By Timothy S. Donahue
The anti-tobacco campaigners are now anti-nicotine zealots. They no longer focus on moving consumers away from deadly combustible tobacco products and instead attempt to vilify the use of any nicotine products. It is now up to manufacturers and retailers to develop and promote less harmful nicotine-delivery mechanisms.
Companies can more effectively convert adult smokers to less harmful products when a brand is designed around genuine consumer behavior, products are combined with scalable support, and the focus is on eliminating the combustion component rather than trying to stop nicotine use altogether. Investors and employers already value measurable results, clinicians respond to clear risk information, and regulators act more quickly when the evidence is specific and local.
The remaining obstacles are well-known. Access barriers, slow product approvals, and policies that consider nicotine itself a hazard turn lower-risk options into political targets and expand illegal markets.
These were the themes central to a panel discussion on the challenges of implementing tobacco harm reduction strategies at the Global Tobacco and Nicotine Forum (GTNF) 2025, recently held in Brussels. During the panel titled “Angle of Approach: Consumers, Combustion, Nicotine – the complex picture of harm reduction,” moderator Nick Kadysh, founder and CEO of PharmAla Biotech, a Toronto-based life sciences company, along with four nicotine industry experts, explored the potential for uniting the industry under a focused, sustainable umbrella of tobacco harm reduction products and policy.
The panel’s tone was practical, and its advice was aimed at industry leaders responsible for product roadmaps, compliance strategies, and commercial partnerships. Kadysh set the tone by asking participants to help establish a stakeholder map that aims to eliminate combustible tobacco use. “How do you see the intersection of, you know, various civil society groups, whether it’s investors, health insurers, and medical professionals, in affecting the global progress of nicotine and tobacco harm reduction?” he asked.
Atheer Al Bin Ali, Chief Legal Officer at Badael, linked harm reduction to a national mandate that has brought the topic into mainstream policy. “Saudi Arabia has vision 2030, was which pretty much has multiple pillars.” She emphasized the Quality-of-Life pillar and its implications for risk-based regulation. She said, “The quality-of-life program basically stands for raising living standards and improving the lifestyle of individuals.”
That framing, she said, has generated institutional momentum. “There’s a huge focus and an increase in awareness and harm reduction specifically, and we also see a movement from regulators in putting the right regulatory frameworks for such a category.”
Al Bin Ali explained that consumers quickly adopt new products, such as nicotine pouches and vapes, while the pace among institutions to embrace harm reduction products is slower and data-dependent. “In terms of consumers, I would say that the moment they [see a product that is less harmful and still delivers nicotine well], they went right into it … So there is a big, let’s say, progression.
The conversations are still ongoing because, you know, it’s a shift. It’s not easy … but it’s moving in a positive direction.” She distinguished controversy from politics in the Gulf region. “Well, it is controversial, but not political. It’s more about evidence.” The common questions are simple. “Do you have enough evidence? Do you have enough science? Where is the data?”
Dr. Carolyn Beaumont, a clinician and tobacco harm reduction educator, warned that many systems keep redefining the problem and then blame the solution. “The global progress? It’s the global lack of progress.” She called it “the global deterioration of public health and nicotine harm reduction,” arguing that the field too often swaps targets. “The primary problem is just inaccurately defined, and it’s shifting from tobacco eradication and combustible tobacco as the primary drivers of non-communicable disease globally, to nicotine eradication as well.”
The effect is to delegitimize safer options. “It’s deliberately making the solution, which is safer products, part of the problem.”
Beaumont advised the industry to equip clinicians with decisive facts that change patient choices. “We doctors, we’re really simple people, all we want to do is save lives.” The message that lands in clinics is specific. “Tell any doctor, okay, tell your patient that if they stop smoking within a year, their cardiovascular disease risk reduction goes down by 50% … in one year.” She also described a policy lesson from Australia’s prescription-only vape model. “It doesn’t work at all. It put so many barriers in the way.” The practical result is a channel shift. “It really is that bad. It’s, you know, I don’t have the exact figures, but it would be something like 95% of the vape use in Australia is from the illicit market.”
Håkan Engqvist, the Founder and Chief Science Officer at Emplicure, kept the technology discussion focused on switching mechanics. He emphasized that early-phase delivery and comfort are crucial and that modern oral products can be designed to meet those needs while remaining low risk. “We have initially focused on a faster release of nicotine, to bring the pouch release closer to the initial release of smoke, to provide more of a kick, so to speak.” The form factor is important for mainstream adoption outside Sweden.
“The traditional nicotine pouches, at least, that are used in Sweden, are relatively bulky,” and “we have also focused on the actual size and experience of the pouch.” Discreteness, he said, can be the difference between curiosity and daily use. “In Sweden, we’re used to people having the bigger nicotine pouches, but in the rest of the world, we have seen that that could be a hurdle for switching.”
