The tobacco industry has transformed into a broader "addiction industry" that now profits from a growing range of nicotine and other addictive products, according to a new editorial led by Professor Anna Gilmore, Director of the Centre for 21st Century Public Health and co-authored by Dr Britta Matthes, Research Fellow within the Tobacco Control Research Group, Professor Coral Gartner from The University of Queensland and Dr Upendra Bhojani from the Institute of Public Health Bengaluru. The authors warn that unless governments adapt their approach, progress in tackling smoking and other commercially driven health harms could be undermined.
Published in The BMJ, the editorial argues that as countries begin adopting tobacco endgame 1 policies, Big Tobacco’s transformation into ‘Big Addiction’ threatens to undermine that progress. Transnational tobacco companies have responded to increasing pressure from tobacco control measures by diversifying into products including e-cigarettes, heated tobacco products, oral nicotine pouches and cannabis-related products.
The authors say this evolution has enabled tobacco companies to maintain and expand addiction markets while continuing to oppose effective public health policies. They note that despite decades of progress in reducing smoking, declines in global smoking prevalence have slowed in recent years while use of non-therapeutic nicotine products like e-cigarettes and oral nicotine has increased rapidly among young people in many countries.
Professor Anna Gilmore comments:
Despite the tobacco industry’s best efforts to derail progress, a tobacco endgame is becoming a genuine possibility in some countries. To make this a reality, governments must step up to the mark in two main ways. They must first future-proof tobacco and nicotine regulation by ensuring it applies to all potential products. Then they need to address the root causes of commercially driven health harms. Otherwise powerful corporations remain able to fight back just as tobacco companies have, and progress will be repeatedly threatened.
Recommendations for policymakers
The authors suggest that tobacco control policies need to go beyond product-by-product regulation and address the wider drivers of commercial harm. They outline four priorities for policymakers:
Countries introducing tobacco endgame measures, including the Maldives and the UK, must ensure robust implementation, enforcement and independent evaluation of new laws.
Policymakers should move beyond regulating products one at a time and instead develop broader frameworks capable of addressing future addictive products before they emerge. The authors point to India's experience, where a ban on e-cigarettes was followed by the rapid growth of nicotine pouches.
Governments should continue investing in evidence-based support to help people stop using tobacco and other harmful addictive products.
Governments must tackle the wider political and economic conditions that enable industries to harm health, including the fact that harmful product industries remain able to shift the costs of their harm onto society, making excess profits.
Dr Britta Matthes notes:
We cannot keep regulating one product at a time then companies develop the next. Governments need to anticipate industry adaptation, protect policymaking from corporate influence, and tackle the wider economic and political drivers that allow companies to profit from harm.
The authors argue that stronger conflict-of-interest protections, new funding mechanisms for public health research and measures to ensure companies contribute to the costs of the harms they create are all needed to support long-term progress.
They conclude that unless governments address these underlying drivers of commercial harm, gains in tobacco control and other areas of public health will remain vulnerable, while growing corporate profits continue to come at the expense of population health and public finances.