When customs inspectors opened two shipping containers at the Port of Santos, they did not find electronic cigarettes. At least, not at first glance. Not on paper.

According to the cargo manifests, the shipment contained something else entirely: toys, tools, computer accessories, auto parts, and musical instruments. Beneath that layer of bureaucratic disguise, however, lay roughly 450,000 e-cigarettes, stacked, packaged, and ready to move.

The shipment had not yet crossed the country, but it had already crossed a more consequential border: the border between prohibition and language. It had ceased to be called by its proper name.

That may be one key to understanding the new illicit nicotine trade in South America. Vapes do not disappear because no one can see them. Customs officers, federal police, users, and sellers see them. What disappears is something else: the chain of accountability: origin, importer, batch number, composition, customs classification, regulatory responsibility, and, above all, money.

The illicit vape trade did not have to invent its own map. It inherited one.

Along the borderlands where Brazil, Paraguay, and Argentina meet, certain goods seem to circulate before they officially exist.

Yet the new trade no longer fits the familiar geography of smuggling. It moves through rivers, bridges, warehouses, highways, and ports. It moves through the Port of Santos, the country’s largest logistics hub, which handled 186.4 million tons of cargo in 2025, nearly 1,000 kilometers from the Triple Frontier. And it moves across a border with no customs checkpoints at all: social media, where 144 million active users form a vast marketplace of storefronts, contacts, and deliveries.

Vapes inherited the road opened by conventional cigarettes. But they learned to travel it differently.

In the Triple Frontier, where Foz do Iguaçu, Ciudad del Este, and Puerto Iguazú face each other across the Paraná and Iguaçu rivers, that road was already there.

Before disposable pods and Instagram ads, conventional cigarettes knew the banks of the Paraná River, the warehouses of Ciudad del Este, the back roads, and the loose hours of inspection. They moved through the hands of scouts, loaders, drivers, middlemen, and bosses, inside an economy trained over decades to turn goods into movable categories.

This geography was never merely territorial. It reorganized the administrative, labor, and social life of the border: local tolerances, tax asymmetries, precarious workdays, selective enforcement, and small zones of ambiguity where the law loses its sharpness without disappearing altogether.

The problem, there, is not always a state’s absence. Often, it is a state that arrives late, arrives partially, or reaches only so far.

Along the Paraguay-Brazil-Argentina corridor, smuggling long ago ceased to be a simple clandestine flow of goods. It became a social, political, and economic infrastructure, inhabited by generations of officials, traders, and workers.

Within that machinery, Paraguay has for decades occupied the nerve center.

Throughout the 1990s, Paraguay ceased to function merely as a corridor for cigarettes produced by transnational companies and began developing its own capacity to produce and distribute them. What had once been a re-export system gradually evolved into an industrial enterprise, complete with factories, supply chains, production lines, surplus output, and regional distribution networks.

Cigarettes no longer simply passed through the borderlands. Increasingly, they were manufactured there, in an economy shaped by the border itself.

That precedent exposes an infrastructure of routes, warehouses, workers, codes of silence, inspection routines, local tolerances, and a quiet talent for turning regulatory gaps into margins.

Cigarettes cut the road first. Vapes followed the tracks.

At the border, this economy has names, hours, and functions. Work is split into roles: bosses, drivers, scouts, flaggers, loaders, and middlemen. Not an indistinct mass of “smugglers,” but a division of labor in which risk and profit rarely land on the same people.

Behind those roles are migration routes, survival tactics, informal jobs, and fragile attempts at social mobility. The border is not only a path for goods. It is a biography, a family strategy, and a way of staying upright where the official and the informal keep bleeding into each other.

Some spend the night watching police checkpoints on their phones. Others push boxes across the river in low boats, after dark. Some arrange payments and routes. Others carry the merchandise on their backs when the truck can go no farther. On certain roads, news of an inspection arrives before the patrol car does.

The local vocabulary is not folklore. It is operational language.

The patrão, for instance, works as an entrepreneur of the crossing: calculating losses, negotiating loads, distributing payments, sometimes from a plastic chair at the back of a hot warehouse.

Cigarreiro, by contrast, works almost like an administrative blur. The word compresses the whole chain into a single figure and erases the distance between those who control the flow and those who put their bodies in the way of seizure, cargo theft, and the diffuse violence of the border.

This market persists not only because the territory has gaps. It persists because it has learned to live inside the intervals of the law. Baggage allowances, traveler quotas, special circulation regimes, and tolerated forms of transport become partial channels of legality.

Through them, merchandise crosses without appearing entirely clandestine. Tourists, buyers, and smugglers shift positions within the same economy of circulation, sustained by that unstable strip between tolerance and infraction.

The Mercosur Common Nomenclature already has a technical name for the product: “electronic cigarettes and comparable personal electric vaporizing devices.” But in Brazil, a technical name does not open the market. Anvisa prohibits the importation, sale, distribution, storage, transportation, and advertising of these products. So when the merchandise enters illegally, it rarely travels under its proper name.

In the containers at Santos, vapes also appeared as beverages, perfumes, small electronics, and empty cell phone packaging. Document falsification was not a bureaucratic detail. It was part of the crossing.

The product disappeared first from the form. At this more sophisticated border, the law does not simply fail. It changes density.

In Paraguay, the clearest trace often appears just before the crossing. If, in Santos, the merchandise vanished into paperwork, at the border it reappeared on the banks of the Paraná River.

Two years ago, in Presidente Franco, Paraguayan authorities seized tens of thousands of counterfeit vaporizers in shipments valued at roughly $1 million. The boxes were near the river, packed, organized, and ready to move irregularly toward Brazil.

The scene suggests that the vape had already entered some point of the Paraguayan chain. The seizure did not reveal the full origin. It caught the antechamber of the crossing: the instant when stock becomes cargo, cargo becomes risk, and the riverbank stops being landscape and becomes passage.

On the other side, the Brazilian state of Paraná appears as an axis of internalization. According to Federal Highway Police statistics, the state accounted for the largest share of electronic cigarette seizures in 2024.

The data does not measure the real size of the market. It measures what enforcement managed to touch. Even so, it shows where the product most often meets the state’s road-bound arm.

Ciudad del Este remains an unavoidable character. Its history of re-export, e-commerce, warehouses, and cross-border circulation helps explain why vapes find a structure already waiting for them.

Still, in the case of electronic cigarettes, the strongest public evidence arrives in fragments: shipments in transit, seizures in Presidente Franco, on highways in Paraná, in tobacco shops, and in interstate operations. The city is part of the scenery. Naming its operators is harder.

In the Triple Frontier, the vape does not disappear all at once. It comes apart in stages. Before reaching the counter of a Brazilian shop, the seller’s Instagram feed, or the insulated backpack of a delivery driver, the device undergoes small metamorphoses. It leaves the global production chain as a nicotine product. It reaches a distributor as electronics. It is entered on a customs declaration as an accessory. It crosses the border as fragmented merchandise. It reappears in Foz do Iguaçu as retail. Finally, it fits in the palm of someone at a bus station.

It is not yet possible to reconstruct this chain with the clarity already achieved for conventional cigarettes. But that opacity is exactly what makes the corridor decisive. The Paraguay-Brazil-Argentina axis is not only a geographic passage. It is a translation machine.

There, what health regulations call an “Electronic Smoking Device” may reappear as a battery, a refill, an aroma diffuser, an electronic component, a parcel, or merchandise carried by a cross-border shopper. The material border matters: the Paraná River, the Friendship Bridge, the warehouses, the sheds, the adapted vehicles. But the more decisive border may lie in the paperwork, in the narrow space between the product’s technical name and the administrative names that let it move.

Recent seizures show that this logistics network is no longer limited to conventional cigarettes. Modified vans, false compartments, taxis, and trucks have begun carrying e-cigarettes hidden among cheap electronics, imported toys, and ordinary goods.

The difference lies in the object itself. Cigarettes left heavy traces: official factories, boxes, boats, trucks. Vapes leave scattered ones: small shipments, dispersed sellers, online platforms, and last-mile delivery circuits. They can be separated into parts, mixed with other cargo, reclassified on a form, and absorbed into the ordinary flow of commerce.

The chain may be less concentrated at the physical crossing than spread across the border, platform, and delivery. That hypothesis is strengthened by the authorities’ indication that Paraguay has become the main gateway for millions of vaping devices sold and consumed illegally in Brazil.

Vapes use the road opened by cigarettes, but they do not travel it the same way. They inherit part of the corridor and its logistical intelligence, but bring another materiality: smaller, lighter, more digital, harder to follow.

The product changes its name, scale, and handler before the state can recognize it as a whole. When it reaches the cities, the vape changes appearance again. At the border, it looked like cargo. In retail, it looks like convenience.

The same device that crossed a clandestine route, hidden among ordinary goods, reappears on a phone screen with promotional photos, same-day delivery, Pix payment, and a warranty promise. Smuggling stops looking like smuggling.

In clandestine shipments and storefronts, the vape rarely appears as a generic product. Recognizable global names surface: Elfbar, Lost Mary, Ignite, Vaporesso, and other brands popular among users. But the logo printed on the package does not answer the central question. It may indicate an original product imported illegally, a parallel import, a copy, a counterfeit package, or an unverified batch.

In a prohibited market, the brand becomes a signal of trust. For the state, however, it is rarely proof of origin. Without traceability, there is no way to know who manufactured it, who imported it, who stored it, what substances it contains, what nicotine concentration was delivered, or whether the batch corresponds to what the box promises.

The difference between a vape seized at the border and a vape sold in a Brazilian city is not necessarily chemical. It is logistical. At the border, it appears as volume: container, truck, box, riverbank, highway. In the city, it reappears as service: flavor, price, same-day delivery, a seller’s recommendation.

One seller who advertises pods on social media, and who spoke on condition of anonymity because he operates in a prohibited market, described instability as part of the business:

“If the police tighten up, I will change the profile name. In two hours, the customer already knows how to find me.”

It may be the same batch that goes to a regulated market, merely broken up. It may be another batch. It may be an original product, a parallel import, or a counterfeit. What is certain is that it is merchandise without a verifiable origin.

And that is precisely the problem: between the wholesale shipment and the unit sold by message, the chain atomizes. The object remains visible. Its history and provenance disappear.

Recent operations show that the chain does not end at the border. In 2024, Operation Vapor Digital identified suspects, tobacco, and pop-up shops, and points of sale on social media. Other actions, in states such as Amazon, Tocantins, Mato Grosso, São Paulo, Rio Grande do Sul, and Santa Catarina, pointed to distribution networks, front shops, cash, frozen assets, and documents used to disguise shipments.

In the city, the vape no longer behaves like illicit cargo. It enters the ordinary life of consumption: gallery shops, tobacco stores, Instagram and TikTok profiles, closed groups, app-based delivery, and instant payment.

Prohibition does not necessarily interrupt the phenomenon.
More often, it reorganizes it.

In Brazil, the internet is no longer just a display window; it has become the corridor itself. A qualitative study of Brazilian users suggests that while the ban makes physical purchases more difficult, online channels have become the main route of access. There, influencers do more than advertise. They test liquids, review brands, compare devices, turn the product into an aesthetic routine, convert it into merchandise, and then quietly DM a link.

What disappears in this passage from contraband to convenience is not only the trail of the product. It is the possibility of public control.

In a regulated market, the state can demand composition, labeling, traceability, age restrictions, manufacturing standards, toxicological limits, and accountability. In an illegal market, none of that is guaranteed. The user may receive a recognizable logo, a sealed box, or a promise of origin. But the promise is not a certificate. The package may say nicotine. It may say flavor. It may say brand. It cannot say, with public authority behind it, what the person is actually inhaling.

This is where the question leaves customs law and enters the realm of bioethics. A prohibition that fails to prevent access but succeeds in destroying oversight produces a peculiar moral inversion: it claims to protect the people while abandoning them to opacity. The consumer is not made safer by ignorance. Nor is autonomy meaningful when the available choice is between combustible cigarettes, an illegal device of uncertain provenance, or no credible information at all.

The paradigm of harm reduction begins precisely at this point. It does not require innocence from the product, nor purity from the user. It starts from a less theatrical premise: people do risky things; public policy should reduce the probability that those risks become injury, disease, or death. In this view, the central question is whether the state can tolerate a situation in which millions of people use nicotine products without quality control, without stable information, and without any reliable mechanism to distinguish a less harmful alternative from a counterfeit hazard.

For Brazil, Mexico offers a warning, not a mirror. Research has revealed an increase in the number of e-cigarette sales points despite a formal ban. Associated Press reports described a harsher landscape: in some regions, traditional drug cartels have begun competing over distribution, intimidating shopkeepers, and taking over sales points.

The Mexican case should not be mechanically translated to the Triple Frontier. But illuminates a risk: when a persistent market is pushed outside regulation, someone else begins to regulate it.

We know the device circulates. What remains far less visible is the machinery that moves it:

Who pays for the lots?
Who controls the capital?
Who assumes the risk, and who later cleans the money?

What role does the formal banking system actually play?
How do banks, money changers, and currency exchange operators arrange the flow of funds beneath the surface of legality?

And to what extent are investment funds, family offices, and otherwise respectable asset-management structures exposed, directly or indirectly, to companies tied to smuggling, whether by financing working capital or by purchasing real estate, warehouses, and equity stakes that may serve as laundering infrastructure?

In practice, the market survives in the gap between intermittent enforcement, widespread availability, and unstable information. The user hears that the product is prohibited, yet finds same-day delivery on popular platforms. He reads health warnings, then watches influencers sampling flavors. He knows there is no formal oversight, yet receives assurances of brand, warranty, and provenance. Doubt does not stop circulation. It becomes part of the cargo.

The vape does not inaugurate a new criminal frontier. The state does. And when it arrives, it enters a terrain already disciplined by cigarettes. The routes, warehouses, middlemen, and operational vocabulary of conventional smuggling predate the device. Brazilian Federal Police operations against e-cigarettes in the Triple Frontier mention structures for manufacturing, storage, loading, and distribution. The overlap is organized. The command structure is not.

Based on publicly available sources, it remains unclear whether the same financiers, factions, or operators who control conventional cigarette smuggling also control the vape market. The hypothesis is plausible. It remains unproven.

The board, however, has changed. The Triple Frontier no longer simply pits countries that prohibit goods against a country that allows goods to pass. Brazil maintains its health ban. Paraguay has rules governing sales, advertising, nicotine, and minimum age. In 2026, Argentina moved away from prohibition and created a registry for nicotine products.

The same object now lives under three legal regimes. In Brazil, the largest market, it is prohibited as merchandise. In Argentina, it may become a registrable product. In Paraguay, it circulates under specific regulation, in a commercial environment historically oriented toward re-export.

The border changes the product without changing its matter: legal here, prohibited there, reclassified a few kilometers ahead.

Argentina’s regulatory shift may bring part of the local market out of the shadows.
It may also create a new gray zone. A vape registered in Argentina remains prohibited the moment it crosses into Brazil. A cheaper product, unregistered or sold in an unauthorized flavor, may continue to enter from Paraguay. A legal market, when expensive, narrow, or weakly enforced, can coexist with a second one that is cheaper, faster, and more opaque.

Where it is prohibited, the vape circulates as contraband. Where it is regulated, registration and a responsible party are required. Where enforcement thins out, it reappears under other names: an electronic device, an accessory, a fragmented parcel absorbed into the daily flow of the border.

In this scenario, prohibition does not necessarily eliminate risk. More often, it displaces risk into the places where the state sees less, tests less, knows less, and protects less.

“I buy from someone I trust. But I don’t know who he buys from. I know there’s no control… that it can be harmful… but regular cigarettes are worse, right?”

The sentence contains the entire ethical impasse. Trust replaces verification. A seller stands in for a regulator. Rumor takes the place of a label. The user is left to perform the risk assessment alone and informally, in the very space where public institutions have refused or failed to organize it.

Those with money, passports, and access to regulated foreign markets can buy products with health controls, recognizable brands, and more reliable channels. Those without such access more often rely on cheap disposables, liquids of unclear origin, uncertain concentrations of substances, and sellers converted into their main source of health information.

The ban, then, does not distribute protection equally. It stratifies exposure.

Within this framework, Argentina becomes a kind of regulatory laboratory for the corridor. Not because it has solved the problem, but because it has chosen to recognize it. Brazil, by contrast, insists on a formal prohibition in the face of a market that is digital, visible, and already partly normalized. Paraguay remains the logistical hinge, sustained by a border historically trained to convert goods into movable categories.

Prohibition creates a margin.

Whoever can move the product across the border, erase it from the paperwork, and make it reappear at retail captures the risk premium. The money enters at the final point as ordinary consumption: a Pix transfer, a credit card charge, a cash purchase, a delivery arranged by message, or an invoice issued for another product. Then it travels back up the chain: retailer, distributor, wholesaler, logistic operator, border supplier, investor.

Investigations have already uncovered cash, frozen assets, companies under scrutiny in distant jurisdictions, and networks moving millions through the formal financial system.

But the hardest layer remains barely visible: who finances the large batches, who absorbs the loss when a shipment is seized, and how the money returns to the border, or leaves the country again.

It is tempting to reduce the market to factions. In conventional cigarette smuggling, documents and investigations have pointed to the involvement of organized and cross-border criminal networks. With vapes, that hypothesis still has to be proved case by case.

What can already be said is that the chain rewards opacity: clandestine importers, distributors, illegal retailers, logistic operators, and possible facilitators. Who captures the largest share remains one of the central questions.

In Santos, inspectors found 450,000 e-cigarettes in a shipment whose documents listed toys, tools, computer accessories, auto parts, and musical instruments. Perhaps this is the most precise image of the market today. The merchandise was there. What was missing was its name.

The law had not disappeared. It was present enough to prohibit, porous enough to let the shipment pass, and, afterward, too fragile to reconstruct its full history. Not only where it came from. Not only who paid for it. But what, exactly, would enter someone’s lungs.

I ~ The Lung and the Void

In late July 2019, a man in his early twenties was admitted to a hospital in southeastern Wisconsin with an oxygen saturation below 85 percent. A level consistent with acute respiratory failure. He was an athlete. He didn’t smoke. He had no known history of lung disease. He was coughing up blood. He breathed with the visible effort of someone trying to pull air through a thick liquid.

The CT scan showed diffuse ground-glass opacities with whitish patches scattered throughout the lungs, as if an oily substance had accumulated in the alveoli and altered their surfaces.

“It looked like a chemical burn,” a pulmonologist involved in the early cases would later say, speaking on condition of anonymity.

The young man had not been in a fire. He didn’t work in a factory. There was no known occupational exposure. Only one clue remained in the medical records, still uncertain: recent use of vaping products.

In the days that followed, more patients began to arrive.

First in southeastern Wisconsin, then in other parts of the state. Young. Healthy. Similar symptoms: shortness of breath, fever, nausea, and bilateral lung infiltrates. No explanation seemed sufficient.

Before it came to resemble a generalized crisis, it was something more elemental: there was not yet a clinical category capable of saying, with any certainty, what was happening.

II ~ The Moment Something Comes Into Being

In Milwaukee, physicians at the Children’s Hospital of Wisconsin were beginning to notice something that did not yet have a name. The cases had not arrived all at once. They came in sequence over the course of weeks, as isolated episodes of acute respiratory failure in previously healthy adolescents, until they gradually began to fit into the same pattern. As the medical records accumulated, the similarities between them no longer seemed coincidental.

In July 2019, eight adolescents were hospitalized with severe lung injuries after reporting recent use of vaping products. The imaging findings were consistent: ground-glass opacities, diffuse inflammation, and signs of an insult that did not match any known infectious pattern.

Pulmonologists and radiologists at the hospital, among them Lynn D’Andrea and Michael Gutzeit, began comparing the cases. Not only the symptoms, but the trajectories: young patients with no relevant medical history, rapid deterioration, and the need for intensive respiratory support.

