Japan’s Tobacco Harm Reduction Strategy Has Dropped Smoking Rates by Over 50% Within a Decade

Why have safer nicotine alternatives in the US not led to the same success achieved in Japan?

Then most recently released Briefing Paper by The Global State of Tobacco Harm Reduction (GSTHR), a project by the UK-based public health agency Knowledge·Action·Change (K·A·C), highlights the dramatic reduction in cigarette sales in Japan due to the introduction of heated tobacco products (HTP). Titled “Cigarette sales halved: heated tobacco products and the Japanese experience,” the paper reported a 52% decrease in cigarette sales over the past decade, emphasizing the potential of tobacco harm reduction when consumers are provided with safer nicotine products (SNP).

Key factors contributing to the success of HTP in Japan include the population’s openness to new technology and significant health concerns among smokers. The absence of competition from other SNPs, such as nicotine vapes and pouches, which are not legally sold in Japan, also played a role. In 2016, 29.7% of Japanese men and 9.7% of women smoked combustible cigarettes. The widespread availability of HTP has been a significant driver in reducing these numbers.

HTPs were introduced in Japan in 2014, with brands like IQOS leading the market. By 2018, one in four tobacco users in Japan used HTP, often as dual users with traditional cigarettes. Critics of tobacco harm reduction point to dual use as a failure, but the GSTHR briefing argues that even reduced smoking rates among dual users represent a health benefit.

The Briefing Paper draws on peer-reviewed studies and new GSTHR research, showcasing the shift in consumption patterns. In 2015, sales of individual cigarettes were approximately 182.34 billion units. By 2023, this number had dropped to 88.1 billion units, a decline of 94.2 billion units. Simultaneously, sales of HTP tobacco sticks surged to 62 billion units within a decade.

The reduction in smoking is also driven by regulatory changes, including increased taxes on cigarettes and restrictions on smoking environments. These policies have nudged smokers to switch to HTPs due to convenience and health concerns.

Another contributor to Japan’s success may be a lack of interference from local authorities
Surprisingly, despite these positive trends, Japan’s approach to harm reduction has been relatively laissez-faire compared to countries like the UK, which actively promote smoking cessation. However, HTP advertising in Japan faces no restrictions on being marketed as less harmful than cigarettes, and the tax on cigarettes is more than double that of HTP, providing a financial incentive to switch.

Industry experts like Derek Yach and David Sweanor highlight additional factors contributing to Japan’s success, including the supportive retail environment in IQOS stores and a cultural openness to new technology. The Japanese population is also less exposed to anti-tobacco misinformation, further facilitating the transition to safer nicotine products.

Is Japan to Asia what Sweden is to Europe?
Commenting on the rapid change in Japan, K·A·C Director David MacKintosh, stated that the availability of safer alternatives has significantly benefited individual and public health. He emphasized that this success story demonstrates the potential for harm reduction strategies to diminish cigarette use without direct government policy. MacKintosh advocates for other countries to learn from Japan’s experience, highlighting that harm reduction empowers individuals to improve their health and that of their communities.

Overall, Japan’s experience underscores the potential of consumer-driven harm reduction in public health. The GSTHR Briefing Paper underscores the power of providing smokers with access to safer nicotine products. And just like Sweden in Europe, Japan should serve as an example to other nations in Asia and worldwide, seeking to implement effective tobacco harm reduction strategies. The Japanese experience demonstrates that with the right tools, significant public health improvements can be achieved swiftly, even in the absence of extensive government interventions.

ECigIntelligence Report: the global HTP market is expected to surpass $30 billion in 2024
Meanwhile, coinciding with the release of the GSTHR report, an analyses issued by TobaccoIntelligence, “A global overview and analysis of the evolution of the heated tobacco industry,” revealed that the global heated tobacco market is projected to surpass $30 billion in 2024. This growth is driven primarily by the European and Asia-Pacific (APAC) regions, with the current market value standing at $28 billion. The number of heated tobacco users globally is approximately 40 million, with Japan and Italy leading in consumption.

The anticipated introduction of HTP to the US market is expected to significantly boost market growth. Barnaby Page, editorial director at Tamarind Intelligence, noted that the success of heated tobacco in Japan and other countries could be replicated in the US, elevating its profile to rival that of vaping. Additionally, potential market entries in China and lower-to-middle-income countries could enhance the role of heated tobacco in harm reduction and further expand the market.

Page emphasized that the absence of HTP in the US has limited their global visibility compared to vaping. However, the expected US launch may act as a catalyst, significantly increasing the adoption and market presence of these products worldwide. This expansion could reinforce heated tobacco’s position in the realm of reduced-risk nicotine alternatives.

Discussing this entry into the US market, Vaping Post asked ECigIntelligence whether HTPs are expected to do as well, given that the US has not embraced tobacco harm reduction in the same way Japan has. A market analyst manager for the agency explained why the popularity of other nicotine alternatives makes the situation look promising.

“In the past, we thought that a large vaping market would probably be a hindering factor for Heated Tobacco. However, Italy’s experience proved otherwise. In the US, the popularity of vape and NP might indicate that consumers are more aware of alternatives. Nevertheless, those who are still smoking (and who likely would not have any issues with a less harmful product made by big tobacco) have not found any existing alternatives persuasive enough to make the switch.

The fact that the product contains tobacco may be a plus for those who are still smoking (the known evil).

On the other hand, one of the significant drivers for Iqos uptake in Japan, according to PMI, was the “interest and adoption of new technologies and innovations,” which vapes have also provided. It is likely that tech-minded smokers have already switched. I don’t see the same cultural aspects in the US, perhaps except for the stealth aspect.”