Regulatory and policy environments

The regulation of safer nicotine products (SNPs) in low- and middle-income countries (LMICs) is often characterised by restriction, inconsistency, and uncertainty. Data from the Global State of Tobacco Harm Reduction 2024 show that while at least one category of SNP (vapes, heated tobacco products, snus, or nicotine pouches) is legally available in 129 countries, covering about 71 % of the global adult population, combustible cigarettes remain legally available everywhere, and regulatory approaches differ widely between jurisdictions [^1]. In many LMICs, existing tobacco control laws were developed before SNPs emerged, leaving policymakers with frameworks that do not distinguish between combustible products and substantially lower-risk nicotine alternatives [^2].

Where regulations do exist, enforcement is frequently weak. Border agencies often lack the capacity to manage flows of imported products, contributing to a thriving informal market where counterfeit or unverified devices are sold without oversight. This regulatory vacuum undermines consumer safety and erodes public trust.

In addition, policy decisions in many LMICs are influenced more by external pressures or global health narratives than by local evidence. These narratives often treat all nicotine use as equivalent to smoking, obscuring the key distinction between nicotine as a drug and the delivery mechanism responsible for harm.

Until such regulatory clarity is achieved, confusion between nicotine and smoking will continue to limit innovation, access, and public understanding of harm reduction in LMICs.