Among the cases documented during that period, a significant proportion evolved more severely: progressive respiratory failure, admission to intensive care units, invasive mechanical ventilation, and, in refractory situations, the use of extracorporeal membrane oxygenation: an extreme measure reserved for patients whose lungs can no longer sustain the oxygen exchange required for life.

What had initially seemed like a series of isolated incidents began to take shape. It was not yet an explanation. But it was already a pattern.

III ~ The Moment the Crisis Becomes Public

On July 25, 2019, the Milwaukee Journal Sentinel published a digital report on eight Wisconsin teenagers hospitalized with severe lung injuries after recent use of vaping products. The article spoke of suspicion. It did not assert causality. But in moments like this, caution rarely lasts as long as the speed of its circulation.

The next day, at 11:19 a.m., the story changed scale.

In a report by Susan Scutti, CNN stated that “eight teenagers were hospitalized with severely damaged lungs,” bringing to national attention a clinical alert that, until then, had remained local: “We suspect these injuries were caused by vaping,” said Michael Gutzeit, medical director at the Children’s Hospital of Wisconsin.

What, in Wisconsin, had still been an unsettling cluster of cases under investigation began to circulate nationally as a sign of a broader public health crisis. The question was no longer only clinical. It had become public:

Is vaping the cause?

The outbreak did not begin there. Bodies had already been falling ill before that. But it was there that it came to exist, for the American public, as a recognizable phenomenon. From that moment on, the country was no longer just observing cases; it was observing a pattern.

And with the pattern came a demand as immediate as it was imperfect: to give it a name.

IV ~ The Bristol Lab

As the crisis expanded in public discourse, its material epicenter lay elsewhere.
It was not a hospital. It was a residential home.

In Bristol, Wisconsin, amid trimmed lawns and pale brick facades, two brothers — Tyler and Jacob Huffhines — were running a home-based operation producing thousands of THC cartridges a day.

There was nothing improvised about it.

Inside the house, investigators found a highly organized assembly line: glass jars filled with dark, viscous oil; boxes containing tens of thousands of empty cartridges; packaging bearing counterfeit brands — Dank Vapes, Dabwoods, Chronic Sour Patch — ready to circulate as legitimate products. The cartridges were distributed through social media and local intermediaries, quickly moving through the informal circuits that already sustained the illicit cannabis market in the United States.

The scale was industrial: 31,200 filled cartridges; 98,000 empty cartridges; 1,616 ounces of THC oil.

The logic, simple. Pure THC distillate was expensive. Thick. Valued precisely for that density, which functioned for the consumer as a visible sign of potency. To increase volume without altering that appearance, it had to be diluted — without appearing diluted.

It was at this point that an economic logic met chemistry.

The solution did not come from a clandestine lab, but from a mundane input of American industry: vitamin E acetate. Produced at scale by companies such as DSM and BASF for the cosmetics, supplement, and pharmaceutical sectors, the compound circulated through industrial supply chains in volumes sufficient to supply not only factories, but also the parallel circuits orbiting the illicit THC market.

Within that illicit context, its function was ideal. Thick, inexpensive, and visually indistinguishable from cannabis oil, vitamin E acetate allowed the concentrate to be diluted while preserving the appearance of quality. In large batches, it could be easily incorporated into the liquid, reducing costs and expanding profit margins.

Within that market logic, it may have seemed like a smart solution. From a pulmonary standpoint, it was a disaster.

Harmless when ingested or applied to the skin, the compound had never been intended for inhalation. When heated and inhaled, it could adhere to lung tissue, interfere with alveolar function, and impair the oxygen exchange on which the body depends to remain alive.

What, at that moment, still seemed like a technical detail — a formulation choice, an adjustment of viscosity — was, without anyone knowing it, the signature of the crime.

There was, however, an obstacle that was not chemical, but social.

Many of the hospitalized patients were minors.

In Wisconsin in 2019, the use and possession of THC by individuals under 21 was treated as possession of a Schedule I controlled substance, punishable by up to six months in jail and a fine of up to $1,000 for a first offense. Repeat offenses could be charged as felonies. And when there was evidence of distribution, penalties could extend to years in prison, aggravated in cases involving minors or proximity to schools.

In that context, silence was not just shame. It was also a calculation.

Stigma, fear of family, fear of school, fear of the police. Everything conspired against the accuracy of the reports. Some patients withheld THC use. Others may simply not have known what was inside the cartridge purchased from a friend, an intermediary, or through social media.

Scott Aberegg, a pulmonologist at the University of Utah Health, would later summarize the problem with brutal candor. There were perhaps only two kinds of people who developed that illness: those who used THC, and those who did not admit it.

The statement was harsh. It was also a clue. Science was trying to narrow down the cause; the accounts, shaped by fear, illegality, and uncertainty, slowed that narrowing. And in the meantime, public language remained wider than the evidence.

V ~ The Broad Word

While the material cause of the outbreak remained invisible, public language moved ahead. By August, the crisis seemed to be everywhere. Headlines repeated the same formula of alarm and imprecision: “mysterious vaping illness,” “vaping-related lung injury.”

The word did more than describe. It organized fear.

“Vaping” — a broad, imprecise term, functional under uncertainty — came to name the phenomenon. Everything fit within it: regulated nicotine devices, illicit THC cartridges, industrial products, and homemade mixtures.

The effect was subtle, but profound. Distinct cases, with potentially different origins, came to be perceived as manifestations of the same problem. The scale appeared to expand: dozens of states, perhaps beyond the borders of the United States. The category was broad enough to sustain that expansion and the moral panic.

Later, a working paper from the National Bureau of Economic Research would describe that moment as an information shock. It was not exactly misinformation. It was something more subtle and, in some respects, more powerful: information that was true, but aggregated too early and too broadly.

The authors estimated that, during the initial EVALI shock, the share of respondents who came to view e-cigarettes as more harmful than conventional cigarettes increased by about 16 percentage points. Before the outbreak, roughly 9 percent of American adults held that view; during the crisis, it rose to approximately 31 percent.

When the CDC later refined its communication and began emphasizing the role of THC and informal sources, the correction was only partial. The initial impression survived the revision of the evidence.

Language had already done what the evidence could not yet do: it had provided an outline. And with that outline, it fixed a vector of fear.

VI ~ The Name

In October 2019, the CDC formalized that still unstable unity. On the 11th, while reporting 1,299 cases and 26 deaths, Principal Deputy Director Anne Schuchat announced in a press telebriefing that the official term would be “EVALI”: E-cigarette or Vaping Product Use-Associated Lung Injury. By the end of the month, the numbers had risen to 1,604 cases and 34 deaths.

The gesture was administrative. It seemed prudent. Technical. Comprehensive. And it was. But it was also doing something else.

Names like this do not merely describe phenomena. They organize the field of what appears plausible and, in doing so, distribute fear, responsibility, and attention. In choosing a word, an authority also chooses a semantic protagonist, a path of interpretation, a field of possible responsibility.

In public health, the first name is rarely the last word of science.
But it is often the word that remains.

The process that led to the choice of the term remains, to a large extent, outside the public record.

VII ~ The Detective Finds the Weapon

As the name consolidated, the investigation advanced. In partnership with state authorities and the FDA, CDC laboratories began analyzing fluid collected directly from patients’ lungs.

The results were difficult to ignore. Vitamin E acetate appeared consistently in the cases. It did not appear in healthy controls. At the same time, another pattern became clear: most patients had used THC-containing products, often obtained from informal sources.

The investigation, published in the New England Journal of Medicine, presented compelling data. Among 51 EVALI patients across 16 states, 48 had vitamin E acetate detected in their lungs. Among 99 healthy participants in the comparison group — including exclusive users of nicotine e-cigarettes — none showed the substance. Among cases with available laboratory or epidemiological data, 47 of 50 had detectable THC, THC metabolites, or reported use of THC-containing products in the 90 days prior to illness.

The hypothesis narrowed. It was not vaporization itself. It was what, exactly, was being vaporized — and where it came from. It was a clear answer to the scientific question. Not to the question already circulating in the public.

The substance that solved a market problem — viscosity — revealed itself in the lung as an agent of chemical asphyxiation.

The weapon had been identified.
It was not the one that had been named.

VIII ~ The Map That Didn’t Add Up

There was an even simpler clue — one that, at the time, was largely overlooked by the corporate press. By 2019, nicotine vaping had already been a global phenomenon for years: millions of users, diverse markets both legal and illicit, and distinct regulatory regimes across the world.

If nicotine vaping were the intrinsic causal agent behind that surge in lung injuries, similar outbreaks should have appeared in other countries.

They did not.

By October 2019, some health authorities were already pointing to a pattern incompatible with the use of regulated nicotine products.

Public Health England issued a statement that read almost like a geopolitical correction to the American language.

The outbreak, the statement said, did not appear to be associated with the long-term use of nicotine e-cigarettes. If it were, the pattern would be different: demographic, clinical, geographic. It would be broader, more distributed, more consistent with the global geography of use.

The statement added something even more delicate: an indiscriminate response could amplify the misunderstanding already circulating about the relative safety of e-cigarettes, and push former smokers back toward conventional cigarettes.

The difference between Atlanta and London was not, at its core, one of data.
It was one of framing.

IX ~ The Shock

The evidence advanced.
The perception did not.

At the peak of the crisis, the share of people who came to view e-cigarettes as more harmful than conventional cigarettes rose sharply. The shift was rapid and persistent.

In October 2019, a survey by the Kaiser Family Foundation found that only about 30 percent of respondents believed e-cigarettes were safer than combustible cigarettes. The clinical crisis was still unfolding. The mental reclassification of risk was already underway.

When the CDC adjusted its communication in December 2019, emphasizing the role of THC and informal sources, the correction came only partially.

By February 2020, the outbreak had largely disappeared. The contaminated supply chain had been disrupted. The final toll would reach 2,807 hospitalizations and 68 deaths.

The epidemiological curve fell faster than the semantic one.
Biology solved the problem. Public language did not.

What emerged was not exactly misinformation. It was something more durable: an inference formed under uncertainty, amplified at a national scale, and later difficult to undo.

A 2022 study by Amanda Katchmar and colleagues examined state health department webpages at three distinct moments. In January 2020, when vitamin E acetate had already been identified as the primary causal link, only a minority of states with comparable data clearly identified the role of vaporized THC, and few mentioned the substance directly.

Many health agencies continued to recommend avoiding all vaping products.

The distinction, now central, was rarely made explicit. The authors concluded that much of the public messaging had not been updated to accurately reflect the risks as they were better understood at that point.

The shock spread as headlines.
The correction came as a shy update.
The clinical crisis began to recede.
The mental reclassification of risk did not.

X ~ The Scar

The most enduring effect was not in hospitals.
It was in people’s minds.

“Vaping” came to be associated with an acute, dramatic, potentially lethal event.

The EVALI outbreak did not produce only a pulmonary crisis. It also produced a mental reclassification of risk. The public did not simply hear about a disease; it learned to associate “vaping” — and, in particular, nicotine e-cigarettes — with an acute, lethal, and visually disturbing event. The shift was deep, rapid, and, by all indications, persistent.

Even as the evidence pointed to adulterated illicit THC cartridges, public perception remained focused on nicotine devices.

The target, once displaced, remained displaced.

In some cases, fear may have led users to abandon vaping as an alternative to smoking. How many people returned to cigarettes is not easy to measure. But the hypothesis does not arise in a vacuum. When two products function as substitutes, changing the perceived risk of one alters behavior toward the other.

At that point, the error is no longer merely semantic.
It begins to produce consequences.

XI ~ The Dispute Over the Name

On August 5, 2021, a group of experts asked the CDC to rename the condition. The proposal: ATHCVALI — Adulterated THC Vaping Associated Lung Injury.

The letter, signed by 75 public health experts, cited a revealing statistic: two-thirds of respondents associated the outbreak deaths with “e-cigarettes such as JUUL”; only 28 percent associated them with “marijuana or THC e-cigarettes.”

The name had already organized the field of suspicion.

The argument was straightforward. The existing term did not clarify. It obscured. It continued to associate the problem with a broader category than the evidence justified, and, in doing so, produced an etiologically loose stigma.

But there was resistance. Renaming could generate new confusion. It could be interpreted as a way to minimize risk.

The debate did not pit science against error. It pitted two forms of responsibility against each other: etiological precision and communicational stability.

Among the signatories was Michael Pesko, who would write again in 2026, urging that the change finally be made.

There is no public record of a formal CDC response to the 2021 request. This does not mean the debate did not occur. It means only that it did not surface. Internal agency documents, if they come to light, may yet show whether there was substantive discussion of renaming — who argued for retaining the term, who proposed revising it, and why the original wording prevailed.

This is not a harm that depends on explicit falsehood. A category that is too broad, named too early, and repeated for long enough is sufficient.

Even after messaging was refined, the correction remained partial.

As of April 2026, it is still possible to find headlines around the world linking lung injuries from the 2019 outbreak to nicotine e-cigarettes. The name continues to do the work that the evidence has already undone.

XII ~ The Secondary Tragedy

Every crisis has its direct victims. Some also leave an indirect trail, less visible, harder to measure. In the case of EVALI, that effect was cognitive and possibly behavioral.

The working paper from the National Bureau of Economic Research is cautious when addressing behavior, but it suggests a plausible consequence: abrupt changes in risk perception may discourage adult smokers from switching from combustible cigarettes to e-cigarettes.

Katchmar and colleagues situate this possibility within a broader economic literature, in which e-cigarettes and combustible cigarettes are treated as substitutes. A study by Cotti and co-authors estimated that a 1 percent increase in e-cigarette prices raises cigarette sales by 1.11 percent. Another study by Saffer and colleagues found that a 10 percent increase in e-cigarette prices led to a 13 percent increase in cigarette consumption, in addition to reducing smoking cessation.

This does not prove that EVALI caused, at a measurable scale, a mass return to smoking. It is not necessary to claim as much.

What can be said, with confidence, is something at once more modest and more important: public language altered the perceived hierarchy of risks.

And when a crisis leads smokers to treat a product known to be more lethal and one presumed to be less lethal as equivalent, or even to reverse that relationship, the indirect harm ceases to be merely conceptual and begins to take practical form.

The amplified fear may have led some users to reassess vaping as an alternative to smoking — and, in some cases, to give it up. It is difficult to determine how many returned to smoking because of the outbreak.

At that point, the error ceases to be merely interpretive.
It becomes measurable harm.

XIII ~ The Name Is Infrastructure

The crisis ended.
The substance was identified.
The illicit market adjusted.
The cases disappeared.
The name remained.

And with it, a version of reality remained broader than the evidence could still sustain.

Perhaps this is the real (and short) story of EVALI. Not only that of a localized respiratory outbreak, nor only that of a communication failure under uncertainty.

But of how, in moments of uncertainty, an authority must produce intelligibility before it can produce certainty, and how that intelligibility, once set in motion, tends to outlive the very evidence that later renders it insufficient.

Perhaps because names, unlike scientific hypotheses, are not designed to disappear. They are designed to remain.

And sometimes, they remain longer than they should.

Science, in general, corrects itself.
Bureaucracy stabilizes.
Public language sediments.

And in the end, what remains is not always what happened.
It is the name we gave to what happened.

* * *

Layden, Jennifer E., et al. “Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin.” New England Journal of Medicine, 2020.

Blount, Benjamin C., et al. “Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI.” New England Journal of Medicine, 2020.

Centers for Disease Control and Prevention. Press Briefing Transcript. October 25, 2019.

Kenosha County Sheriff’s Department. “Sheriff reveals details of illegal THC vaping cartridge investigation.” September 11, 2019 (updated October 1, 2019). Kenosha County, Wisconsin.

Ghinai, Isaac, et al. “E-cigarette Product Use, or Vaping, Among Persons with Associated Lung Injury — Illinois and Wisconsin, April–September 2019.” Morbidity and Mortality Weekly Report 68, no. 39 (October 4, 2019): 865–869.

Children’s Wisconsin. “Teens hospitalized with lung damage after reportedly vaping.” July 26, 2019.

Scutti, Susan. “8 Wisconsin teens hospitalized with severe lung damage due to vaping, doctors suspect.” CNN, July 26, 2019.

Grothaus, Michael. “‘This is an evil I haven’t faced before,’ says surgeon of vaping-disease teen who received double-lung transplant.” Fast Company, November 13, 2019.

UK Medicines and Healthcare products Regulatory Agency. “E-cigarette use or vaping: reporting suspected adverse reactions, including lung injury.” January 2020.

Kaiser Family Foundation. “Data Note: Public Views on vaping and E-Cigarettes.” October 2019.

Dave, Dhaval M., Daniel L. Dench, Donald S. Kenkel, Alan D. Mathios, and Hua Wang. “News that Takes Your Breath Away: Risk Perceptions During an Outbreak of Vaping-related Lung Injuries” National Bureau of Economic Research Working Paper No. 26977, April 2020.

Katchmar, Amanda, Paul Shafer, and Michael Siegel. “Analysis of State Portrayals of the Risks of E-Cigarette Use and the Cause of the EVALI Outbreak.” Harm Reduction Journal 19 (2022): 112.

Letter to the Centers for Disease Control and Prevention regarding renaming of EVALI to ATHCVALI, signed by 75 public health experts, August 5, 2021.

Pesko, Michael F. “Evidence-based Request to Revisit CDC Terminology for EVALI.” Letter to Jay Bhattacharya, Acting Director, Centers for Disease Control and Prevention, April 4, 2026.

On the morning of March 2, 2020, the phone rang while I was having coffee in a hotel in Mexico City. It was my brother. Our mother, seventy-four years old, was being placed in palliative care.

After the call, an odd silence remained, pierced by practical noises: canceling commitments, closing my suitcase, calling a cab, getting to the airport, finding a seat on the next flight.

For nearly eighteen hours, between Mexico City and Porto Alegre, I thought about the smell of tobacco that had clung to her clothes for years. Minister. Chanceller. Free. More than four decades of smoking cigarettes had carried her into the terminal stage of cancer.

The following dawn, I found myself in the waiting room of the intensive-care unit at Santa Casa Hospital, looking at my mother unconscious behind the glass walls of a small isolation room.

For a long time, that image remained in me without theory. There was the glass, the artificial light, the old smell of tobacco, and, later, the cigarette my brother lit. He, too, fit inside that correct and insufficient word: smoker.

In my memory, the smoke said something about my mother, but not enough.
It did not tell the story of her life. It did not say what the cigarette had occupied, what it had promised, what it had taken away — nor what, in it, continued to resist, even when we all knew the risk.

The death of Nina Rosa, my mother, left me facing a failure of language.
So when I came across the symbol created by Kurt Yeo, I did not first see it as a brand. I recognized in it another attempt to give that absence a name.

Five points gravitate at the ends of a hollow elliptical curve, circling an empty center, somewhere between a ribbon, a flower, and an orbit.

At first glance, it seemed simple: a reversible mark, capable of surviving equally well in black or white. But a symbol is never only what is drawn. It is also what it teaches us — or forces us — to see.

And if the design itself appeared simple, the accompanying letter was not.

Skip and Kurt Yeo’s letter does not merely present a logo. It tries to free a movement from any single owner, precisely because so many wish to claim it. More than that, it restores complexity to people whom official discourse so often reduces to cases, failures, addictions, or numbers.

There, Kurt and Skip were not speaking only about tobacco products or campaigns. They were speaking of people: those who had tried to quit; those who could not; those who had lost someone; those who had sought a less harmful way out while still carrying guilt, ambivalence, and memory.

In the symbol, the gaze shifts: it begins with the person, not the cigarette; with life, not the industry, the campaign, or the statistic. The ribbon breaks isolation. The orbit sustains movement.

The five principles Yeo inscribed in the symbol — respect for the person, commitment to evidence, harm reduction, autonomy, and sociocultural sensitivity — do not form a doctrine; they reorient the gaze.

