Stakeholder engagement: collaboration for impact

Progress on THR in LMICs depends on cooperation between different groups, but in practice this collaboration is often limited. In particular, nicotine users and consumer advocacy organisations are rarely included in policy discussions, even in high-income countries.

Civil society organisations working in areas such as HIV, tuberculosis, mental health, and poverty often see the impact of smoking first-hand. These groups can highlight where current cessation support falls short and where harm reduction might help. However, many remain cautious about engaging with THR because of regulatory uncertainty or concern about controversy.

Nicotine consumer advocacy groups, where they exist, offer practical insight into affordability, access, and real-world use of safer products. Their involvement in formal policymaking is uncommon. In the United Kingdom, for example, the New Nicotine Alliance has contributed to consultations and public discussions on vaping, but such input is usually informal rather than built into decision-making. In Sweden, widespread use of snus has influenced smoking trends, yet users themselves are rarely part of regulatory processes. Across Europe more broadly, nicotine users are more often regulated than consulted.

Researchers support stakeholder engagement by providing local evidence. Even small studies on smoking behaviour, product availability, or quit attempts can help ground policy discussions in reality rather than assumptions.

Policymakers and regulators ultimately make decisions, but without input from users and front-line organisations, policies can be difficult to enforce or may unintentionally strengthen informal markets.

In practice, decisions about tobacco harm reduction are usually made by governments and technical experts, with limited input from people who smoke, consumer groups, or front-line organisations. This gap helps explain why some policies are poorly aligned with real-world behaviour, difficult to enforce, or contribute to informal markets. Including user perspectives alongside public health expertise does not mean weakening regulation; rather, it helps ensure that harm reduction policies are workable, credible, and responsive to local conditions.