Tobacco Asia

34 tobaccoasia Issue 4, 2026 July / August smoking-related disease as the same public health problem. Indus- try voices say WHO's tone is shifting toward treating any positive messaging about smoke-free products as deception by default. That criticism reflects broader frustration within segments of the nicotine industry. GINN warned that if governments place all nicotine products into a single category, the outcome could be perverse. "If governments regulate nicotine pouches as though they pose risks comparable to cigarettes, they may unin- tentionally protect the cigarette market and encourage smoking by making lower-risk alternatives less accessible, less acceptable, or less accurately understood," the group wrote. Howard echoed that point, arguing that regulation needs to distinguish between combustible and noncombustible prod- ucts. "The scientific evidence overwhelmingly demonstrates that nicotine pouches present a materially different risk profile than combustible cigarettes," he said. He reiterated that pouches avoid combustion, smoke inhalation, and exposure to many of the toxicants most strongly linked to smoking-related illness. Howard also cited prior FDA language: "FDA itself has recognized that adults who completely switch from cigarettes to nicotine pouches may significantly reduce their exposure to harmful and potentially harmful constituents (HPHCs)." Manufacturers and harm-reduction advocates argue that the WHO report pays too little attention to adult smokers who might use pouches to quit cigarettes. Prof. Caitlin Notley, a pro- fessor of addiction sciences at the University of East Anglia, said the report overstates the "no evidence" line on cessation. "The WHO report is a comprehensive report on oral nic- otine pouches," she said. "It suggests that claims that nicotine pouches are helpful smoking cessation aids are unsubstantiated. This is not quite accurate, as there is emergent evidence of the potential role of nicotine pouches for smoking cessation." Notley pointed to her group's review of more than 20,000 YouTube comments about pouches. People described using pouches to move away from smoking and, in some cases, from vaping. She described this as exploratory but said it shows that lower-harm consumer options can help some people. WHO repeatedly returns to flavors, branding, and online campaigns. Critics counter that locking down communication about relative risk can strengthen cigarettes by keeping adult smokers in the dark and reducing legal competition. Meanwhile, WHO's best case rests on messy regulation. Pouches have spread into markets with uneven rules and weak enforcement. WHO argues that many products arrived after tobacco-control systems were established, leaving gaps that companies could exploit through tweaks, online sales, and formulation changes. WHO estimates that about 160 countries still lack pouch- specific frameworks. Sixteen countries ban pouches outright, and 32 regulate them to some extent. The result is a patchwork of tight controls in one place and near-total freedom in another. Even many harm-reduction supporters acknowledge that the category needs tougher standards: manufacturing rules, clearer nicotine labeling, environmental impact assessments, child-re- sistant packaging, and meaningful enforcement against youth- targeted marketing. Dr. Harry Tattan-Birch, a senior research fellow at Uni- versity College London, said WHO was right to highlight the loopholes. "The WHO report shows the wide-reaching ways in which nicotine pouch companies are trying to sell their prod- ucts, including in ways that may appeal to young people, and how these products have fallen between the cracks of existing legislation," he said. "Because they do not contain tobacco leaf, and are not vapes, they have often not been covered by tobacco- or vape-specific rules." The fault line The fight ultimately boils down to a single policy choice: should nicotine be regulated primarily by addiction risk or by risk rela- tive to combustible smoking? WHO's report leans strongly to- ward precaution. Its recommendations amount to one of the most aggressive global wish lists for pouches: flavor bans, ad limits, nicotine caps, plain packaging, social-media controls, and higher taxes. Critics say that set of tools could backfire. Flavors are the biggest pressure point. WHO says flavors attract kids. Industry voices argue that flavors help adult smokers leave cigarettes be- hind and stick with a lower-risk option, the same argument that has shaped the vaping battles worldwide. Some in the industry also say WHO's approach could shield cigarettes, making pouches less appealing, less available, and harder to discuss legally. Tattan-Birch agreed that bans can be counterproductive. "Nicotine pouches do not produce smoke or require inhalation into the lungs, meaning they are likely to be substantially less harmful to health than cigarettes," he said. "But an outright ban on nicotine pouches, while ciga- rettes remain widely available, could be counterproductive for public health." Howard called for "risk-proportionate" regulation that re- spects the distinct toxicology of smoke-free oral nicotine while maintaining scientific scrutiny. In practice, he said, this means focusing premarket review on chemistry, manufacturing, toxi- cology, ingredients, and product quality, while addressing lon- ger-term behavioral or clinical questions through post-market surveillance and targeted studies. "That does not mean reduced scientific standards or re- duced oversight," he said. "Rather, it means focusing regulatory review on the issues most relevant to the actual risks presented by the product category." Others warn that heavy advertising limits can create space for illicit sellers who ignore the rules. Countries with strict vape restrictions have already seen illicit disposable vape markets grow, and GINN warned that prohibition-style approaches can fail when they do not distinguish cigarettes from lower-risk al- ternatives. Instead, the group advocated strict youth protection, clear nicotine labeling, manufacturing standards, real age verifi- cation, and evidence-based communication on relative risk. Harm-reduction advocates say relative risk still carries weight until better data arrives. Tattan-Birch described the bal- ancing act: reducing appeal and access for kids and for people who would not otherwise use nicotine, while keeping the door open for adults who smoke and might benefit. He also urged caution regarding cessation claims. "The recent Cochrane review found that the current evidence is too limited and uncertain to conclude that nicotine pouches help people quit smoking," he said. "More studies are needed." Sweden remains the reference point in these arguments. In the US, FDA has authorized multiple ZYN and on! PLUS pouch products via the PMTA pathway. France has moved to broadly

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