The first principle is the simplest.

Perhaps that is precisely why it is also the most neglected: respect for the person.

No one is only what they consume. Nor what they tried to leave behind and could not. Nor what illness made of their body. My mother smoked for more than four decades. But she did not fit inside the word “smoker.” My brothers do not fit inside it either. No one does.

The anthropologist Simone Dennis helps name the world against which this principle stands: the atmosphere. Not merely the physical air, threaded with smoke, but the moral air in which the person who smokes comes to exist as a nuisance, a threat, a failure, or as the leftover residue of a public-health pedagogy that failed to persuade.

Dennis describes this atmosphere as air made of legislation, campaigns, glances, prohibitions, shame, warnings, good intentions, and discreet punishments.

It is this air that Skip and Yeo’s letter breathes — and refuses. It does not merely ask why someone smokes; it asks what world that gesture comes from, and under what circumstances the cigarette begins to seem like the only thing possible.

Where that air says, “you are a mistake,” the letter replies: you are a living person, shaped by contexts that also helped make you who you are.

Respecting the person does not mean turning every individual experience into a general rule; that would merely replace one simplification with another. This is why Skip and Yeo inscribe a second decisive principle: commitment to evidence.

In the letter, evidence does not appear as a weapon to end the conversation, but as a discipline for making it more honest. It brings together reliable information, structured data, and lived experience.

These three forms of knowledge are not equivalent, nor do they serve the same function. Data help measure risks; studies compare harms. The experience of those who smoke helps explain why a recommendation, even when correct, can fail in the face of fear, dependence, pleasure, grief, cost, shame, or lack of access. Without data, harm reduction becomes wishful thinking. Without experience, it becomes an order handed down from above.

It is here that the third principle ceases to sound technical and reveals its most human moral claim: harm reduction. Its strength lies in refusing the theater of purity. Between quitting completely and remaining exposed to maximum harm, there are lives trying to survive imperfectly.

Harm reduction is born in that interval. It neither demonizes nor romanticizes; it does not deny illness; it does not turn an alternative into absolution. It simply recognizes that, when the ideal way out does not happen, a less destructive path can still save something. It recognizes that you, or someone you love, matters.

Once we accept that harm can be reduced, the question is no longer merely a sanitary one. It becomes political: who has the authority to define the risk another person may take?

It is here that Didier Fassin helps us recognize morality as a form of governance. In his work, care and control often move together: one protects, informs, restricts, and corrects. The problem begins when protection starts speaking for the person, and calling it care while taking away their voice.

Autonomy, in this context, is not abandonment disguised as freedom. It is the opposite: offering information, alternatives, and real conditions so that someone can take part in the decision about their own life.

For years, my mother was told to stop smoking. No one ever asked why she smoked, what the cigarette gave her, or what alternatives were actually within her reach. The autonomy that Skip and Yeo’s letter claims is the right to access the knowledge that makes choice possible.

Autonomy, however, never takes place in neutral space. No one makes decisions outside a home, an income, a language, a belief, a routine, a solitude, or a community.

For this reason, the fifth principle — sociocultural sensitivity — may be the one that keeps the other four from becoming abstractions. In criticizing the narrow view of human nature that guides certain forms of public health, the anthropologist Andrew Russell shows that people who smoke are not ‘defective calculators’. They are complex, situated beings, crossed by pleasure, habit, attachment, desire, loss, anxiety, belonging, and ambivalence. A policy that ignores this may be technically correct — and humanly blind.

Consistent with this ethics, Yeo’s final gesture is to do with the symbol what the principles ask us to do with people: remove ownership, open space, restore agency.

Michael Lambek, in studying the ethics revealed in everyday acts — and not only in formal codes — reminds us that morality is embedded in action, in speech, and in the responsibility we assume before others.

Yeo could have protected the symbol as a signature, a brand, or moral capital. Instead, he relinquishes it. And that relinquishment does not decorate the letter; it sustains its deepest argument.

Perhaps this is why the symbol works. Not because it resolves the dispute over tobacco, nicotine, industry, politics, or public health. It does not. But because it shifts the point of departure.

Before the campaign, the person. Before the statistic, the life. Before condemnation, listening. Five points at the edges of a circular form: not a closure, but a reminder that no one should be excluded from the conversation about their own survival.

The symbol remains open because the story it tries to represent has not ended either. There are still those who smoke, those who try to quit, those who relapse, those who seek a less harmful way out — those who need evidence without contempt, and care without tutelage.

Five points save no one. But perhaps they show where a decent conversation must begin: with the person who is still there.

The letter functions like a small lantern: it does not illuminate the entire field, but it shows where we can still place our feet.

Delivery is promised within two hours, by motorcycle, with no tax ID, no company registration, no receipt, and almost no paper trail.

“Don’t worry, it’s all original,” an automated message replies.

On apps, age restrictions often amount to little more than a click confirming that the buyer is over 18. Brazil’s National Health Surveillance Agency, Anvisa, prohibits the sale of these products. The market does not argue. It does not wait for authorization. It simply delivers.

In Brazil, vapes, pods, and other electronic nicotine devices cannot be sold legally. The country banned them in 2009 and reaffirmed the prohibition in 2024, after years of regulatory dispute and pressure from industry groups, medical organizations, consumer advocates, and harm-reduction specialists.

The ban is not symbolic. It covers almost the entire commercial life of the product: manufacture, importation, advertising, distribution, and sale. In 2024, Anvisa not only maintained the prohibition but also expanded the regulatory scope to include devices, refills, accessories, and online promotion. The result is a legal architecture that leaves little room for formal market entry and enormous room for informal circulation.

The issue, then, is not regulation versus no regulation. Total prohibition is itself a form of regulation — one that, in Brazil’s case, appears to shift much of the market’s practical control away from the state and toward informal sellers, digital platforms, and smuggling routes.

A harm-reduction approach would begin from a different premise: nicotine products should be regulated according to risk, use, age access, and enforceability, rather than treated as a single moral category.

The dispute is not only about whether vapes should be legal. It is about who controls the existing nicotine market. Brazil enters this new phase with two conflicting inheritances: a country long regarded as a global reference in tobacco control, and one of the largest illicit cigarette markets in the Americas.

But Brazil is no longer the only country confronting this contradiction. Across the Pacific, Australia chose a different restrictive architecture. Rather than allowing a consumer vape market, it channeled legal access into a therapeutic pharmacy model: nicotine vaping would be treated less as an ordinary consumer product than as a tool for smoking cessation or nicotine-dependence management.

On paper, the Australian system appears almost opposite to Brazil’s. Brazil pursued prohibition. Australia pursued medicalization.

Yet both countries are confronting similar pressures: informal supply chains, digital distribution networks, weakened practical oversight, and markets adapting faster than regulators can control them. The comparison matters because it shifts the question. The issue is not only what each country intended to regulate, but what their policies left outside the legal door.

Brazil: The Ban That Entered the App

With more than 213 million people, Brazil turns seemingly modest percentages into mass-market phenomena. What might remain a niche in smaller countries can quickly become a logistics chain, an informal resale network, a tax dispute, and a nationwide supply system.

In markets of this size, products used repeatedly rarely disappear simply because they have been banned. They leave the storefront. They enter the app.

Long before the vape boom, Brazil had already shown how difficult it was to control the traditional cigarette market. Electronic devices did not create nicotine informality in the country. They found an infrastructure already in place: smuggling routes, shadow distribution networks, established demand, and limited state capacity for enforcement.

In 2025, roughly one in every three cigarettes consumed in Brazil circulated outside formal tax, regulatory, and health-surveillance systems. Public authorities were competing not only with legal manufacturers but also with packs sold at improvised stands, small neighborhood markets, and kiosks supplied by routes that cross borders before reaching major cities.

Brazil shares nearly 16,900 kilometers of land borders with ten South American countries. Beyond the border line itself lies the country’s 150-kilometer Border Strip, where illegal cargo can be broken up, stored, transferred, and redirected toward urban markets.

A KPMG report commissioned by the tobacco industry has estimated that Brazil accounts for more than half of the illicit cigarette market among surveyed Latin American countries. Federal enforcement officials now describe electronic cigarettes as part of that same criminal opportunity.

The point is not that vapes and illicit cigarettes are identical markets. They are not. Their consumers, aesthetics, technologies, and channels of circulation differ. But they meet inside the same structural weakness: a large nicotine market where prohibition, price gaps, porous borders, digital platforms, and limited enforcement capacity can turn restricted products into ordinary commodities.

Brazil’s informal nicotine market is no longer peripheral.
It has become part of the system.

Australia: The Pharmacy Door and the Market Outside

Australia increasingly faces its own version of that contradiction. The Australian government attempted to address vaping not through outright prohibition, but through therapeutic gatekeeping. Vapes would be treated as medical products rather than consumer products. Pharmacies would replace vape shops. Doctors and pharmacists would become the new access points.

But the real market evolved differently.

Consumers did not stop wanting convenience, flavor variety, familiar products, immediate access, or social accessibility simply because the state reclassified vaping as therapeutic.

The result has been the emergence of two systems side by side: a tightly regulated, pharmacy-centered legal pathway and an unofficial market of tobacconists, imported disposables, Telegram groups, under-the-counter retail, social media promotion, and organized criminal supply networks.

Australia, therefore, produced a contradiction remarkably similar to Brazil’s:
a formal regulatory system existing beside a rapidly adapting informal market.

The pharmacy-only model also faces a quieter problem: legal access can exist on paper while remaining narrow, inconsistent, or inconvenient in practice.

Many pharmacies do not stock nicotine vaping products at all. Others stock only a limited range of devices, nicotine strengths, or products. Some pharmacists remain reluctant to participate because of uncertainty, reputational concerns, lack of commercial incentive, or personal opposition to vaping itself.

For many smokers, the legal pathway exists technically, but not practically.

Obtaining products may mean finding a participating pharmacy, navigating consultations or prescriptions, locating available stock, accepting limited product options, and repeatedly dealing with supply inconsistency.

A smoker attempting to move away from cigarettes does not experience regulation as an abstract public-health framework. They experience it behaviorally: Can I reliably obtain a product that works for me?

When the answer becomes uncertain, consumers often move toward the parallel market. That is one of the strongest comparative insights between Brazil and Australia. Brazil may show the limits of prohibition. Australia may show the limits of medicalization when the legal pathway narrows relative to demand.

The Smuggling of Words

The new clandestine market is not built only on routes, warehouses, and border crossings. It is also built on words.

To evade platform filters and enforcement, pods and electronic cigarettes often appear under other names. On digital marketplaces, they have been advertised as “air fresheners,” “essential oils,” “diffusers,” “essences,” and even “kitchen items.” On delivery apps, some sellers list devices under categories such as “natural supplements.”

The logic is simple: change the language to keep the market moving.

What once depended mainly on border routes and informal retail now also moves through search terms, closed profiles, temporary posts, messaging apps, and delivery systems.

The market no longer behaves like a traditional black market. Increasingly, it behaves like platform commerce.

This is what makes the modern nicotine debate so difficult for governments: the market is no longer only geographic. It is algorithmic.

The same digital infrastructure used for food delivery, social media advertising, and online retail can also be used to distribute restricted nicotine products.

In both Brazil and Australia, regulators are attempting to control these markets with twentieth-century enforcement structures, even as the markets themselves evolve through twenty-first-century digital systems.

The result is constant adaptation. Each new restriction generates new workarounds. Each enforcement action produces new distribution methods.
The market mutates faster than regulation itself.

The Two Bodies in the Room

That redistribution of control has become most politically charged when it comes to adolescents.

Among Brazilian students aged 13 to 17, the share who had tried e-cigarettes rose sharply between 2019 and 2024. Similar fears now shape Australian policy debates around youth vaping, disposable devices, flavors, and social-media visibility.

For public-health authorities, the concern is not simply nicotine itself, but renormalization: the possibility that a generation raised after decades of anti-smoking campaigns could once again be drawn into nicotine use.

Yet adolescents are not the only bodies in the room.

Brazil still has millions of adult smokers already exposed to the cumulative harms of combustible cigarettes. Australia does too.

A policy built only around preventing youth initiation risks leaves adult smokers in the most harmful form of nicotine use. A policy built only around harm reduction risks normalizes a new nicotine market among adolescents.

Neither problem disappears through moral certainty alone.

This is where both countries become accidental laboratories. One pursued prohibition; the other pursued therapeutic containment. Both reveal the same underlying tension: when legal systems disconnect from demand, markets reorganize outside them.

This does not mean nicotine products should circulate without restriction. Nor does it mean regulation cannot fail. It can be captured by commercial interests, weakened by bureaucracy, hollowed out by poor enforcement, or designed in ways that exclude the smokers it claims to help.

But the alternative to regulation is not necessarily control.

In both Brazil and Australia, the alternative increasingly appears to be the informal market: less traceability, less accountability, weaker age verification, less transparency, and weaker public oversight.

The deeper question is no longer only whether governments oppose nicotine use. It is whether they can still govern markets that emerge online, spread socially, adapt algorithmically, and only later appear in the physical world.

Brazil banned vaping. Australia medicalized it.

Both may now be revealing the same uncomfortable truth: when law becomes narrower than demand, markets do not disappear.

They mutate.

Comparative Fact Sheet: Brazil and Australia

Population

Brazil: 213 million people in 2025.

Australia: roughly 27 million people in 2025.

Why it matters: Brazil’s scale turns even modest prevalence rates into mass-market phenomena. Australia, by contrast, shows that a smaller population and stronger border controls do not necessarily insulate a country from illicit-market pressure.

Youth Vaping

Brazil: according to official data, 29.6 percent of adolescents aged 13–17 had tried electronic cigarettes in 2024.

Australia: national surveys have also shown substantial experimentation among adolescents and young adults, especially during the disposable-vape era, despite tighter restrictions and import controls.

Why it matters: Both countries reveal the same political paradox: restrictive policy frameworks have not prevented significant experimentation among youth.

Adult Use

Brazil: estimated daily adult e-cigarette use reached 2.6 percent in 2024, measured in state capitals only, roughly 4 million people.

Australia: adult vaping prevalence is substantially higher than Brazil’s, especially among younger adults and former smokers. Despite Australia’s pharmacy-only therapeutic framework, nicotine vaping had already become widely embedded among consumers before and during the current restrictions.

Why it matters: this creates a contradiction inside the Australian model: a formally therapeutic product now functioning socially as a mass consumer product.

Illicit Cigarette Trade

Brazil: 41.8 billion illicit cigarettes were consumed in 2025, representing an estimated illegal market share of 35.6 percent.

Australia: Australia is facing a rapidly expanding illicit tobacco market, driven in large part by high tobacco excise taxes and growing organized crime involvement. Illegal tobacco retailing has become increasingly visible, with illicit tobacconists operating openly in several cities. Fire bombings, extortion, and turf conflicts linked to the tobacco trade have also become recurring national news stories.

Why it matters: Brazil’s illicit market is older and structurally embedded. Australia’s is newer, but expanding quickly and becoming politically destabilizing. Both point to the same underlying principle: when price, restriction, and demand diverge too sharply, parallel markets emerge.

Geography and Borders

Brazil: 16,900 kilometers of land borders with ten South American countries.

Australia: an island nation with a far more controlled border environment.

Why it matters: This is perhaps the most politically revealing comparison. Brazil’s illicit nicotine market is often explained through porous borders, continental geography, and limited enforcement capacity. Australia lacks those structural vulnerabilities. Yet despite geographic isolation and heavy border policing, it has still developed a large illicit vape and tobacco market.

Australia, therefore, complicates the easy explanation that Brazil’s problem is only porous borders or weak state capacity. In both countries, illicit markets also reflect consumer demand, digital commerce, taxation pressures, and regulatory mismatch.

Enforcement

Brazil: 550,000 electronic cigarettes were seized in 2024.

Australia: authorities have expanded seizure operations against illicit vaping and tobacco imports, while state governments have carried out repeated raids on tobacconists and informal retailers.

Why it matters: In both countries, stronger enforcement has coincided with the continued expansion of illicit supply. High seizure numbers may signal state action, but they also reveal the scale and persistence of the market itself.

Public Opinion and Regulatory Legitimacy

Brazil: 58.8 percent of submissions to Anvisa’s public consultation opposed continuing the vape ban.

Australia: the policy debate has become increasingly polarised among public-health authorities, harm-reduction advocates, pharmacists, smokers, consumer groups, and enforcement agencies.

Australia has not held an equivalent public consultation producing a directly comparable figure. Still, dissatisfaction with the pharmacy-only framework has increasingly centered on limited access, uneven pharmacy participation, inconsistent supply, high prices, consumer inconvenience, and the growth of the illicit market.

Why it matters: both countries now face a growing legitimacy problem: a widening gap between official nicotine policy and actual market behavior.

What the Comparison Reveals

Brazil and Australia chose radically different nicotine strategies. Brazil pursued prohibition. Australia pursued medicalization.

Yet the numbers point toward a similar structural outcome: persistent consumer demand moving into informal, digitally adaptive, and increasingly difficult-to-control supply systems.

Brazil’s scale makes the phenomenon massive. Australia’s smaller size makes it politically embarrassing and revealing. If even a wealthy island nation with centralized border controls and a pharmacy-only framework cannot contain informal nicotine markets, the problem cannot be explained by porous borders or weak state capacity alone.

The comparison raises a broader question about suppression-based policy itself: what happens when the legal pathway becomes narrower than demand?

The WHO’s nicotine pouch report is somewhat right about the marketing problem but uneasy about the harm-reduction problem.

It highlights a typical commercial style: playful, vibrant packaging; influencer marketing; sports sponsorships; aspirational branding; and trendy language. It also features flavors, discreet formats, and tobacco-free language. These strategies can lower the symbolic barrier to nicotine use, especially for adolescents and young never-smokers.

But the report struggles with the harder ambiguity: the same attributes that may attract never-users can also help adult smokers move away from cigarettes.

That is the fault line. Nicotine pouches are not harmless. But they are also not combustible cigarettes. Public health can readily recognize the first fact. It still hesitates before the second.

Why It Matters

For decades, tobacco control was organized around a clear enemy: the cigarette. It joined nicotine, combustion, addiction, disease, death, and industry manipulation in a single object.

Nicotine pouches disrupt that clarity. They deliver nicotine without tobacco leaf, without smoke, without smell, and without combustion, the mechanism responsible for most smoking-related harm.

The WHO report responds mainly through the grammar of precaution. That is understandable. Youth uptake matters. Marketing matters. Dependence matters.

But precaution becomes incomplete when it cannot accommodate relative risk.

If public health treats all nicotine products as extensions of the cigarette, it may protect the moral clarity of tobacco control while weakening its capacity to reduce harm among smokers who have not quit.

Evidence at a Glance

• The WHO report warns that nicotine pouch marketing is expanding faster than regulation.

• Its central concern is commercial capture: flavors, packaging, digital influence, sports sponsorships, and “tobacco-free” branding.

• In Great Britain, nicotine pouch use among 16-to-24-year-olds rose from 0.7% in January 2022 to 4.0% in March 2025; among young men, it reached 7.5%.

• The same data show overlap with smoking and vaping, making it difficult to reduce the trend to simple initiation.

• In the United States, youth pouch use among 10th- and 12th-grade students increased from 2023 to 2024, alongside dual use with e-cigarettes.

• The unresolved question is whether growth reflects initiation, experimentation, dual use, substitution, cessation attempts, or all of these at once.

Why This Matters for Policy

Scientific

• The key question is not whether nicotine pouches are safe. They are not risk-free. Nothing is.

• The key question is: safe compared with what?

• Compared with abstinence, pouches carry risk. Compared with combustible cigarettes, the toxicological distance is substantial. The main devastation caused by smoking comes from combustion: tar, carbon monoxide, ultrafine particles, and thousands of toxic compounds generated by burning tobacco.

