Yet the road to reducing addiction has deviated, with neon disposable devices now marketed on TikTok and mass consumption snowballing among never-smokers.
The language of harm reduction has been co-opted by the tobacco industry, whose interests lie in driving profit ahead of public health: to reclaim this, we must demystify and expose the reality of so-called harm reduction products.
From cessation device to lifestyle accessory
E-cigarettes were adopted by smoking cessation services because, unlike patches or gum, they replicate the behavioural rituals of smoking while delivering a purportedly cleaner aerosol. Public Health England’s 2015 assessment that vaping was “95% less harmful” than smoking entrenched its perception as an almost harm-free substitute. This narrative developed more quickly than the underlying science, pervading the public imagination long before concerns about longitudinal safety data.
And – crucially – the tobacco industry’s primary intention is not to promote these devices as cessation tools, but to market them as consumer nicotine products – designed for sustained, recreational use. The original premise was sound; its wholesale export into convenience stores and sweet-shop flavours was not.
Why first-time vapers really begin
Few teenagers who vape cite quitting cigarettes as a reason when asked: instead curiosity, fruity flavours, and peer influence dominate, according to both the US Centers for Disease Control and Prevention and qualitative work with British adolescents, who describe being “handed one at a party” or wanting “to see what the hype was about” as reasons for starting.
ASH’s 2024 youth survey echoes those motivations: over half of never-smokers who experimented with vapes said they “just wanted to give it a try”, while only one in twenty cited smoking cessation. Initiation is driven less by nicotine withdrawal than by aggressive marketing of devices with child-friendly flavours.
Marketing schemes that would make Joe Camel blush
The Federal Trade Commission’s third E-Cigarette Advertising and Sales Report shows that promotional spending in the United States jumped from $769 million in 2020 to $859 million in 2021, with two-thirds spent on price discounts, wholesale allowances and point-of-sale displays. These include pop-up adverts in gaming apps, “unboxing” videos on YouTube, and candy-coloured kiosks opposite school gates.
The promotion of confectionery-flavoured varieties mirrors the Joe Camel campaign of the early nineties (albeit with cartoon mascots replaced by micro-influencers). In 1991, a study found Old Joe was recognised by 91% of six-year-olds – almost as many as those who recognised Mickey Mouse.
Despite a changed image, the lesson here remains the same: utilising marketing strategies that position harmful products as entertainment to a new market of “replacement smokers” perpetuates their use, and risks future generations’ health.
Surging youth consumption patterns
While data shows a plateau in youth vaping in the UK, a pooled analysis of the Global Youth Tobacco Survey covering 68 countries estimates that 9.2% of 12- to 15-year-olds used e-cigarettes in the past month, with prevalence as high as 33% in Guam. In most low- and middle-income countries the figures remain lower than in higher-income nations, but Lancet Global Health has warned that weak regulation and cheap disposable e-cigarettes will drive uptake. Devices outlawed in the UK are precisely those gaining market share from Lagos to La Paz: the sheer scale of this issue requires cohesive action to combat its global encroachment.
A booming – sometimes illicit – market that shows no sign of retreat
Far from exiting tobacco, multinationals are rebalancing portfolios: Philip Morris International reported that smoke-free products generated 42% of all revenue in the first quarter of 2025, up from 39% the previous year. This understates the true market, because illegal trade is booming alongside legal vape sales. Trading-standards officers seized almost 1.2 million unregulated vapes in the UK in 2024 – worth nearly £9 million – an increase of 44% on the previous year. These figures indicate that we must continue to stifle the tobacco industry’s narrative around harm reduction products beyond the introduction of bans on disposable sales.
It’s time to take harm reduction seriously
Harm reduction remains a legitimate, evidence-based goal for adult smokers, but the virtue of this sentiment is being undermined by industry tactics – with a clear discrepancy between the industry’s narrative of striving for a “smoke-free future”, and the public health interests of ending addiction altogether.
Policymakers across the globe should regulate nicotine devices with the same stringency applied to cigarettes, throttle the flavour pipeline driving youth vaping, and fund cessation services that lead users off nicotine sustainably, rather than deeper into the grip of addiction.
The tobacco industry remains what it has always been: a ruthless, profit-driven machine built on addiction and deception. So, the question is whether we can rise above our differences, think clearly, and act together. Public health demands nothing less. We cannot let harm reduction products such as e-cigarettes become the next Joe Camel: an eye-catching marketing ploy that leaves future generations’ health paying the consequences.
During the World Conference on Tobacco Control 2025, a powerful call to action – the Dublin Declaration – reaffirmed the urgency of global tobacco control efforts. We must commit to achieving the key priorities if we are to keep the next and now generations safe.