By Marewa Glover

Each year, smoking claims more than 68,000 lives in South Korea. Yet rather than facilitating a shift away from cigarettes, the country's policies are making that transition more difficult.

South Korea taxes certain reduced-risk nicotine products at higher rates than cigarettes, communicates to people who smoke that all nicotine products carry equal harm, and regulates lower-risk alternatives as if they were combustible tobacco. The outcome is unsurprising: progress in reducing smoking has plateaued.

This regulatory posture places South Korea at odds with a growing number of countries that have embraced tobacco harm reduction as a complementary strategy to traditional tobacco control. The World Health Organization, while remaining cautious about e-cigarettes, acknowledges in its reporting that countries adopting comprehensive approaches that include lower-risk alternatives have seen measurable public health gains.

A new report from Smoke Free Sweden, titled Tale of Two Nations: South Korea v Sweden, demonstrates that an alternative path exists.

Sweden has reduced its adult daily smoking rate to just 5.3 percent — barely one-third of South Korea's 15.3 percent. Sweden's rapid march toward official smoke-free status has been driven by a fundamental recognition: the true enemy is smoking, not nicotine.

Rather than treating all nicotine products as equally hazardous, Sweden acknowledged the scientific consensus that the overwhelming harm from smoking stems from inhaling the toxic smoke produced when tobacco is burned. Swedish policy gave adults who smoked access to lower-risk nicotine alternatives — including snus, nicotine pouches, and vapes — and taxed those products in proportion to their comparatively lower risk, allowing them to compete with cigarettes.

The results have been remarkable. Since 2012, Sweden has cut its smoking rate by 54 percent. The country now records Europe's lowest rates of tobacco-related disease and mortality, with a male lung cancer death rate 61 percent below the European Union average. This represents decades of population-level evidence.

The United Kingdom has moved in a similar direction. Public Health England, now part of the UK Health Security Agency, has consistently maintained that vaping is a fraction of the risk of smoking and has actively promoted switching as a cessation strategy, contributing to UK smoking rates falling to record lows.

New Zealand has arrived at the same conclusion through a different route. While Sweden's success has been powered largely by snus and nicotine pouches, New Zealand embraced vaping as a smoking cessation tool, backing the approach with clear public health messaging and supportive regulation. The results have been equally striking.

Since 2018, New Zealand has accelerated its decline in smoking at an unprecedented pace. Major research published in The Lancet found that the annual rate of decline surged from 3.5 percent before vaping was actively promoted to 17.9 percent between 2018 and 2023 — a fivefold acceleration. Adult smoking prevalence has fallen to just 6.8 percent, roughly half the level recorded only a few years prior.

Closer to South Korea, Japan offers another relevant data point. After heated tobacco products were introduced to the Japanese market, cigarette sales declined sharply, providing real-world evidence that adult smokers will migrate to reduced-risk alternatives when they are available and accessible.

Sweden and New Zealand achieved these outcomes using different products but the same underlying principle: they provided people who smoke with appealing alternatives that carry far lower health risks than cigarettes and ensured those alternatives remained accessible. Their experience shows that countries can achieve dramatic reductions in smoking when public policy reflects the evidence on relative risk.

As the Two Nations report makes clear, South Korea continues to disregard these lessons. For decades, the country has relied on conventional tobacco control measures. Taxes, smoking bans, and public education campaigns helped reduce smoking from 22.9 percent in 2010 to 15.3 percent today. However, that progress has largely stalled.

Existing policies are no longer delivering meaningful declines, while smoking continues to impose an enormous human and financial toll.

Under South Korea's current weight-based tax system, nicotine pouches are taxed at more than four times the rate applied to cigarettes. They are also subject to many of the same marketing and sales restrictions as combustible tobacco, and online sales are prohibited entirely.

These policies diminish both the appeal and the affordability of products that could help people abandon cigarettes.

As someone who has spent decades researching smoking cessation and public health in New Zealand, I have witnessed firsthand how evidence-based harm reduction can rapidly cut smoking rates. South Korea has the opportunity to achieve comparable progress. The question is whether its policymakers will follow the evidence — or continue to shield the cigarette market through policies that make safer alternatives harder to obtain.

The stakes are high, and Sweden and New Zealand have charted the way forward. South Korea's leaders must now decide how many more lives will be lost before they follow that example.

Marewa Glover is a behavioural scientist and director of the Centre of Research Excellence: Indigenous Sovereignty & Smoking, based in Auckland, New Zealand. The views expressed in this column are her own. — Ed.