• The WHO report sees absolute risk clearly. It is less comfortable with relative risk.

Regulatory

• The report reflects a regulatory imagination still shaped by the cigarette.

• That creates a problem. If pouches are regulated only as a youth threat, adult smokers may lose access to lower-risk alternatives. If they are promoted without guardrails, youth uptake may expand.

• The task is not to choose one reality and deny the other. It is to regulate by user, product, risk, and context.

• That means strict age controls, marketing restrictions, product standards, surveillance, and honest communication about comparative risk.

Equity Implications

• The missing figure in much of the WHO’s framing is the persistent adult smoker.

• As smoking declines, it becomes more concentrated among people facing psychological distress, low income, precarious work, interrupted schooling, and social exclusion. For many of them, quitting is not simply a matter of information or willpower.

• A public-health model that rejects lower-risk alternatives because they fall short of abstinence may leave the most vulnerable smokers with the most harmful product.
  

Communication

• The WHO is right to expose some language of commercial seduction.

• But public health also has a language problem of its own. When it refuses to distinguish nicotine from combustion, or lower-risk products from cigarettes, it produces confusion in the name of protection.

• And confusion favors the cigarette. When everything is made to sound equally dangerous, the most familiar product keeps its advantage.

The Strategic Question

The question is not: How do we stop nicotine pouches?

The better question is: Can public health prevent youth capture without denying harm reduction to smokers still exposed to combustion?

Recommended Actions

For Regulators & Public-Health Agencies

• Separate youth-prevention policy from adult harm-reduction policy.

• Regulate marketing, packaging, flavors, age access, nicotine strength, and product quality.

• Communicate clearly that lower risk does not mean risk-free.

• Monitor initiation, dual use, substitution, cessation attempts, and relapse separately.

• Stop treating all nicotine use as morally equivalent to smoking.

For Politics

• Do not use precaution as a substitute for proportionality.

• Keep combustion at the center of tobacco policy.

• Recognize that harm reduction is not surrender; it is a response to the limits of abstinence-only models.

• Ask whether restrictions reduce harm or preserve the cigarette’s dominance.

• Treat the nicotine policy as a question of inequality, evidence, markets, and risk, not only youth protection.

For Journalists & Opinion Leaders

• Avoid turning the report into a simple “new nicotine epidemic” story.

• Distinguish initiation, experimentation, dual use, substitution, and cessation.

• Keep adult smokers in the frame.

• Report marketing risks without collapsing all nicotine products into cigarettes.

• Explain the difference between nicotine, tobacco, and combustion.

The Risk of Misreading

This is not a defense of nicotine pouches as harmless products.

It is a critique of a public-health reflex: seeing every new nicotine technology primarily through the moral memory of the cigarette.

The WHO report is strongest when it exposes certain commercial tactics. It is weakest when it treats ambiguity as a regulatory inconvenience rather than as the central fact of the post-cigarette nicotine landscape.

Bottom Line

The WHO can see the danger of nicotine pouches as products of initiation. It still struggles to see their possible role as products of substitution. That is the unresolved public health problem after the cigarette.

Argentina has not simply legalized vapes. It has been admitted that prohibition no longer controls.

For more than a decade, electronic cigarettes were formally banned while circulating through kiosks, social media, informal deliveries, suitcases, school backpacks, and parallel markets. The law said absence. Daily life said coexistence.

ANMAT’s 2026 reversal, therefore, marks less a conversion to harm reduction than a bureaucratic recognition: the market had already arrived, grown, and escaped meaningful oversight.

The new regime brings electronic cigarettes, heated tobacco products, nicotine pouches, liquids, cartridges, and sticks into the legal sphere, but only under strict registration, traceability, taxation, flavor limits, health warnings, and state surveillance.

Argentina is not opening the market. It is trying to make it visible.

Why It Matters

The Argentine case exposes a basic policy failure: prohibition can survive legally while collapsing administratively. A ban may still exist on paper even after the state has lost the ability to inspect products, verify composition, prevent youth access, tax sales, or influence consumer behavior.

That is the real significance of the reform. Argentina is no longer regulating a future threat. It is trying to govern an accomplished fact.

The harder question is whether the new legal market will actually displace the informal one. If registered products become expensive, scarce, flavor-restricted, and surrounded by communication so cautious that adult smokers cannot understand relative risk, the reform may produce only a formal surface.

At the same time, the old gray market continues underneath it.

Evidence at a Glance

• Argentina banned electronic cigarettes in 2011, but the market continued to circulate informally.

• On May 4, 2026, ANMAT revoked the previous prohibition.

• The agency acknowledged that absolute bans can push consumers into informal and illegal circuits where products of unknown origin and composition circulate.

• Resolution 549/2026 created a Registry of Tobacco and Nicotine Products covering electronic devices, vape liquids, heated-tobacco products, sticks, and nicotine pouches.

• Disposable vapes remain banned; liquids and sticks may only use tobacco flavor; nicotine pouches may use tobacco or menthol.

• Decree 305/2026 increased import duties on several non-combustion nicotine products, bringing their tax burden closer to traditional tobacco.

• The Ministry of Health cited that 35.5% of adolescents had tried an electronic cigarette at least once — evidence that youth use had expanded before legalization, not because of it.

Why This Matters

Scientific

• The reform forces a distinction that much of Latin American public health still avoids: nicotine is not the same as combustion.

• No nicotine product is risk-free. Dependence, youth uptake, and product quality all matter. But treating every nicotine product as morally and scientifically equivalent protects the cigarette by default. For adult smokers, the relevant comparison is not vaping versus clean air. It is vaping versus continued smoking, informal products, or no realistic pathway away from combustion.

Regulatory

• Argentina is choosing a middle path: neither full consumer-market liberalization nor pharmacy-style medicalization.

• But the middle path is not automatically balanced. It can become a corridor so narrow that only large companies, expensive products, and highly controlled formats survive legally. The core test will not be the elegance of the decree. It will be enforcement: kiosks, e-commerce, parcels, borders, social networks, and sales to minors.

• The old mistake was believing prohibition meant control. The new mistake would be believing registration does.

Equity Implications

• Legalization does not guarantee access.

• Laboratory testing, registration, certification, traceability, import duties, and compliance costs favor large operators. Smaller importers, independent shops, and informal sellers may remain outside the legal market. Adult smokers, especially those with lower incomes, may face legal products that are more expensive, less varied, and harder to find than the informal alternatives already available.

• A harm-reduction pathway that exists only in regulation does not reduce harm. It must exist at the counter: affordable, available, understandable, and capable of competing with the cigarette.

Communication

• Argentina wants to legalize without appearing to endorse. That is politically understandable, but risky.

• If public messaging says only that “no product is risk-free,” without explaining comparative risk, adult smokers may hear equivalence. And when everything sounds equally dangerous, the cigarette keeps its advantage: familiarity.

• The state must prevent youth-oriented marketing without silencing information for adult smokers. Protection for minors and clarity for adults are not the same task.

The Strategic Question

The question is not: Are vapes safe?

The better question is: Can Argentina create a legal market restrictive enough to limit minors’ appeal, but accessible enough to help smokers move away from combustion?

Recommended Reflections and Actions

For Journalists & Opinion Leaders

• Do not describe the reform as simple legalization. It is legalization under surveillance.

• Keep the cigarette in the story: the most harmful product remains legal, familiar, and widely available.

• Follow the street, not only the Official Gazette: prices, shelves, kiosks, online sellers, parcels, borders, and school access.

• Avoid the false binary of “pro-vape” versus “anti-vape.” The real story is control, informality, youth protection, adult substitution, and relative risk.

For Regulators & Public-Health Agencies

• Build a registry that is fast, transparent, technically credible, and publicly accountable.

• Distinguish youth prevention from adult harm reduction.

• Monitor price, access, product availability, illicit-market persistence, and adult substitution away from cigarettes.

• Communicate relative risk clearly without turning products into lifestyle objects.

• Evaluate whether flavor restrictions reduce youth use or simply preserve the informal market.

For Politics

• Stop treating prohibition as proof of seriousness.

• Invest in the administrative capacity the reform requires: laboratories, inspectors, customs control, digital monitoring, and enforcement.

• Ask who the new compliance system favors: public health, consumers, large corporations, or the state’s need to appear in control.

• Measure success by outcomes, not decrees: less smoking, less illicit supply, less youth access, more traceability.

The Risk of Misreading

This is not a clean victory for harm reduction. Argentina has not fully embraced substitution, nor guaranteed meaningful access for adult smokers.

It is also not a meaningless bureaucratic shift. It ends a fiction: the idea that prohibition had kept vapes outside Argentine life.

The danger now is replacing one illusion with another, moving from pretending prohibition was control to pretending traceability is governability.

Bottom Line

Argentina has stopped pretending that prohibition worked. Now it must prove that regulation can do more than document what it still cannot control.

For deep reading:

Small, white, almost imperceptible, the nicotine pouch seems designed to escape not only other people’s gaze, but also the classic categories of tobacco control.

It produces no smoke. Leaves no smell. Does not burn. Raises no columns of vapor. Contains no tobacco leaf. Slips beneath the lip. It can be used in silence: in a meeting, on a flight, in a living room.

And yet it carries nicotine — a substance whose public-health meaning changes radically depending on how it is consumed and, above all, on the product it replaces.

For decades, the enemy seemed easy to name. The cigarette condensed dependence, combustion, and death into a single object. Anti-smoking efforts were organized around that clarity. Smoking killed. The consensus was solid because the harm was, too.

Nicotine pouches broke that geometry.

Unlike cigarettes, they deliver nicotine without combustion and, with it, without the primary mechanism that produces most of the toxins associated with smoking. But they do so through devices designed to appear clean, discreet, and compatible with a daily life governed by productivity, mobility, and self-improvement — an aesthetic already familiar from products that promise focus, performance, and balance.

Discretion, pleasure, performance, convenience, and design now come to orbit a molecule historically linked to harm, dependence, and the moral imagination of the cigarette.

It was precisely this ambiguity that led the World Health Organization to sound the alarm. In its report, Exposing Marketing Tactics and Strategies Driving the Global Growth of Nicotine Pouches, published on May 15, the WHO describes a market outpacing the capacity to regulate it. To a large extent, the document reads this phenomenon as a technological update of older tobacco-industry strategies.

Its concern centers on categories that are already familiar: fruit and candy flavors, eye-catching packaging, influencers who replace mass advertising with the continuous intimacy of personalized feeds, sports sponsorships, aspirational branding, and the use of “tobacco-free” language in campaigns that can turn nicotine dependence into a lifestyle aesthetic.

The concern is not imaginary.

In Great Britain, a study by Tattan-Birch, Jackson, Shahab et al. published in The Lancet Public Health estimated that nicotine pouch use among 16-to-24-year-olds rose from 0.7% in January 2022 to 4.0% in March 2025; among men in that age group, it reached 7.5%. But those numbers, on their own, do not fully explain what this growth means. The study shows substantial overlap with smoking and vaping, and it also suggests that some smokers are using pouches in quit attempts. What it does not establish, by itself, is how much of the increase reflects initiation, dual use, temporary experimentation, or partial substitution for cigarettes.

In the United States, data from Han, Harlow, Miech et al. also found that nicotine pouch use among 10th- and 12th-grade students increased from 2023 to 2024, along with a rise in dual use with e-cigarettes. The pattern suggests a shift in the youth nicotine market, but it does not, by itself, establish that this is simply a new epidemic of initiation.

WHO’s warning moves chiefly on the terrain of precaution. Less as a response to conclusive evidence that pouches are creating, on a large scale, a new population of dependent users among non-users, and more as a reaction to the convergence of sensory appeal, discreet use, aspirational marketing, and low risk perception.

The controversy deepens because the disagreement lies not only in the regulatory responses but in the very causal premises of the debate.

Peter Hajek, for example, has questioned the robustness of some claims about permanent nicotine-related damage to the adolescent brain. He argues that many such inferences derive from animal models exposed to doses and conditions only weakly comparable to real human consumption. Researchers such as Lion Shahab and Cristine Delnevo, meanwhile, challenge the causal reading of the so-called gateway effect. For them, the association between trying non-combustible nicotine products and later smoking may reflect less a gateway than a shared predisposition to risk-taking behavior, which part of the literature calls common liability.

Nicotine itself, moreover, is pharmacologically less simple than the public imagination usually allows. That does not make it harmless. But it does make the old equivalence between nicotine, combustion, and harm less stable.

But this is where the debate grows more complicated than the WHO’s precautionary logic seems able to accommodate.

Because the very attributes that may widen experimentation among adolescents — discretion, flavors, the absence of smoke — also appear, for millions of adult smokers, as concrete means of replacing the cigarette.

The same product that may function for some as a gateway can operate for others as a route out.

And perhaps it is precisely this uneasy coexistence that contemporary regulatory systems have not yet learned how to govern.

But perhaps the hardest part of this debate does not lie with adolescents who may begin. That group matters, of course — epidemiologically and ethically. The problem is that contemporary public health has come to focus almost exclusively on those who might start using nicotine, and less and less on those who have never managed to stop.

While governments and international bodies concentrate their energy on containing new forms of initiation, another population remains partly out of frame: millions of smokers who go on consuming combustible cigarettes despite decades of campaigns, tax increases, health warnings, and cessation policies.

For a significant share of these smokers, quitting ceased long ago to be a simple matter of public health information. And those who still smoke today no longer resemble the average smoker of the 1980s or 1990s.

As smoking declined, it also became more concentrated. More and more, it came to settle among socially vulnerable groups: people living with psychological distress, exposed to precarious work, low income, interrupted schooling, social exclusion, and more persistent forms of dependence.

In many countries, smoking has ceased to be a habit evenly distributed across the population and has become, instead, a marker of inequality.

From here on, the discussion of risk shifts scale.

At the individual level, no nicotine-containing product is entirely without risk. No substance introduced into the human body is biologically neutral: dose, frequency, age, clinical condition, and individual vulnerability all matter. And dependence remains dependence.

But from a toxicological point of view, the distance between a nicotine pouch and a combustible cigarette is immense.

The main public-health devastation caused by smoking has never come from nicotine in isolation, but from combustion: tar, carbon monoxide, ultrafine particles, and thousands of compounds generated by burning tobacco.

By that logic, replacing cigarettes with non-combustible products may represent a substantial reduction in harm for persistent smokers.

And it is precisely this difference that creates an important political discomfort.

Public health rarely governs a single kind of risk. It has to decide, all at once, what to do with the harm of a product in itself, with the harm of that product relative to what it may replace, and with the aggregate effects of its circulation in society.

In the case of pouches, those scales do not converge easily.

Absolute risk reminds us that no nicotine product is neutral. Relative risk shows that the toxicological distance between a pouch and a combustible cigarette is enormous. Population risk asks a different question: how many adolescents may initiate use, how many smokers may leave combustion behind, how many will remain dual users, and how many non-users may be drawn into the nicotine market.

The problem is that each of those questions may push public policy in a different direction.

Advocates of harm reduction often point to the Swedish experience as population-level evidence of this shift. In Sweden, where the use of oral nicotine products such as snus has historically replaced a significant portion of cigarette consumption, lung cancer rates and tobacco-related mortality are among the lowest in Europe. Critics respond that highly specific cultural and regulatory contexts make simple generalizations difficult. Even so, the Swedish case remains one of the most uncomfortable facts for regulatory models that tend to treat all forms of nicotine as equivalent in risk.

Part of the difficulty lies, too, in the scale chosen to interpret the phenomenon.

The recent rise of nicotine pouches among adolescents is often narrated in relative terms: it “quadrupled,” it “exploded,” it “advanced rapidly.” And in some specific markets, the expansion has indeed been fast.

But relative growth and population magnitude are not the same thing.

Even in the countries where the increase among young people has most alarmed health authorities, pouches are still circulating at levels far below those historically reached by combustible cigarettes.

And yet the global map of youth tobacco use itself prevents combustion from disappearing from view.

In its Global Report on Trends in Prevalence of Tobacco Use 2000–2030, WHO estimated that 9.7% of adolescents aged 13 to 15 were using tobacco in 2022; in the regional projections through 2030, no region falls below 9%. Even where the rate is lower, as in Africa, it remains around 9.5%; in Europe, it reaches 11.6%.

None of this diminishes the importance of prevention among adolescents. But it does suggest that contemporary nicotine policy may be trying to respond, at the same time, to two distinct phenomena: the massive persistence of combustion and the much more recent, and numerically smaller, emergence of alternative non-combustible products.

The risk, then, is that the symbolic speed of the new may obscure the epidemiological persistence of combustion.

The codes no longer belong to the classic imagery of tobacco: smoke, ashtrays, yellowed stains on the fingers, the smell embedded in clothes.

The new products circulate through a different aesthetic. They come in colorful, seductive packaging, draw on pop culture references, offer flavors that evoke fruit, candy, or energy drinks, spread through digital platforms, and carry with them a constant promise of discretion.

For much of the twentieth century, the tobacco industry sold a sense of belonging through images of masculinity, risk, and rebellion. Now the repertoire has changed. Contemporary consumption rarely presents itself as excess. It prefers the language of balance, efficiency, and self-management.

It is within this landscape that WHO locates its central concern: the possibility that products designed to appear clean, modern, and tobacco-free may lower the symbolic barriers to entry for adolescents and young adults.

What unsettles some public health authorities may not be the presence of nicotine alone, but the possibility that it might once again circulate socially without carrying the full moral iconography of the cigarette.

For a long time, nicotine, harm, combustion, and morality were compressed into a single symbolic entity. Nicotine pouches break that compression.

Contemporary life, after all, already runs on continuous architectures of stimulation. Breakfast arrives calibrated in caffeine. Midday demands focus and output. The afternoon comes in cans of sugar, taurine, and neurochemical marketing. At night, apps turn anxiety into a monthly subscription, while alcohol, melatonin, or anxiolytics artificially reorganize rest.

None of this erases nicotine’s specificity or its physiological potential for dependence. But it does help explain why pouches circulate with relative ease within a cultural ecosystem already accustomed to discrete, continuous, and socially normalized forms of behavioral capture.

Perhaps the contemporary problem lies not only in the existence of these mechanisms of capture, but in the way we decide which of them to treat as moral deviance, and which to absorb, without much alarm, as lifestyle.

The problem begins when attributes such as flavor, discretion, and convenience come to be read almost automatically as signs of youth capture.

These attributes do not carry a fixed epidemiological meaning. For an adolescent who has never smoked, sweet flavors may function as a path to experimentation. For an adult smoker who has consumed a pack a day for twenty years, those same flavors may help break the sensory bond with the cigarette.

It is this ambiguity that unsettles the old categories of tobacco control.

For decades, nicotine, cigarettes, and death could be treated almost as a single moral entity. The dominant harm was concentrated in the combustible cigarette, and any expansion of nicotine use seemed, by definition, threatening.

Pouches break that equivalence. They reduce a substantial part of the harm associated with cigarettes while, at the same time, making dependence more discreet, more palatable, more compatible with the contemporary aesthetic of performance and convenience.

The WHO report itself moves within this frame. In describing pouches as products designed to sustain dependence, and in warning that their commercial strategies may expose a new generation to addiction, the document is not speaking only about toxicology or regulation. It translates the circulation of these products into a moral language of capture, manipulation, and generational threat.

It is here that the report reveals, at once, both its strength and its limit. It is right to identify a sophisticated contemporary grammar of commercial capture. Nothing different from other products. But it stumbles when it tries to govern ambiguous technologies through moral categories forged for far more homogeneous threats.

The report reveals, in the end, that international nicotine policy seems to operate more comfortably in the face of the emerging risk of initiation than in the face of the historical persistence of combustion.