Engqvist welcomed proportional rules that rein in extremes and protect category credibility. “What is discussed in Sweden is maybe the amount of nicotine per pouch,” and “regulators come in and help us, so to say, to regulate not the use, but the formulations.” He called it “very, very good,” the classic state role of setting boundaries that enable responsible competition.
Dr. David Utley, President and CEO of Pivot Health Technologies and a former Stanford head and neck cancer surgeon, urged the room to develop systems that guide dual users all the way to being smoke-free. “All right? Sound bite is, I don’t think harm reduction should be so complex. If you don’t believe in harm reduction, I told Nick last night, you’re a troglodyte, and I know there’s no troglodytes in this room.”
He explained a model that makes risk visible and progress trackable at scale. “We measure carbon monoxide in the breath,” and “we also provide coaching and behavioral support, etc.” Employers and health plans are the economic engine. “Large companies and large insurance companies in the U.S. are very motivated to help their employees and their members quit smoking because smokers cost more to employ.”
He explained a simple enterprise education step that many suppliers can copy. “Have you heard about tobacco harm reduction?” The medical and policy leaders he briefed said they had “never heard about it.” After a basic overview of evidence and outcomes, “every single one of them said, we’re on board, if it will help more people get smoke-free.”
Utley saw dual use as a transitional issue, not a permanent one. “Smokers are hopeless. They lack hope they can quit,” but with the right support, “you can win, I promise you.” He clearly stated the goal: “Zero is the end game. Zero is the only way to significantly reduce harm.” Without biomarker feedback, partial switchers “feel like they’re safer and they’re not.”
With daily interventions, clear goals, and a sensor, we can achieve approximately 88% of dual-use smokers either quitting completely or reducing their cigarette consumption by at least 50%. The only way to reach this is through engagement. His instruction to manufacturers was clear: “Pair every can, every device, every pouch with scalable digital support.”
Kadysh pressed on whether political pressure will continue to distort the operating environment. Utley responded with a straightforward assessment that many executives share privately. “The only reason it’s controversial is because the primary provider of reduced harm products are cigarette manufacturing companies, period.” He added that if identical products had been introduced by pharma, “I don’t think this would be a very controversial thing.” His clinical perspective on the current tools was clear. “These are great products. I would recommend these if I was still in practice.”
Al Bin Ali stated that consumer preferences and the national vision will continue to pressure institutions to adapt. “I do believe that consumer behavior or preference is definitely a powerful driver, and especially when the vision of the country and consumer demand are well aligned, this only puts some kind of … pressure on regulators to move forward.” Official sponsorship matters for scale. “We need the Ministry of Health and the public health authority to step in because whenever they do, consumers will feel that this is more credible.”
For operators deciding where to invest, the panel’s strategy was clear. Build the front door before the back door opens by collaborating with ministries on pre-market procedures and providing complete, locally relevant science. When authorizations lag, document adult outcomes that resonate with employers, payers, and clinicians. Focus on dual users as the main growth group by adding a simple biomarker to the customer journey and automating progressive goals that make risk reduction visible.
Design for behavior with early-phase delivery, discreet and comfortable form factors, and seamless purchase options. Embrace proportionate standards that eliminate extremes and build mainstream confidence.
Beaumont’s closing advice was to fix the inputs that shape clinical decision making. Guidelines that pivot from smoking risk to nicotine abstinence confuse primary care and stall adoption of safer options. “Tell any doctor” about the immediate cardiovascular gains from stopping smoking, “and after 15 years of being smoke-free, it goes back to baseline.”
With lung cancer screening posters now appearing across clinics and the conversation pulled back to smoking as the risk factor, she sees near-term openings for practical referrals to regulated products that match patients to tools.
The hour did not attempt to rewrite the mission. Instead, it focused on doing the obvious things well and efficiently. Kadysh emphasized execution and accountability. Al Bin Ali demonstrated how a national vision can align regulation with consumer demand. Beaumont reminded the industry that combustible cigarette smoke causes disease and that straightforward medical messages influence behavior.
Utley showed how making zero cigarettes the default is possible through combining products with sensors, coaching, and enterprise distribution. Engqvist illustrated how form factors affect real-world results and investor interest.
The key message for nicotine companies was clear. Make the safer option the easy one, track progress clearly, provide clinicians with useful facts, and simplify regulators’ tasks by doing solid science and presenting it in their language. The market trend is already apparent. The challenge is whether the industry will act on it with the same discipline consumers show daily when choosing products that move them away from combustible cigarettes.