* * *

World Health Organization (2026). Exposing marketing tactics and strategies driving the global growth of nicotine pouches. World Health Organization. https://iris.who.int/handle/10665/385691. License: CC BY-NC-SA 3.0 IGO

Source notes

Public health studies and reports

• Alkharaan, Hassan, Abdulaziz Alrubayyi, Majed Kariri, et al. “Investigating Oral Nicotine Pouch Use Among Adults in Riyadh, Saudi Arabia: Prevalence, Awareness, Susceptibility, and Associated Symptoms.” Frontiers in Public Health 13 (2025): 1607656. https://doi.org/10.3389/fpubh.2025.1607656.

• Conde, Monserrat, K. Tudor, R. Begh, et al. “Electronic Cigarettes and Subsequent Use of Cigarettes in Young People: An Evidence and Gap Map.” Addiction 119, no. 10 (October 2024): 1698–1708. https://doi.org/10.1111/add.16583.

• Dautzenberg, Bertrand, et al. “Systematic Review and Critical Analysis of Longitudinal Studies Assessing Effect of E-Cigarettes on Cigarette Initiation Among Adolescent Never-Smokers.” International Journal of Environmental Research and Public Health 20, no. 20 (2023): 6936. https://doi.org/10.3390/ijerph20206936.

• Delnevo, Cristine D. “E-Cigarette and Cigarette Use Among Youth: Gateway or Common Liability?” JAMA Network Open 6, no. 3 (March 2023): e234890. https://doi.org/10.1001/jamanetworkopen.2023.4890.

• Farsalinos, Konstantinos. “Nicotine Pouches: An Aid in Smoking Cessation, or a New Public Health Hazard?” Internal and Emergency Medicine 21, no. 3 (April 2026): 843–858. https://doi.org/10.1007/s11739-026-04278-1.

• Shahab, Lion, Emma Beard, and Jamie Brown. “Association of Initial E-Cigarette and Other Tobacco Product Use with Subsequent Cigarette Smoking in Adolescents: A Cross-Sectional, Matched Control Study.” Tobacco Control 30 (2021): 212–220.

• Sun, Ruoyan, David Méndez, and Kenneth E. Warner. “Association of Electronic Cigarette Use by US Adolescents With Subsequent Persistent Cigarette Smoking.” JAMA Network Open 6, no. 3 (March 2023): e234885.

Clinical research and neuroscience

• Barreto, George E., Alexander Iarkov, and Valentina Echeverria Moran. “Beneficial Effects of Nicotine, Cotinine and Its Metabolites as Potential Agents for Parkinson’s Disease.” Frontiers in Aging Neuroscience 6 (January 2015): 340.

• Belluardo, Natale, G. Mudò, M. Blum, and K. Fuxe. “Central Nicotinic Receptors, Neurotrophic Factors and Neuroprotection.” Behavioral Brain Research 113, nos. 1–2 (August 2000): 21–34. https://doi.org/10.1016/S0166-4328(00)00197-2.

• Goniewicz, Maciej L. “Biomarkers of Electronic Nicotine Delivery Systems (ENDS) Use.” Addiction Neuroscience 6 (2023): 100077.

• Green, Harry Jacob, et al. “An Exploratory, Randomized, Crossover Study to Investigate the Effect of Nicotine on Cognitive Function in Healthy Adult Smokers Who Use an Electronic Cigarette After a Period of Smoking Abstinence: Study Protocol.” International Journal of Clinical Trials 9, no. 2 (2022): 136–142.

• La Rosa, Giusy Rita Maria, et al. “Self-Reported Oral Health Outcomes After Switching to a Novel Nicotine Pouch Technology: A Pilot Study.” Acta Odontologica Scandinavica (2025). Advance online publication.

• Nop, Olivia, et al. “Nicotine and Cognition in Cognitively Normal Older Adults.” Frontiers in Aging Neuroscience 13 (May 2021): 640674. https://doi.org/10.3389/fnagi.2021.640674.

• Quik, Maryka, Xiomara A. Perez, and Tanuja Bordia. “Nicotine as a Potential Neuroprotective Agent for Parkinson’s Disease.” Movement Disorders 27, no. 8 (2012): 947–957.

• Rezvani, Amir H., and Edward D. Levin. “Cognitive Effects of Nicotine.” Biological Psychiatry 49, no. 3 (2001): 258–267.

• Spasova, Violeta, et al. “Impact of Nicotine on Cognition in Patients With Schizophrenia: A Narrative Review.” Cureus 14, no. 4 (April 2022): e24576.

Market analysis and behavior

• Fearon, Ian M., et al. “Curiosity and Intentions to Use Myblu E-Cigarettes and an Examination of the ‘Gateway’ Theory.” Drug Testing and Analysis 15, no. 10 (October 2023): 1252–1261.

• Minton, Michelle. “Perverse Psychology.” Competitive Enterprise Institute, January 2020.

• Russell, Christopher, Willie J. McKinney, and Ian M. Fearon. “Behavioral Intentions Assessment of a Disposable E-Cigarette Among Adult Current, Former, and Non-Smokers in the United States.” Drug Testing and Analysis 15, no. 10 (October 2023).

• Warner, Kenneth E., and David Méndez. “E-Cigarettes: Comparing the Possible Risks of Increasing Smoking Initiation With the Potential Benefits of Increasing Smoking Cessation.” Nicotine & Tobacco Research 21, no. 1 (2019): 41–47. https://doi.org/10.1093/ntr/nty062.

Conferences, talks, and other documents

• Benowitz, Neal L. “Nicotine Addiction: From Biology to Regulatory Policy.” Presentation at the CAsToR Symposium, May 17, 2023.

• Newhouse, Paul A. “Long-Term Transdermal Nicotine for the Treatment of Mild Cognitive Impairment.” Vanderbilt Center for Cognitive Medicine / Vanderbilt University Medical Center, talk/interview, 2022.

• Yang, Zhongli, and Ming D. Li. “Effects of Tobacco on Feeding and Energy Homeostasis.” Unverified institutional citation; likely a chapter, lecture, or review rather than a standalone journal article.

The Core Tension

Smoking has declined, but not equally. The cigarette has retreated from offices, prestige culture, and public space, yet it has not disappeared from the lives of those most exposed to social and economic vulnerability.

The central tension is this: tobacco control often celebrates aggregate decline, while the remaining burden of smoking becomes increasingly concentrated among poorer and more precarious groups. What looks like public-health success at the population level may conceal a harder reality: harm has not vanished. It has moved down the social gradient.

The cigarette is no longer simply a habit, an addiction, or an individual choice. In many contexts, it has become a marker of class — not because smoking has changed in itself, but because its persistence now tracks the line between those able to move away from harm and those left closer to it.

Smoking has ceased to be socially diffuse and has become concentrated, which changes its political meaning .

Why It Matters

The decline of smoking is real. But treating that decline as a uniform victory is analytically lazy and politically dangerous.

It ignores the fact that those who continue to smoke are increasingly people whose lives are shaped by low income, precarious work, interrupted education, mental distress, weaker support networks, and irregular access to quit.

Public health often speaks of “the smoker” as if this were a neutral and universal category. It is not.

The term can erase the material conditions under which smoking persists. When campaigns rely mainly on warning, stigma, taxation, and individual responsibility, they assume that all people have the same capacity to respond. They do not.

Evidence at a Glance

A study by Sarah Jackson, Sharon Cox, Jamie Brown, and Vera Buss, published in Nicotine & Tobacco Research, used data from 2022 to 2024 for England, Scotland, and Wales.

Average consumption among smokers was estimated at 10.4 cigarettes per day, equivalent to 28.6 billion cigarettes per year.

Smoking prevalence was 18.8% in C2DE social grades, compared with 10% among higher-income groups.

Daily consumption was also higher among more vulnerable smokers: 11 cigarettes per day, compared with 9.4 among wealthier groups.

Annual per-capita consumption sharpened the inequality: 755 cigarettes among the most vulnerable groups, versus 343 among the wealthiest.

The central finding is not only that cigarettes are still consumed at scale, but that consumption is socially patterned. Harm is concentrated where vulnerability is already concentrated.

Why This Matters for Policy

Scientific

• Smoking should not be studied or discussed only as an aggregate behavior. The relevant question is no longer simply how many people smoke, but who continues to smoke, where, under what pressures, and with what realistic options for quitting or reducing risk.

• This requires a more stratified public-health lens. Class, income, geography, mental health, housing insecurity, education, race, gender, and access to care are not secondary variables. They are part of the conditions through which smoking persists.

• The scientific mistake is to treat behavior as detached from circumstance. The political mistake is to call that detachment neutrality.

Regulatory

• Policies designed for “the population” may fail when the burden has already become concentrated in a specific segment of society. Generic warnings, higher prices, denormalization campaigns, and punitive restrictions can produce unequal effects when applied to unequal lives.

• This does not mean abandoning tobacco control. It means making it more intelligent. Regulation should continue to reduce the appeal, availability, and harms of combustible tobacco, but it must also recognize that taxation and stigma alone cannot produce equal outcomes in unequal social conditions.

• A serious regulatory approach would ask not only whether a measure reduces smoking in aggregate, but whether it reduces the burden among those who are most exposed.

Equity Implications

• If smoking is increasingly concentrated among poorer and more vulnerable groups, then tobacco harm has become an equity issue. The remaining smokers are not merely people who failed to absorb public-health messaging. They are often people living under social conditions that make quitting harder, relapse more likely, and alternatives less accessible.

• Smoking now draws a border: not simply between smokers and non-smokers, but between those who were able to move away from harm and those who remained exposed to it.

• That matters because policies that treat unequal populations as if they were equal may look universal while functioning unjustly.

Communication

• Public-health communication still too often relies on moral simplicity: the responsible subject quits; the irresponsible subject persists. This framing may be rhetorically efficient, but it is socially crude.

• The language of individual responsibility can obscure the conditions that sustain smoking. It turns structural inequality into personal failure. It makes the smoker appear as someone who refuses correction, rather than someone whose options may be materially narrower.

• Journalists, advocates, and public-health institutions need to stop reproducing the abstract figure of “the smoker” without asking what kind of life that figure is being made to stand in for.

The Strategic Question

The strategic question is not: Why do people still smoke?

That question is too thin.

The better question is:

Who continues to smoke, under what pressures, in which social conditions, and with what real possibilities of escape?

Once the question changes, the policy horizon changes with it.

The issue is no longer only individual cessation. It becomes the unequal distribution of harm, and the failure of public policy when it treats unequal lives as if they were equally free.

Recommended actions

For regulators and public health agencies

• Stop designing tobacco policy around an abstract, universal “smoker.”

• Stratify smoking data by class, income, geography, mental health, housing, ethnicity, gender, and access to care.

• Evaluate tobacco control measures not only by the aggregate decline in prevalence, but also by their effect on the most exposed groups.

• Combine cessation support with mental health services, social support, and targeted community interventions.

• Treat harm reduction as an equity issue and not just a regulatory controversy.

• Avoid policies that intensify stigma without expanding realistic pathways away from combustible tobacco.

For Politics

• Stop using individual responsibility as a substitute for social policy.

• Recognize that smoking persists where other vulnerabilities accumulate.

• Address the harms of tobacco as part of a broader inequality agenda that involves poverty, housing, work, mental health, and access to care.

• Ask whether current policies reduce harm among the most vulnerable – or simply make smoking less visible to the most protected.

• Avoid the false comfort of universal policies that appear neutral but work unevenly.

For journalists and opinion leaders

• Avoid portraying remaining smokers as simply irrational, irresponsible, or ill-informed.

• Report the decline in smoking along with the concentration of smoking. Aggregate success without distributional analysis is incomplete.

• Ask who benefits from current political narratives and who disappears into them.

• Cover harm reduction without caricature: Lower-risk alternatives are not harmless, but blocking them can also have human costs.

• Replace the moral drama of “bad choices” with the more difficult story of unequal conditions, limited agency, and concentrated exposure.

The risk of misreading

This argument does not absolve the market. It does not romanticize smoking. It does not deny addiction, illness, or death.

The issue is clearer: a political mentality that reduces smoking to individual failure cannot explain why smoking declines most quickly among the protected and persists where life is most precarious. It also fails to explain why moral pressure alone cannot reach those who live under the harshest restrictions.

The danger is not that tobacco control becomes too serious about smoking. The danger is that it remains serious in the wrong way: morally severe, socially blind, and insufficiently attentive to the unequal distribution of harm.

Bottom Line

Smoking no longer describes society as a whole. Reveals where protection ends.

The Core Tension

• The combustible cigarette remains legal, visible, and widely available.

• Lower-risk nicotine products — vapes, snus, nicotine pouches, heated tobacco — are often treated with greater suspicion than cigarettes.

• Since 2014, the Global Forum on Nicotine has served as one of the main spaces where this contradiction is openly examined.

• The central dispute is not only scientific, but moral, regulatory, economic, political, and communicational.

• The 2026 theme, Prohibition and Public Health, returns to the unresolved question: what is public health protecting when the deadliest product remains available while less harmful alternatives are restricted?

Why It Matters

The debate over nicotine is often presented as a conflict between public health and industry. But the deeper question is whether public health can still distinguish between products, risks, contexts, and people. When all nicotine use is morally collapsed into the cigarette, policy loses the ability to reduce harm where abstinence has failed.

The GFN matters because it forces a difficult question into public view: if millions continue to smoke, and if noncombustible alternatives carry lower levels of risk, then prohibition is not automatically protective. It may become a way of preserving the cigarette’s dominance under the language of caution.

Evidence at a Glance

• 2014: GFN begins in Warsaw around the distinction between nicotine, dependence, combustion, and death.

• 2015–2017: The Forum shifts from endgame rhetoric to harm reduction, accountability, technology, and consumer inclusion.

• 2018–2019: The debate expands from toxicology to language, perception, compassion, and the moral imagination of public health.

• 2020–2022: Pandemic-era digital expansion turns GFN into a broader platform for mediation, archiving, translation, and public debate.

• 2023–2025: The Forum becomes less peripheral, confronting the interpretation of evidence, economics, communication, misinformation, and political resistance.

• 2026: “Prohibition and Public Health” crystallizes the paradox: why prohibit lower-risk alternatives while cigarettes remain legal?

Why This Matters for Policy

Scientific

• Public-health language often merges nicotine, tobacco, combustion, and harm into one moral category.

• Harm reduction depends on distinguishing dependence from the main drivers of smoking-related disease.

• Evidence must be interpreted by product type, use pattern, exposure, and population — not by symbolic association with smoking.

Regulatory

• Bans on lower-risk products can unintentionally protect the combustible cigarette.

• Regulation should differentiate risk instead of treating all nicotine products as equivalent.

• Overly restrictive rules may push consumers toward informal markets or back to cigarettes.

Equity Implications

• Smoking is concentrated among populations marked by inequality, dependence, precarious access to care, and misinformation.

• Policies built around ideal behavior often fail people who cannot or will not quit immediately.

• Harm reduction becomes an equity question when safer alternatives are available only to the informed, wealthy, or legally protected.

Communication

• The conflict is no longer only about what science shows.

• It is about what journalism, institutions, platforms, and public-health messaging allow society to hear.

• Miscommunication can become regulation by other means.

The Strategic Question

The question is not whether every nicotine alternative should be celebrated. The question is whether public health can regulate according to real differences in risk, or whether moral discomfort will continue to produce policies that leave the cigarette structurally protected.

Recommended Actions

For Regulators & Public-Health Agencies

• Regulate nicotine products according to relative risk.

• Separate youth-protection policy from adult smoking-cessation policy.

• Preserve access to lower-risk alternatives while controlling marketing, quality, labeling, and age restrictions.

• Treat prohibition as an intervention with consequences, not as a moral default.

For Politics

• Stop using “protecting public health” as a substitute for measurable outcomes.

• Ask whether bans reduce smoking or simply reorganize the market.

• Include consumers, clinicians, researchers, and affected communities in policy design.

For Journalists & Opinion Leaders

• Avoid collapsing vaping, heated tobacco, pouches, snus, nicotine, and cigarettes into one category.

• Report conflicts of interest without using them as a shortcut to avoid evidence.

• Cover both risks: youth uptake and adult smokers being denied lower-risk options.

The Risk of Misreading

• Harm reduction is not deregulation.

• Lower risk does not mean harmless.

• Industry involvement does not necessarily create real conflicts of interest.

• Youth protection remains necessary.

But none of these facts eliminates the central problem: cigarettes kill through combustion, and policies that obscure that distinction may preserve harm.

Bottom Line

Warsaw keeps asking the question public health keeps postponing: what is being protected when the cigarette survives, and its alternatives are treated as the greater threat?

The forbidden product acquired the functional invisibility of tolerated things. It needed no official storefronts, no public recognition. It only had to move through the right channels, among people accustomed to living in a country where the distance between rule and reality is rarely an administrative accident; sometimes, it is the very method of government.

The ban remained on paper—reaffirmed by ANMAT in 2016, as though repeating a prohibition were enough to make it real. The market, however, already existed in everyday life.

On May 4, 2026, the Argentine state decided to interrupt the performance, or at least rearrange the stage.

ANMAT, the health authority responsible for medicines, food, and medical technology, revoked the ban it had imposed in 2011.

This was not exactly a liberal conversion. Still less was it a sudden enthusiasm for harm reduction, an idea still treated with unease by much of Latin America’s public-health bureaucracy. It was something rarer: a tacit admission that a rule can survive for years after it has lost contact with the world it claims to govern.

Administrative Order 2543/2026 overturned the rule that had prohibited, throughout Argentine territory, the importation, distribution, sale, and advertising of electronic cigarettes and their accessories. The ban that had promised control had ended up producing something else: a market without registration, without reliable traceability, and without effective health oversight.

In bureaucratic language, that literary genre governments deploy when they need to admit failure without ever uttering the word, the agency acknowledged that absolute prohibitions, when faced with dynamic markets and a high capacity for substitution, can push consumers into informal and illegal circuits, where products of unknown origin and even murkier composition circulate.

Translation: vapes did not disappear. They merely migrated into zones where the state could no longer see them, even as it continued to pretend to control them.

At bottom, Argentina did not decriminalize a desire. It tried to bring back to the surface a market that had never agreed to live entirely underground.

The Confession

ANMAT Administrative Order 2543/2026 is not merely a health regulation. Its recitals carry something rarer than a regulatory shift: the quiet admission that an absolute ban produced precisely what it had promised to prevent.

For years, products of unknown origin circulated without effective health oversight. The state could prohibit them. But prohibiting has never been the same as knowing. Still less as monitoring.

The word “failure” does not appear. Official documents rarely allow themselves that degree of exposure. They prefer cushioned verbs, impersonal constructions, and technical abstractions carefully designed so that no one has to claim authorship of the disaster.

They do not say: “We were wrong.”

They say: “accumulated experience has shown.”

They do not say “the ban failed.”

They say: “absolute prohibition schemes may encourage informal channels.”

Contemporary bureaucracy almost never acknowledges its dead. It merely recalibrates categories, updates protocols, and publishes new guidelines.

The 2011 ban belonged to another world.

At the time, the electronic cigarette was still treated as a technological eccentricity: an object difficult to classify, part imported gadget, part public-health threat, part internet curiosity.

The state answered with the reflexive grammar of defensive public health: prohibit first; understand later—provided there was still time.

But the market did not remain within the legal definition. What in 2011 fit under the narrow label of “electronic cigarette” had, fifteen years later, become an entire architecture of devices, liquids, salts, sticks, disposables, parallel imports, digital sellers, and informal circuits able to change shape faster than any regulatory agency can publish a resolution.

The law stood still. The market did not.

That is why ANMAT’s confession runs deeper than it seems. It does not repeal a failed rule. It recognizes, though without saying so outright, that public policies can fail not for lack of intention but from an excess of abstraction: when they begin governing imaginary categories while real life takes place somewhere else.

In trying to erase the market, the state lost the ability to see it.

The Ministry of Health added a politically uncomfortable figure to the diagnosis: according to the ministry itself, 35.5 percent of adolescents said they had tried an electronic cigarette at least once.

The percentage matters less as a moral scandal than as an administrative symptom. It reveals that vaping had already entered young people’s everyday lives long before formal legalization, and without any minimally consistent public-health mediation.

For better or worse, then, Argentina is not regulating a future possibility. It is trying to recover some degree of legibility over a phenomenon that expanded first and only afterward entered the institutional field of vision.

That changes the very meaning of public policy. The country is not trying to regulate the arrival of an unknown product. It is trying to catch up with something that has already arrived, and settled in before registration, before laboratories, before health warnings, and, in many respects, before the state itself had the capacity to understand it.

The reform, then, does not appear to spring from an ideological conversion to harm reduction. It emerges from a colder calculation, almost humiliating for a state that spent years mistaking prohibition for control: if the market does not disappear, perhaps what remains is at least the possibility of tracing it, taxing it, measuring it, and reducing part of the opacity in which it thrived.

What Changes in the Air

The market now being born will be legal, but narrow.

The new regulation bans disposable electronic cigarettes with prefilled solutions, restricts flavors, and tightly controls how products may be presented. Liquids and sticks may taste only of tobacco; nicotine pouches, of tobacco or menthol.

It is a public-health policy, of course. But it is also an aesthetic policy.

For those accustomed to the informal market—artificial fruits, chemical desserts, mentholated ice, fluorescent packaging, and devices designed to look like fashion accessories—the authorized market will seem almost monastic. The official palette will have few colors. The permitted smell will, almost always, be that of the old tobacco that public policy itself claims to want to overcome.

There is something paradoxical in this: the conventional cigarette remains available in every kiosk in the country, sold in standardized packs, yet fully integrated into Argentine daily life. Products without combustion, by contrast, enter the market as bodies under permanent surveillance, authorized only under aesthetic restraint and regulatory suspicion.

Then come the administrative reins.

Resolution 549/2026 created the Registry of Tobacco and Nicotine Products, a single database for manufacturers, importers, products, and packaging. The rule covers electronic devices, vape liquids, heated-tobacco products, sticks, and nicotine pouches.

The Undersecretariat for Health Planning and Programming will have forty-five days to put the system into operation. The bureaucratic detail matters less for the deadline than for what it reveals: even under a government that has turned anti-state rhetoric into a daily spectacle, reorganizing the market will require exactly what Mileiism most likes to declare obsolete: a robust, slow, far-reaching, and permanently interventionist administrative machine.

The market, then, is not simply being thrown open. It is being born conditional on the construction of that machinery.

Only registered products will be allowed to circulate legally. Manufacturers and importers will have to demonstrate origin, composition, quality, traceability, labeling, and health responsibility.

The technical details fill the annexes. But the political meaning is simpler and much older: the state is trying to regain control over a market that spent years operating without formal authorization, though never without consumers.

The third layer is economic.

Decree 305/2026 brought heated tobacco products, cartridges, bars, electronic cigarettes, and nicotine pouches under the temporary increase in the Extrazone Import Duty, applying to these goods the ceiling that Argentina has consolidated before the World Trade Organization.

The official justification is to bring their tax burden closer to that already imposed on traditional tobacco products.

The message, however, is more transparent: these products may lose their clandestine status, but they must not become cheap, abundant, or culturally seductive.

Legality arrives accompanied by labels, traceability, high taxation, and symbolic restraint. As if the state were saying: you may exist, but only without enthusiasm.

Neither the United Kingdom nor Australia

Argentina is not alone in this impasse. The whole world is trying to work out what to do when nicotine detaches itself from combustion and, for the first time in more than a century, the cigarette ceases to be its inevitable technological form.

No country has fully solved the problem. What exists are competing models of regulatory anxiety.

The United Kingdom chose to treat electronic cigarettes as a cessation tool aimed at adult smokers. For years, the NHS publicly maintained that vapes are far less harmful than combustible cigarettes and can help smokers give up tobacco. But that defense of substitution has always come with a carefully drawn boundary: the products are not recommended for nonsmokers and may not be sold to anyone under eighteen, even if they smoke cigarettes.

Even so, the British model may have been the first major contemporary state experiment built on an idea that remains politically uncomfortable for parts of the international public health community: nicotine and combustion need not remain morally inseparable.

The United States took another path, more legalistic, slower, and more corporate. To legally market a new tobacco product, companies must obtain prior authorization from the FDA, which assesses whether its release is “appropriate for the protection of public health,” weighing risks and benefits for both users and nonusers.

The decisive detail lies precisely in that formula: “public health” includes not only current smokers, but also future, hypothetical, statistical bodies, especially adolescents who might never have smoked, but whom contemporary regulatory rhetoric has turned into the central character in almost every debate about nicotine.

In May 2026, the FDA authorized new ENDS products, including the first items in that category with flavors that were neither tobacco nor menthol. The decision does not dismantle the American regulatory filter. It merely shows that even rigid systems end up making exceptions when they must acknowledge what part of the political discourse still resists admitting: relative risk matters.

Australia went to the pharmaceutical extreme of the equation. Since July 2024, vapes can be sold only in participating pharmacies, including nicotine-free versions. Since October of that year, pharmacists have been allowed to supply therapeutic products containing up to 20 mg/ml of nicotine to adults without a medical prescription, provided certain clinical and regulatory conditions are met.

The result is a curious model: nicotine remains legal, but surrounded by the symbolic atmosphere of a controlled medicine. As if the Australian state accepted its existence only once it had been converted into a clinical object, almost stripped of culture, pleasure, or autonomy.

Argentina is trying to draw an intermediate formula. It does not prescribe vapes as medicine. It does not release them as ordinary consumer goods. It does not explicitly adopt the language of harm reduction. Nor does it maintain absolute prohibition.

It registers, taxes, limits, traces, and watches.

It is a middle-ground policy. But the middle ground, especially in an age of regulatory panic and mutating markets, rarely means balance.

Sometimes it means only managed hesitation.

Who Gets In and Who Is Left Out

The new market is being born legal, but not necessarily accessible. Every regulation draws its own maps of belonging. On one side are actors capable of translating bureaucratic demands into economic operation. On the other are those too small to sustain legal departments, laboratory certifications, formal traceability chains, and permanent negotiations with health authorities.

The ban filtered by illegality.

The new order may instead filter by the ability to survive the cost of compliance.

For large companies, the new regime means regulatory adaptation. For small importers, independent manufacturers, and specialized shops, it may mean something else: the transformation of legality into an economic barrier.

The requirement of laboratory testing, certificates, technical documentation, traceability, batch control, compliance, and individual registration for each product favors those who already have working capital, a consolidated legal structure, access to laboratories, and a long history of managing their own legitimacy.

The multinationals start ahead, which would hardly surprise anyone watching a government that routinely denounces the excesses of the state while reorganizing markets in profoundly selective ways.

Philip Morris International, the owner of Massalin Particulares in Argentina, suspended in 2023 a $300 million plan to produce next-generation products at its Merlo plant after the Ministry of Health banned heated tobacco devices.

British American Tobacco, for its part, already operates globally with comprehensive portfolios across great vapor, heated tobacco, and modern oral products, including brands such as Vuse, glo, and Velo.

This is precisely the kind of company for which the vocabulary of contemporary regulation—traceability, compliance, certification, monitoring—does not pose an existential threat. It provides market infrastructure. Because large corporations do not merely survive bureaucracy. They often grow through it.

Small operators face another landscape.

Some will manage to formalize probably more in retail and distribution than in the manufacture of technically complex devices.

Others may remain where they have always been: in the gray zone between social tolerance, practical illegality, and economic survival. Especially if legalized products reach shelves expensive, limited in variety, and slow to arrive.

The reform may therefore produce an ambiguous effect: pulling part of the market out of the shadows while concentrating the legal surface in the hands of those who already had enough scale to pay for the right to remain visible.

The Smoker at the Half-Open Door

For the adult smoker, public policy rarely arrives as theory. It arrives at the counter, priced. As the presence or absence of stock. As packaging that is intelligible, or deliberately opaque. As the concrete difference between finding a possible alternative and, almost without thinking, returning to the familiar pack.

In the best-case scenario, the reform will produce a banal scene: an adult walks into an authorized shop, finds a registered product, reads the nicotine concentration, identifies the manufacturer, understands at least minimally what he is buying, compares prices, and decides to try something else.

Nothing epic. No public-health redemption. Just the small daily gesture of not lighting the next cigarette.

In the worst-case scenario, the scene changes.

The legalized product arrives expensive, scarce, limited in variety, tobacco-flavored, and surrounded by language so cautious it can barely explain its own existence.

The package warns but does not inform. The seller fears saying too much. Public discourse avoids any nuance that might sound less abstinence-minded than is acceptable. And so the smoker returns to what he already knows: the traditional pack or the same informal market the reform claimed it wanted to replace.

This is where harm reduction stops functioning as a technical slogan and faces its hardest test: existing materially.

An alternative confined to bureaucratic registration does nothing to reduce harm. It merely produces the administrative appearance of public policy.

To compete with the cigarette, it has to exist in the real world: at a possible price, with concrete access, in everyday circulation, through intelligible information, and in that gesture repeated thousands of times a day, the decision to postpone, replace, or simply not light the next one.

The Argentine government avoids calling this logic by the name it almost touches but never fully embraces: harm reduction.

Its grammar prefers the aseptic language of administrative technique—risk management, surveillance, monitoring, control. There is no enthusiasm for substitution. Nor any explicit recognition that adult smokers may deserve clear access to potentially less harmful alternatives.

There is, instead, a permanent discomfort with any policy that accepts discussing nicotine outside the classic language of blame.

ANMAT itself states that no tobacco or nicotine product is risk-free and that all involve potential dependence and adverse effects.

That is true.

But it is also a carefully incomplete truth.

Public health rarely operates in moral absolutes. It works through differences in risk, gradations of harm, comparative probabilities, and imperfect choices made by real people in real conditions.

The decisive question, then, was never whether nicotine is completely safe.

The question is: safe compared with what?

And it is precisely there that contemporary health discourse begins to hesitate.

Resolution 549/2026 recognizes that the public should be informed about differences in relative risk among products associated with traditional cigarettes, with or without tobacco, with or without nicotine. But legally recognizing this is easier than culturally accepting it.

Because informing people about differences in risk means admitting something politically uncomfortable for parts of the public-health bureaucracy: different products may not deserve the same moral frame.

The problem is that silence also produces regulatory effects.

When the state—captured by the interests of whoever happens to hold the net—avoids distinguishing combustion from substitution, it creates a discursive fog in which radically different products begin to look equivalent. And in that carefully managed confusion, the conventional cigarette preserves its greatest historical advantage: familiarity.

In the end, the answer will not lie only in the text of the rules. It will stand in front of the shelf. In what the smoker finds. In what he can understand. In what he can afford. And in what he decides—or manages—not to light.

The Paradox of the Lit Cigarette

No image better captures the Argentine reform than this: the conventional cigarette, a product whose health risks have been documented for decades, remains legal, available, and perfectly integrated into the everyday landscape of kiosks across the country.

Meanwhile, products that deliver nicotine without combustion enter the market amid regulatory suspicion: restricted flavors, monitored packaging, rigorous technical requirements, permanent traceability, and limits that the traditional cigarette never faced as it cemented its cultural presence over the course of the twentieth century.

The cigarette has a brutal historical advantage: it arrived before contemporary guilt. It established itself as a taxable commodity, a social habit, and a familiar object at a time when our societies had not yet developed the current moral, scientific, and regulatory machinery around nicotine.

The new products arrive too late to receive any presumption of innocence.

They enter a world that already knows the human cost of tobacco, and so, from the moment of their regulatory birth, they carry a kind of hereditary guilt.

Argentine policy does not resolve this paradox.
It merely rearranges it administratively.

For advocates of harm reduction, the contradiction seems obvious: the deadliest product remains widely accessible, while non-combustion alternatives appear surrounded by preventive restrictions and permanent institutional distrust.

Health authorities, however, tend to frame the question differently. The focus shifts from the existing adult smoker alone to future, hypothetical, statistical adolescents, young people who might never have smoked, but who have become central figures in the contemporary regulatory imagination.

The concern is not illegitimate. The problem begins when it is used to justify responses that cannot distinguish among combustion, substitution, relative risk, and adult use proportionately.

At that point, the debate no longer operates only in the field of public health. It also becomes a symbolic administration of fear.

Between these two pressures—the concrete harm faced by the smoker now and the potential risk posed to the adolescent projected into the future—Argentina is trying to draw a narrow corridor.

And narrow corridors rarely remain neutral for long.
Sooner or later, they reveal who is actually allowed through.

The Future That Has Already Arrived

The most sensitive point in the reform is, as almost always happens in debates over nicotine, youth.

The figure of 35.5 percent among adolescents became politically explosive not only because of the number itself, but because it reveals something more uncomfortable: vaping had already entered young people’s everyday lives long before formal legalization, and long before the state had any consistent capacity to monitor it.

The Precautionary Principle, evidently, failed.

For better or worse, then, Argentina is no longer responding to a future hypothesis. It is trying to manage an accomplished fact.

The official strategy seeks to reduce appeal: it bans disposables, restricts flavors, imposes health warnings, prohibits packaging associated with children’s or adolescents’ worlds, controls advertising, tracks products, and seeks to remove from the market any aesthetic that brings nicotine into pop culture.

The regulatory text seems to be waging war not only against devices but also against a specific visual language: artificial sweets, saturated colors, toy-like design, objects made to circulate on social media, school backpacks, and the emotional economies of youth.

There are reasons for this.

With or without proportionality, and almost always without a minimally serious discussion of combustion, relative risk, substitution, or the informal market, disposables have become, in several countries, the great visual emblem of the contemporary crisis of adolescent vaping.

By removing them from the legal market, Argentina is trying to prevent regulatory formalization from being mistaken for cultural legitimation.

But the problem with almost every policy based on symbolic containment is that it inevitably meets the street.

Real life.

Who will inspect kiosks, specialty shops, e-commerce, social networks, international parcels, and sales to minors?

How often?

With what budget?

With which laboratories?

With which inspectors?

With which borders that are genuinely controllable in a region crossed every day by informal circuits of goods?

Will Argentina have the technical capacity to verify composition, emissions, and nicotine concentration?

Will it have enough customs infrastructure to contain unauthorized products coming from Paraguay, Bolivia, Brazil, Chile, and Uruguay?

And will the registry be able to keep pace with a market whose principal skill has always been changing shape before the state finishes writing its next resolution?

Perhaps the reform’s fragility lies less in its normative architecture than in the administrative fantasy that so often accompanies such projects. Because, if enforcement fails, the country may end up producing two parallel markets: one formal, expensive, narrow, and concentrated in the hands of large operators; the other informal, cheap, varied, and as invisible to the state as it has always been.

Or perhaps even more invisible precisely because there is now a political need to pretend it is under control.

The Corner Test

The law changes in the Official Gazette. The market decides afterward whether to follow. It is, then, on the corner and not in ANMAT’s recitals that Argentina’s reform will truly be tested.

At the moment when a teenager looks for a disposable, an adult smoker tries to replace a pack of cigarettes; a seller chooses between registering and continuing to operate outside the system; an inspector decides whether to go in or look away; a parcel crosses—or crosses with no difficulty at all—the border.

The new regime is born surrounded by requirements: mandatory registration, traceability, high taxation, technical limits, flavor restrictions, health warnings, advertising controls, and the permanent promise of enforcement.

It may reduce some of the risks associated with the clandestine market.

But it may also produce something else: economic concentration, barriers to entry, high prices, unequal access, and the persistence of the very same informal circuit the reform promised to illuminate. Because markets rarely disappear when they lose formal legitimacy. They merely learn new ways to circulate.

Faced with this landscape, will the Argentine state be able to see more clearly what, for years, it preferred to pretend did not exist?

The answer will not lie only in laboratories, customs offices, or digital registries. It will be in the street. In the speed with which the informal market adapts. In the state’s capacity—or incapacity—to keep pace with mutating markets. In the difference between real control and administrative choreography.

Because an uncomfortable possibility hangs over the whole reform: that the country spent years mistaking prohibition for control and now risks mistaking traceability for governability.

And perhaps that is the true Argentine paradox.

After more than a decade trying to expel vapes from the legal surface, the state has finally decided to recognize them. But recognition is not the same as understanding. Still less as control.

In Practice

Are vapes legal now?

Yes, but only within the new regulatory regime. Products will have to be registered and meet requirements for traceability, labeling, health oversight, and inspection. The sale of unregistered items will remain prohibited.

Which products fall under the new rules?

Electronic cigarette devices, vape liquids, heated-tobacco products, sticks, and nicotine pouches. The legislation tries to gather under a single regulatory architecture an ecosystem that, for years, grew precisely through fragmentation and informality.

What changes for adult users?

In theory, legal products will have to disclose origin, composition, nicotine concentration, manufacturer, and health registration.

But the authorized market will be far narrower than the informal one. Disposables remain banned; liquids and sticks may only be tobacco-flavored; nicotine pouches are restricted to tobacco or menthol.

Legalization arrives accompanied by aesthetic, fiscal, and regulatory restraint.

And for smokers?

For the first time, there is a legal possibility of accessing non-combustion nicotine products within a formal system of control.

But real access will depend on something less abstract than decrees: price, availability, permitted information, and the legal market’s ability to compete with what already exists outside it.

Can minors buy them?

The legislation aims to make access harder by restricting flavors, advertising, packaging, disposables, and traceability.

But laws do not enforce themselves. Effectiveness will depend on the Argentine state’s real capacity to control physical sales, e-commerce, social networks, and informal circulation.

Are prices likely to rise?

Probably.

Import duties, laboratory testing, registration, certifications, and regulatory costs tend to make legal products more expensive than the informal versions already available on the parallel market.

And parallel markets tend to thrive precisely when the distance between legality and accessibility becomes too large.

Does the traditional cigarette remain legal?

Yes.

The reform changes the regulatory status of non-combustion products. Still, it does not alter the legality of conventional cigarettes, which remain fully available, taxed, and woven into the country’s daily routine.

What remains unknown?

Which products will actually be approved. How much they will cost. How quickly the registry will function. How enforcement will be carried out. And, above all, whether the legal market will manage to reduce the relevance of the informal circuit, or merely coexist with it.

Because regulating a market is one thing.
Convincing that market to leave clandestinity behind is another.

There is, in almost every contemporary public dispute, a recurring detail: before you can win the argument, you must win the form. Before reason, the field; before proof, the device that determines what can count as proof.

Who speaks.
In what format.
By which method.
With what vocabulary.
By what criteria of validity.

Contemporary politics and health policy, perhaps more than any other domain, rarely exclude voices through outright censorship. It excludes them through the design of the room, the syntax of the protocol, and the quiet liturgy of procedures.

Some experiences make it into spreadsheets, systematic reviews, and technical reports. Others remain outside, reduced to testimony, to noise, to isolated cases, to affect without status. They are not so much refuted as managed downward — demoted in category.

It is from this fissure that THR Global emerges.

Conceived by Kurt Yeo — co-founder of Vaping Saved My Life, a South African consumer group that advocates for tobacco harm reduction and vaping-related education, and a longtime smoker who claims to have quit through flavored vapes — the platform condenses a drama larger than himself: the attempt to make a private experience pass through the customs of evidence and enter, with some degree of legitimacy, the space where policy takes shape and circulates as official language.

At first glance, the initiative may seem like just another advocacy site in an already saturated ecosystem of campaigns, manifestos, reports, and testimonials on vaping, nicotine, and smoking cessation. Look closer, however, and its ambition runs deeper.

THR Global does not simply aim to publish stories; it seeks to recalibrate the regime of value in which those stories circulate. It seeks to transform what, for years, has been treated as a dispersed, subjective, and politically minor experience into something closer to a legible body of social evidence.

In simple terms, the platform seeks to address a problem that advocates of tobacco harm reduction have long recognized: despite possessing thousands — perhaps millions — of stories, the movement still lacks proportional weight in the arenas where policy takes shape, acquires normative force, and is enforced.

This is THR Global’s central point: not merely to give visibility to consumers, but to give institutional form to that visibility.

What begins to take form

Public discourse about digital platforms tends to exaggerate their novelty, as if each interface inaugurated a world. In the case of THR Global, however, what matters is not the technology but what it seeks to discipline: the shape of experience. This is not about technical innovation, but methodological ambition.

The platform rests on a simple — and deeply political — premise: personal accounts from former smokers who switched to lower-risk alternatives have been systematically underestimated, not only because of what they say but because of how they appear: fragmented, discontinuous, confined to the least-valued format of public debate: the isolated testimony.

The proposed response is standardization.

Each submission follows a structured format: smoking history, prior quit attempts, product used, and perceived outcomes. A seemingly neutral gesture, simple, almost administrative. But this is where the operation begins.

Instead of scattered narratives, a series.
Instead of the irreducible anecdote, comparability.
Instead of “my case,” the possibility of a pattern.

It is less innocent than it appears.

Because in standardizing testimony, the platform is not merely organizing information. It is intervening in the conditions under which something can be recognized as knowledge.

It is claiming a place within a hierarchy that has historically separated lived experience from valid evidence — not as a substitute for clinical science, controlled trials, or epidemiological surveillance, but as what these frameworks tend to overlook: the thickness of practice, the time of trial, the silent accumulation of trajectories that do not fit within experimental designs.

What “anecdote” does

Every public controversy generates its own glossary and its own instruments of disqualification. In the debate over tobacco harm reduction, one of them gained particular force: “anecdote.”

Consumers, activists, and pro-THR groups have, for years, heard variations of the same sentence: personal stories are not enough; testimony is not science; individual experiences cannot guide population-level policy.

In strictly methodological terms, the objection is not trivial. Self-reported accounts carry well-known limitations: selection bias, fallible memory, retrospective enthusiasm, lack of controls, and an inability to establish causality with the rigor required by certain research designs.

But “anecdote” does more than point to a technical limitation. It functions as a boundary-making device. It turns a vast body of experience into disposable material. It draws a line, often a comfortable one, between what can circulate as legitimate knowledge and what can be consigned to the sphere of inconsequential subjectivity.

THR Global enters at that boundary. Its most audacious gesture is not to claim that individual testimony is worth more than science, but to suggest that science itself — when translated into policy — may operate incompletely by systematically excluding those who experience the concrete effects of its decisions.

A subtle inversion.
And for that reason, a powerful one.

The question is no longer “are these stories just anecdotes?” It begins to unfold into others. Politically, why do millions of convergent experiences still lack proportional weight in the arenas where health policy is made? Scientifically, why are they still treated as epistemologically invisible, even when, taken together, they begin to delineate a pattern that resists easy dismissal?

What centralization makes possible

Every platform is, first and foremost, a technology of centralization. And every act of centralization — sooner or later — becomes a struggle over power: whoever organizes, defines; whoever defines, hierarchizes; whoever hierarchizes, decides what can circulate as relevant.

In the world of harm reduction, fragmentation among actors, roles, and levels of action has long been a structural weakness.

There are consumer associations in different countries — sometimes more than one within the same territory — as well as support groups, forums, local campaigns, independent studies, and a wide range of narratives scattered across spaces that barely intersect or rarely act in synergy.

Each node operates with what it has at hand, stretching its capacities to cover gaps that more coherent coordination might distribute differently. This disorganization of the symbolic and political division of labor does not stem from individual failure but from the absence of articulation among existing capacities.

The volume is there.
The energy is there as well.
What is often missing is a mechanism to convert dispersed capacities and talents into coordinated action. Without it, collective force tends to fall short of its critical mass.

What is dispersed almost always appears smaller than it really is.

And, in the case, what does not present itself within a shared regime of collection, classification, and presentation tends to seem inconsistent — even when it reflects recurring patterns. This is not merely a question of quantity. It is a question of institutional legibility: the capacity of an experience to be read, compared, retained, and ultimately admitted to the circuits where reality acquires administrative and political consequence.

It is at this point that THR Global intervenes: not in the content of the stories, but in the conditions of their legibility. By centralizing testimonies within a common format, the platform seeks to produce what bureaucracies, reports, and policy frameworks more readily recognize: series, repetition, scale, and archive.

It aims to show that some individuals have managed to quit smoking using less harmful alternatives, and that this outcome recurs across contexts, countries, and conditions, with a consistency that becomes increasingly difficult to ignore.

This is the project’s real ambition: not only visibility but also a more stable form of inscription in the debate — a shared point of reference, an archive that can serve as a resource when those voices are once again reduced to the status of exception, noise, or particular interest.

Questions of credibility

But every platform that sets out to correct a narrative imbalance runs into the same question sooner or later: who authorizes the authorizer?

In the field of tobacco and nicotine, this question is far from rhetorical. Few issues carry such a dense history of corporate fraud, scientific manipulation, aggressive lobbying, and institutional capture. For decades, doubt was manufactured as a survival strategy. That history has not faded; it continues to operate as a lens, a suspicion, a mode of reading.

It is on this mined terrain that THR Global encounters its central paradox.

For its supporters, the project corrects a historical exclusion: it restores presence to consumers systematically marginalized in health debates. For critics — and even for more cautious observers — it occupies a zone of ambiguity, where the language of harm reduction can function as a pathway for the reentry of commercial interests under a new moral and regulatory grammar.

In this context, distrust is not a detail; it is a condition of reading. The platform is not merely competing for attention but for legitimacy. And that contest will be decided less by the sheer volume of testimonies than by how they are produced, organized, scrutinized, and made auditable.

In other words, centralizing stories is not enough. It will be necessary to demonstrate that this centralization functions not merely as a refined technology of persuasion, but as a transparent infrastructure capable of turning lived experience into material that can be examined, compared, and engaged with within public debate.

On the force of biography

Kurt Yeo’s presence in the project’s announcement helps explain why it resonates. He embodies a recurring figure in contemporary harm reduction politics: the long-term smoker who claims to have found, in alternative products, especially flavored vapes, a way out that decades of failed attempts could not provide.

This type of biography — to which, in some way, I also belong — carries a particular force. It strains purism. It displaces the pedagogy of guilt. It suggests that public health does not always prevail when it demands complete and ideal abstinence, and that it may save more lives when it allows for imperfect solutions that are nonetheless less lethal than combustible cigarettes.

The power of this narrative lies in its capacity to speak of failure and survival. Not of theory, but of the body. Not of abstract regulatory design, but of the daily reality of someone who tried to quit and could not — until they did, by a path that many policymakers still hesitate to legitimize.

Yet it is this same biography that exposes a tension difficult to reconcile at the center of the debate. Health authorities view the flavors that, for some adults, were decisive in quitting through a different lens: not as individual experience but as a matter of population-level prevention.

The same product, the same substance — but a regime of evaluation that does not quite know how to handle the concrete success of a smoker when it appears to disrupt the abstract calculus of collective risk. What a personal story describes as redemption may, on the other side, be read as a disturbance to an equilibrium that was never designed to accommodate this kind of evidence.

THR Global situates itself within this contradiction without resolving it.
Perhaps that is not its role. Perhaps its function is different: not to arbitrate between lived success and regulatory concern, but to make the incommensurability between these two regimes more visible and more documented — and harder to dismiss without making explicit which one is being privileged and why.

Perhaps this is the debate’s blind spot: not the absence of data, but the difficulty of allowing distinct forms of evidence to coexist without one negating the other.

Data, and dignity

There is something deeper at stake here than the dispute between clinical studies and what has come to be known as real-world evidence. Platforms like THR Global operate in a zone where information and recognition cease to function as separate spheres. What is at issue is not merely what counts as data, but who is authorized to appear as a subject of knowledge.

For many consumers of lower-risk products, exclusion from the debate does not register merely as a technical error. It is experienced as a form of diminishment: the feeling of not being taken seriously, of not being heard on one’s own terms, of being continually translated into categories that fail to recognize the path one has lived.

This is not only a matter of underrepresentation.

More often, it is the perception of being reduced to an object of policy, never a legitimate interlocutor. In this displacement, something is lost: a form of epistemic dignity. Experience exists, but acquires no status. It speaks, but produces no effect.

This friction produces more than discomfort. It produces a form of revolt — not only against decisions, but against the way certain bureaucracies listen, or fail to listen. There are moments when a voice is recognized only when it confirms the expected script. Outside it, it becomes noise.

This revolt is understandable and, for that reason, vulnerable to capture. It can be mobilized both as a legitimate demand for recognition and as an argument for the dissolution of any form of regulation. The line between autonomy and exposure is not always clear.

THR Global speaks to this discomfort, but does not control it. Its subtext is clear: consumers are not merely recipients of public policy, but producers of knowledge about what worked, what failed, and what remained unresolved in their trajectories.

What the platform offers, therefore, is not merely the collection of data. It is a form of symbolic restitution — an attempt to restore status to experience, not as absolute truth, but as part of a field that has, until now, operated through poorly examined exclusions.

This gesture gains force especially in fields marked by asymmetries of voice, where lived experiences circulate widely but rarely arrive intact at the sites where they acquire institutional weight.

In such environments, gathering testimonies becomes more than an act of documentation. It becomes a form of self-inscription: we were here, we made this transition, our trajectories exist beyond the narrow categories through which they are typically read.

On the limits of the project

But any serious reading must resist the temptation of easy celebration.

First: standardization strengthens, but it also simplifies. Translating life stories into comparable fields entails selection, compression, and variable choice. Part of the density of individual accounts is lost when they are fitted into the model that enables their aggregation. What makes each experience singular — socioeconomic context, regulatory environment, consumer culture, comorbidities, unequal access, family pressures, trajectories of relapse — rarely fits entirely within structured forms.

Second: the classic risk of any advocacy platform — becoming a selective mirror of its most engaged participants. Who submits testimony? Who does not? Who feels compelled to participate — and who remains at the margins? Who has had negative experiences and chooses to remain silent? A collection of this kind can reveal patterns, but the logic of voluntary participation will always shape it.

Third, and most decisive: transforming testimonies into standardized data does not resolve the problem of causality or population-level generalization. A person who quit smoking using vapes may have done so for other reasons — changes in routine, life circumstances, coincidence, or placebo effect. The platform does not control for these variables. It records correlations; it does not establish causation.

This does not invalidate it.

But it imposes a limit and requires humility in how its findings are presented.

The relevance of a platform like THR Global will depend, to a large extent, on its willingness to clearly state what it can and cannot demonstrate. Its political strength lies in the organization of experience, not in any claim to rival, on its own, the best available science.

If it attempts to occupy that position, it weakens itself. If it embraces its specific role — that of a civic infrastructure aimed at making visible a form of evidence often underestimated — it may become harder to ignore. Yet there remains a dissonance that no formulation fully resolves. For those who have lived through this transition — and I include myself — the problem rarely presents itself as a question of method.

It presents itself as a question of time — of repeated attempts, of persistence. It is in this interval that the distance between analysis and experience ceases to be merely theoretical and becomes something far more difficult to sustain.

Where the question shifts

At its core, THR Global is not merely intervening in narratives about vaping or nicotine. It is contesting something more fundamental: the definition of who has the authority to shape what counts as reality.

Global public health organizes itself around aggregated data, meta-analyses, guidelines, conferences, and treaties. Necessarily. But it also rests on silent exclusions: which lives enter the frame as relevant data, and which remain reduced to personal cases without collective consequence.

The platform strains this arrangement by asserting that organized consumer experience can be part of political deliberation — especially in matters involving behavioral transition, risk substitution, and engagement with products that fall outside the classic pharmaceutical model.

The conflict, therefore, is not merely scientific.
It is epistemological and institutional.

THR Global shifts the question: when public policy regulates alternatives to cigarettes, why is the voice of those who have successfully transitioned still denied, or, when it does enter, so late, so weakened, and so often under suspicion? And what would happen if that voice, consistently assembled, began to operate as a pattern rather than an exception?

The answer does not yet exist.
But the question now has infrastructure.

Perhaps the most revealing aspect of THR Global is this: its emergence says as much about the state of the harm reduction movement as it does about the limits of traditional channels of representation. Platforms like this emerge when entire communities come to understand, in practice, that existing instruments were not designed to absorb what they have to say.

THR Global is both a symptom and a strategy.

A symptom of a prolonged impasse between consumers, regulators, researchers, and governments who observe the same phenomenon through distinct moral frameworks and evidentiary models.

A strategy because it attempts to correct this asymmetry not through direct rhetorical confrontation, but through infrastructure: collection, standardization, visibility, scale, memory.

Instead of responding to exclusion with protest alone, it responds with an archive. Instead of reacting to the charge of anecdote with indignation, it responds with method.

A lucid choice. And a risky one.

Lucid because it recognizes that, in the contemporary world, what does not become a system rarely becomes influential.

Risky because any attempt to convert suffering and relief into comparable data runs the risk of being read as advocacy in another guise — or of losing, in the process, part of what gave it force.

In the end, it is difficult not to recognize what is being built.

Calling THR Global a database is accurate, but insufficient.
Calling it an advocacy tool is also accurate, but it’s still not sufficient.
What is emerging is a more ambiguous, counter-chamber of public health policy, where experiences that previously existed in fragments now aim for public consistency.

The premise is clear: that the organized repetition of accounts can generate pressure; that the consumer voice, once made legible, will no longer sound like an exception; that the archive, at times, can do what an isolated argument cannot — sustain presence.

What remains open is how this will be read: as inconvenient evidence to be confronted, or as well-structured advocacy to be neutralized.

For those who know this transition from the inside, that reading is never abstract: it determines whether a lived trajectory is treated as knowledge or returned to the domain of suspicion.

And there is another, quieter risk. In a field marked by deep asymmetries, caution itself can become a vulnerability. Epistemic restraint — necessary to avoid overstating what can be demonstrated — may, on the other side, be read as a lack of force. Between asserting limits and sustaining presence, a difficult interval opens.

Perhaps, for now, THR Global’s most decisive contribution lies not in convincing its critics, but in shifting the terrain of the dispute. In showing that, in the twenty-first century, the struggle for recognition in public health is waged not only in laboratories, guidelines, or treaties, but also in the design of platforms that determine who can be seen, compared, counted, and ultimately considered.

In the global debate on tobacco and nicotine, this may be the most consequential dispute of all. Not because the platform will prevail, but because it has already changed the question.

No longer whether individual stories matter, but how they are assembled into a collective force that counts.

He had grown up in a family where smoking was less a habit than an atmosphere.
His parents smoked. So did his uncles, his aunts, and his grandfather. As a child, he was sent to the corner store to buy cigarettes for the adults—and paid, sometimes, with the change.

He started smoking at twenty. By his late twenties, he was already smoking heavily.
His father died at fifty-three, of a heart attack, just before Kurt’s wedding.

What followed was not a decision, but a sequence: attempts, failures, returns.

What eventually worked did not look like a solution. It was an early, rudimentary vaping device with a small blue light at the tip. It helped him reduce. Not quit.

The shift came later, with a different device bought informally from someone selling equipment out of the boot of a car. Within days, he stopped smoking.

The result was immediate. The meaning was not.

“I tried to quit for years,” he says—the kind of sentence that usually closes a conversation rather than opens one.

Millions have said some version of it.
And yet these stories rarely cross the line that separates experience from evidence.

This interview begins at that boundary and asks what it takes to cross it.

When did you first realize that the issue was not only quitting smoking, but the fact that this experience had almost no recognized place in public debate?

Kurt: That realization came gradually, but it became clear once I started speaking to more people who had successfully moved away from smoking, using alternatives like vaping or other reduced-risk products.

What stood out wasn’t just that people had quit smoking; it was how similar many of their experiences were — and yet how invisible those experiences were in any formal discussion.

People could tell you, quite clearly, how long they had smoked, how many cigarettes they used per day, what they switched to, how long they had been smoke-free, and whether they had tried to quit before.

These are not vague stories; they are structured, recallable pieces of information that align closely with the kinds of questions we ask in the THR Global testimonial form.

But outside of informal conversations, none of this seemed to have a recognized place.

In public debate, the focus is often either on clinical data or on population-level statistics.

The lived experience of switching — what actually happens between being a smoker and becoming smoke-free — tends to fall into a gap.

It’s often dismissed as anecdotal, even when thousands of people are describing very similar journeys.

That was the turning point for me.

It wasn’t just about quitting smoking anymore; it was about the fact that these real-world transitions, which are happening at scale, weren’t being captured in a way that could be meaningfully aggregated, understood, or even acknowledged in policy discussions.

THR Global is really a response to that gap.

Not to replace science, but to ensure that these experiences are collected in a structured, consistent way, so that they can at least exist alongside other forms of evidence, rather than being excluded entirely.

When did you understand that the issue was not a lack of stories but that even thousands of them still did not count as evidence?

Kurt: That became clear once the volume of stories stopped being the issue.

Early on, you assume that if enough people share similar experiences, that in itself will start to shift the conversation.

But what I began to see is that volume alone doesn’t change how something is treated.

You can have thousands of people describing very similar transitions, which they do, but it still doesn’t “count” in any formal sense.

The reason is structural.

These experiences exist, but they’re scattered, inconsistent in format, and not captured in a way that enables aggregation or comparison.

One person writes a paragraph on social media, another gives a quote in a news article, someone else shares a comment in a forum, and consumer groups like the one I founded in South Africa provide space to capture these stories.

Even if the underlying information is similar, it doesn’t accumulate into something that can be easily recognized or engaged with as a body of evidence.

That’s when it became obvious that the issue wasn’t a lack of stories; it was the lack of a consistent framework for capturing them.

With THR Global, the intention is to take what people already know about their own journeys and structure it in a simple, consistent way.

The same core questions are asked of everyone.

Individually, each story still matters.

But when that information is collected in a standardized format, it starts to do something different; it becomes possible to see patterns, to understand scale, and to at least present these experiences in a way that can be engaged with more seriously.

It doesn’t automatically turn them into clinical evidence, and it’s not trying to.

But it does move them out of being isolated anecdotes and into something more coherent, something that can no longer be dismissed simply because of how it’s presented.

When lived experiences are labeled as “anecdotes,” are we describing a methodological limit—or enforcing a boundary on what can be taken seriously?

Kurt: I think it’s a bit of both, but in practice, it often functions as a gatekeeping mechanism.

There is a legitimate methodological point; individual experiences, on their own, are not controlled studies. They can’t establish causality in the way clinical research is designed to.

That’s understood, and it’s important not to overstate what a single story can prove.

But what I’ve seen is that the label “anecdote” is applied very broadly, regardless of what the experience actually contains.

Many people can give quite specific, structured accounts of their journey: how many years they smoked, how many cigarettes per day, how many quit attempts they made, what they switched to, and how long they’ve remained smoke-free.

These are not just impressions or opinions; they are consistent data points that people can reliably report about themselves.

The problem is that when these experiences are not captured in a consistent format, they remain fragmented.

And once they are fragmented, it becomes easy to dismiss them collectively as anecdotal, even when thousands of them are describing very similar patterns.

So while there is a methodological limitation at the level of a single account, the way the term is often used prevents these experiences from even entering the conversation in a meaningful way.

It’s less about what the information is and more about how it is presented and whether it fits existing formats.

What THR Global tries to do is address that second part.

By asking the same core questions of every participant.

Alongside their written story, the aim is to bring consistency to these experiences.

That doesn’t turn them into clinical trials, but it does make them more comparable and more visible as a collective body of real-world transitions.

At the very least, it challenges the idea that all lived experience can be dismissed in the same way, simply because of the label that’s applied to it.

When did it become clear to you that the issue wasn’t the stories themselves, but the absence of a common structure to make them visible?

Kurt: That idea emerged once it became clear that the problem wasn’t what people were saying; it was how those experiences were being captured.

After seeing so many similar stories, the next step was trying to understand why they still weren’t being taken seriously.

And the answer was quite practical: there was no consistency.

The same underlying information was there, but it was scattered across different formats, different platforms, and different levels of detail.

That makes it very difficult for most to engage with it as a coherent body of information.

The shift in thinking came when I started looking at what people were actually able to report about themselves in a structured way.

Most people can answer the same core questions: how long they smoked, how much they smoked, when they started, how many times they tried to quit, what they switched to, whether they still use that product, and how long they’ve been smoke-free.

Alongside that, they can describe, in their own words, what that transition looked like.

Once you realize that, the gap becomes obvious.

The issue isn’t that the data doesn’t exist; it’s that it hasn’t been consistently collected.

That’s where the idea for THR Global took shape.

The written story still matters; it provides context and meaning, but the structured data points allow those experiences to be grouped, filtered, and understood at scale.

It doesn’t change the nature of the experience itself, but it does change how it can be seen.

Instead of isolated accounts, you begin to see patterns.

And once patterns become visible, it becomes much harder to dismiss the entire category of experience outright.

So the idea wasn’t about changing the stories; it was about changing how they are organized so they can actually be recognized for what they collectively show.

What is lost when a lived experience is translated into a standardized format?

Kurt: Something is definitely lost, and it’s important to be honest about that. When you standardize an experience, you inevitably compress it.

A person’s journey from smoking to being smoke-free is often complex.

It includes moments of relapse, personal motivations, social context, and even identity.

When you reduce that to structured fields like years smoked, cigarettes per day, number of quit attempts, product used, and years smoke-free, you’re selecting only certain aspects of that experience.

The nuance, the emotion, and the individuality don’t fully translate into those fields.

That’s why, for me, the written testimonial is not secondary; it’s essential.

It allows people to explain how and why the transition happened in their own words, which no structured format can fully capture.

But the trade-off is deliberate.

Without some level of standardization, those experiences remain difficult to compare or aggregate.

You can’t easily see patterns across thousands of people if every story exists in a completely different format.

So there’s a balance.

The structured questions (smoking history, quit attempts, product use, outcomes) provide a common framework that makes the experiences comparable.

The written story preserves the human context that would otherwise be lost.

THR Global doesn’t try to replace one with the other.

It’s about holding both at the same time: enough structure to make the information usable at scale, and enough openness to ensure that the individual experience isn’t reduced to just a set of data points.

Would you say that the problem today is not a lack of evidence, but the limits of what we are prepared to recognize as evidence?

Kurt: I think that’s a fair way to describe part of the problem. There isn’t a shortage of people who have successfully moved away from smoking and use safer alternatives.

You can see that in the consistency of what people report about themselves: that information exists and is repeated across many individuals.

The issue is that this type of information doesn’t always fit neatly into the formats that are typically recognized as evidence in formal settings.

If it’s not generated by a specific study design, it tends to fall outside the main body of what gets considered, regardless of how consistent or widespread it is.

At the same time, it’s important not to overstate what these experiences can do. They don’t replace clinical trials or population-level studies, and they’re not meant to. They can’t answer every question, particularly around causality or long-term risk.

What they can do is show, in a structured and consistent way, how people are actually transitioning in the real world. And that’s a dimension that isn’t always fully captured elsewhere.

So the gap isn’t simply about having more or less evidence; it’s about the types of evidence we’re set up to recognize.

THR Global is really about making sure that this particular type of information is at least visible and organized, so it can sit alongside other forms of evidence rather than being excluded because of how it’s presented.

To what extent does the exclusion of consumer experience shape not only public debate, but the very questions that scientific studies are built around?

Kurt: It has a real impact, because what gets discussed publicly often shapes what gets studied in the first place.

If consumer experience is largely absent from the conversation, then the research questions tend to be framed without that perspective.

Studies may focus on product characteristics, risks, or usage patterns in general, but they don’t always reflect the actual transition people go through.

We also see exaggerated claims based on the mere existence of a toxin, rather than on necessary levels based on how it is used in the real world.

What’s interesting is that many of these elements are things people can report quite consistently about themselves.

In the THR Global form, we ask straightforward questions, and when you start seeing that information across large numbers of people, you begin to get a clearer picture of the pathway, not just the endpoint.

If that kind of structured, real-world experience isn’t visible, it’s harder for it to inform study design.

The result is that certain aspects of the transition may be underexplored or treated as secondary, simply because they’re not part of the initial framing.

That doesn’t mean scientific studies are doing something wrong, as they rightly operate within established methodologies for good reason.

But it does mean that if a whole category of experience isn’t systematically captured and surfaced, it has a limited opportunity to influence what questions are asked or how studies are structured.

What THR Global aims to do is make that layer of experience more visible and more consistent.

Not to direct research, but to ensure that there is a clearer, organized account of what people are actually doing in the real world.

From there, it becomes easier for that perspective to at least be considered alongside other inputs when research questions are being shaped.

If this disconnect persists, where, if at all, does user experience enter the research process?

Kurt: At the moment, it tends to enter the process in quite indirect and inconsistent ways.

You might see it at the very beginning, where researchers draw on general observations or prior literature to frame a question.

It can also appear later, when studies include self-reported measures.

But even then, that input is usually tightly constrained by the study’s design, rather than coming from a broader, organized body of consumer experience.

Outside of formal studies, user experience often sits in the background, in surveys, small qualitative studies, or cited as context in discussions, but it’s not consistently structured or aggregated at scale.

That makes it difficult for it to play a more central role in shaping hypotheses or interpreting results.

What’s largely missing is a middle layer: a way to capture real-world transitions in a consistent, structured format for large numbers of people, without trying to turn that directly into a clinical study.

That’s where something like THR Global fits in.

By asking the same core questions and recording a written account, this approach creates a dataset of lived experience that is both human and structured.

It doesn’t replace formal research, but it can sit upstream of it.

In practical terms, that means user experience can start to inform the process earlier and more clearly, helping to highlight patterns, raise relevant questions, and provide context that might otherwise be missed.

So right now, user experience does enter the research process, but often in a fragmented way.

The aim here is simply to make that contribution more visible, more consistent, and easier to engage with, without overstating what it represents.

The platform does not replace science, but it suggests that certain dimensions of experience fall outside traditional models. Do you see that as a flaw or as a structural limitation?

Kurt: I would describe it more as a structural limitation than a flaw. Traditional scientific models are designed to answer specific types of questions, under controlled conditions, with a strong emphasis on isolating variables and establishing causality.

That’s exactly what they should be doing, and it’s why they are so important.

But because of that design, they don’t always capture the full shape of real-world behavior, particularly transitions from smoking to safer alternatives, which are often non-linear.

People don’t always switch in a single or consistent step.

They may try to quit multiple times, move between products, use more than one product for a period, or adjust their behavior over time before becoming fully smoke-free.

These are aspects of experience that people can describe quite clearly about themselves.

When you look at those responses collectively, you start to see patterns in how these transitions actually happen in practice.

The limitation is that traditional models are not always designed to capture such evolving, real-world pathways in a broad, continuous way.

They tend to take snapshots under defined conditions, which is necessary for their purpose, but it means certain dimensions of experience sit outside that frame.

So it’s not about one approach being right or wrong; they’re doing different things.

THR Global aims to make those real-world pathways more visible and consistently captured so that they can coexist with more formal research.

If anything, the value is in recognizing that both perspectives are needed.

One provides controlled, testable insights; the other shows how people are actually navigating these changes in everyday life.

In practice, who decides what counts as a valid story—and how do you ensure the platform doesn’t reproduce the same filters that have historically excluded these experiences?

Kurt: In practice, the platform itself doesn’t try to define a “valid story” subjectively. Instead, it defines a valid submission as one that meets a clear set of structured criteria.

Every testimonial goes through the same process. We ask the same core questions, alongside a written account of their experience.

There are also basic checks, such as email verification and moderation, to filter out spam or duplicate entries.

So the gatekeeping, to the extent that it exists, is technical rather than interpretive.

We’re not assessing whether someone’s experience is “good enough” or whether it aligns with a particular narrative.

If someone can provide a coherent account of their own journey and complete the required fields, their story has a place.

That’s quite deliberate.

One of the issues historically is that experiences get filtered after the fact; they’re selected, summarised, or excluded depending on how well they fit a particular framework.

What we’re trying to avoid is introducing that kind of subjective layer at the point of collection.

At the same time, we do have to be realistic.

The structure itself is a form of filtering.

By deciding which questions to ask, we are shaping how the experience is captured.

That’s unavoidable.

The difference is that the framework is transparent and applied consistently to everyone.

It doesn’t change depending on the story being told.

So the aim isn’t to remove all filters; that’s not possible, but to make them explicit, consistent, and minimal.

That way, the platform doesn’t decide which experiences matter; it simply provides a common structure through which those experiences can be shared and understood.

The platform does not resolve that. It makes it visible. And in doing so, it leaves something more difficult than a lack of evidence: that the limits may lie not in what we know, but in what we are prepared to recognize as knowledge at all.

If THR Global works as intended, what changes first: the conclusions, or the boundaries of what can be recognized as evidence?

Kurt: If it works as intended, the criteria change first or at least begin to expand. THR Global isn’t designed to produce new scientific conclusions on its own.

It’s not running controlled studies or testing hypotheses.

What it does is make a large body of real-world experience visible in a structured and consistent way.

Right now, much of that experience falls outside what is typically recognized as evidence, not because the information isn’t there, but because of how it’s captured and presented.

By standardizing the core data points, alongside the written story, the platform makes it easier to see patterns across many individuals.

The first shift, then, is not that conclusions suddenly change, but that this type of information becomes harder to ignore.

It starts to sit more clearly alongside other forms of evidence, rather than being dismissed outright as disconnected anecdotes.

Over time, that can influence how questions are framed, what gets explored further, and how different types of information are weighted.

But that’s a secondary effect.

So the immediate impact is on recognition, expanding what is seen as relevant and worth engaging with.

Any change in conclusions would come later and would still depend on how this structured, real-world data is considered alongside more traditional forms of research.

Today, what is the question the harm reduction debate still struggles to ask—perhaps because it would require changing the very way we understand evidence?

Kurt: One of the questions that still isn’t comfortably asked is the following:

What do real-world transitions actually look like at scale when people move away from smoking and use safer alternatives?

Not in theory, and not in tightly controlled conditions, but in practice, across large numbers of people.

It sounds like a simple question, but to answer it properly, you need a type of information that doesn’t fit neatly into the usual categories.

You need to understand not just whether people quit but how they got there: how long they smoked, how much they smoked, how many times they tried to quit, what motivated the quit attempt, what methods they attempted, why those attempts were unsuccessful, whether they switched gradually, whether they used more than one product, and how long they’ve remained smoke-free.

Individually, people can answer those questions quite clearly about themselves.

But collectively, that information hasn’t really existed in a way that allows it to be seen as a coherent body of insight.

At the moment, the debate tends to focus on endpoints or controlled comparisons.

The pathway—the lived process of switching—is less visible, partly because we don’t have a widely accepted way of treating that kind of information.

So it’s not that the question is impossible to ask.

It’s that answering it properly challenges the boundaries of what we currently recognize as evidence.

And until those boundaries shift, that question remains only partially explored.

* * *

Before any framework, before any platform, before any argument about what counts, there are people like Kurt: trying, failing, returning, and trying again.

Long before these stories became a problem of evidence, they were already a matter of survival. THR Global is one attempt to provide them with a place where they can gather, be compared, and be heard.

https://thrglobal.org

The platform does not resolve the tension. It gives it form.

And in doing so, it leaves something more difficult than a lack of evidence: the possibility that the limits may lie not in what we know, but in what we are prepared to recognize as knowledge at all.

What follows, then, is not an answer, but an attempt to think through that limit.

Robert Beaglehole, Ruth Bonita, and Tikki Pang, all with long experience inside the WHO, want to unsettle that arrangement. Their argument is simple enough to state and difficult enough to absorb: the real enemy is not nicotine, but smoke. Global policy, they suggest, should stop treating vapes, snus, heated tobacco, and nicotine pouches as morally equivalent extensions of the cigarette and begin to see them, at least in part, as tools for hastening its decline.

That, though, is only the surface of the argument. What is truly at stake is the power to redefine what the field recognizes as success. For years, success seemed to have a stable name: fewer smokers, less nicotine, less dependence, less tobacco in circulation. Beaglehole, Bonita, and Pang propose another hierarchy. The defeat of the cigarette, they suggest, may matter more—and more urgently—than the disappearance of every form of nicotine use. Their target is exact: adult daily smoking prevalence below five per cent by 2040. The price is more delicate: accepting that nicotine dependence may not disappear, but migrate into less lethal forms.

It is a technical proposal. It is also a manageable heresy.

There is hardly any dissent about the diagnosis. Tobacco remains one of the world’s leading preventable causes of death: more than seven million people die from it every year. The burden falls with particular brutality on low- and middle-income countries. Even where consumption has fallen, the costs remain: damaged bodies, strained health systems, entrenched inequalities. Among the various ways of consuming nicotine, the cigarette remains by far the most devastating. And one figure gives the impasse its geographic scale: China and India alone account for more than a third of the world’s adult smokers, a weight that makes any global strategy incomplete if it cannot reckon with those two giants.

None of this is new. What matters is what follows from it. The field has achieved a great deal and may, for precisely that reason, have reached a point of fatigue. Since entering into force in 2005, the Framework Convention on Tobacco Control has given the world the grammar of the fight: health warnings, advertising restrictions, smoke-free environments, taxation, and cessation support. It turned tobacco control into a recognizable international language. It gave method to what had once been scattered. It gave legitimacy to what had once been isolated resistance.

Beaglehole, Bonita, and Pang do not diminish that legacy. They depend on it. Their case begins by acknowledging that the FCTC was decisive. But the old repertoire, they argue, no longer delivers decline at the speed now required. Tobacco control has entered a harsher phase. Smoking is increasingly concentrated among poorer, older, more heavily dependent smokers, many of them marked by repeated and unsuccessful attempts to quit. In that view, the cigarette no longer looks simply like a widespread habit. It looks like a hard residue, lodged among the most vulnerable and the hardest to reach with conventional tools.

The slowdown is not just a mood. It shows up against international targets that, at the current pace, no longer look plausible. The WHO’s voluntary goal of reducing tobacco use by thirty per cent by 2025 has fallen short; SDG 3.4, which calls for reducing premature mortality from chronic disease, is also off track; and the UN, in its 2025 political declaration, fixed its ambition at fewer than a hundred and fifty million people using tobacco by 2030 a figure that, as the authors note, would do little to alter the scale of the global burden.

If combustion is the central problem, policy cannot go on treating all nicotine products as moral equivalents. The cigarette stops being merely one more product in the tobacco universe. It becomes, explicitly, the singularly most destructive one. Everything else has to be reorganized around that difference.

The shift can look small, almost semantic. It is not.

For a long time, much of tobacco control operated as if its regulatory ideal were the progressive elimination of nicotine. Beaglehole, Bonita, and Pang propose another horizon: not necessarily a world free of nicotine, but one in which the combustible cigarette has become residual. What changes is not just the instrument. It is what counts as success.

They know how much resistance that shift will invite. So they make a shrewd political move. Harm reduction is not presented as something imported from outside tobacco control, but as something that has always been there, at least in latent form. The turn is anchored in the Convention itself. Article 1(d) of the FCTC, they remind the reader, includes harm reduction within the broad definition of tobacco control. The gesture matters. It lowers the charge of deviation and changes the terms of the argument. The question is no longer whether this belongs in the field, but why, if it does, it has remained at the margins for so long.

Under the heading “smoke-free nicotine products,” they draw together things regulatory practice often prefers to keep apart: nicotine-replacement therapy, snus, e-cigarettes, heated tobacco, and nicotine pouches. These are not the same thing. They have different histories, uneven evidentiary foundations, different risk profiles, distinct regulatory origins, and commercial interests that do not always converge. Even so, they are grouped for a strategic reason: all of them displace combustion from the center of the experience. From that framing comes a policy that is as simple to state as it is hard to ignore: regulate each product in proportion to its risk.

The idea can sound almost banal when put so plainly. In the abstract, it is hard to argue that the most lethal product should receive the same treatment as the least lethal one. And yet that is where the most uncomfortable accusation enters: in the name of prudence, tobacco control may have produced an incoherence. Cigarettes remain widely available, while potentially less harmful products face, in many settings, equivalent—or even greater—restrictions. The result, the authors suggest, is a policy that has treated unlike things as alike and, in doing so, helped shield the market for the most dangerous product.

What follows is a proposed regulatory order. Combustible cigarettes should bear the full weight of taxation and restriction. Smoke-free alternatives should indeed be regulated, but regulated to ensure safety, curb youth-oriented marketing, prevent uptake among non-smokers, and reduce environmental harms, not in ways that strip them of their capacity to compete with cigarettes. This is not a plea to liberate nicotine. It is a demand for a different hierarchy of severity.

That demand cannot survive without another struggle: the struggle over language. Public communication is central to the whole argument. Many adult smokers, Beaglehole, Bonita, and Pang suggest, remain trapped inside a flattened perception of risk. They do not clearly distinguish the harms of cigarettes from the harms of other nicotine products.

Part of that is the result of ambiguous messaging; part of it comes from alarmist media coverage; part of it reflects the difficulty, within public health itself, of sustaining a language of relative risk without seeming indulgent toward dependence. What they want, at bottom, is a new lexicon. Not an indulgent one, but a way of speaking that can say plainly that smoke kills more than nicotine, and say it clearly enough, including from the WHO.

Here, the dispute stops hiding behind products and data. It becomes a quarrel over what public health is willing to say aloud. Do more cautious messages protect adolescents? Or do they confuse adult smokers who might otherwise leave cigarettes behind? Do clearer messages about relative risk aid cessation? Or do they reopen a culture of nicotine normalization? Beaglehole, Bonita, and Pang take a side. Without more direct speech, harm reduction will remain confined to the policy footnotes.

Any argument that tries to displace doctrine needs territory. This one is no exception. The examples are already loaded with meaning in the international debate.

Sweden appears as the country in which cigarettes seem to have lost centrality while other forms of nicotine—above all snus—have gained ground. Japan emerges as the case in which the introduction of heated tobacco coincided with a sharp decline in cigarette sales. The United States enters as the setting in which the decline of adult smoking unfolded alongside the expansion of vaping. And New Zealand, more than any other example, is cast as a laboratory of the future.

New Zealand serves two purposes. The first is public-health related. It offers evidence that smoking declines can accelerate when regulated alternatives become more widely available, including among groups historically hit hardest, such as Māori and other disadvantaged populations.

The second is political. In 2022, the country approved an endgame package with hard measures: denicotinization of cigarettes, a drastic reduction in retail outlets, and a “smoke-free generation” law. After the change of government, much of that package was repealed before it could take effect. The episode is read as a lesson: perhaps more coercive strategies are too fragile to endure; perhaps a transition built on regulated substitution is less elegant, but more sustainable.

That reading is intelligent because it turns repeal into argument. What might have looked like the defeat of a harder-line project becomes indirect proof that another path is needed.

Of course, the resistance is easy to predict. Youth, long-term uncertainty, dual use: these are the gates that mark the frontier of what remains acceptable in the field.

On youth, the aim is to weaken the harder versions of the gateway hypothesis by insisting that many observational studies confuse correlation with a shared predisposition to risk.

On long-term effects, the authors concede uncertainty, but insist that the absence of combustion already changes the equation.

They make another defensive move as well: the review literature, they note, places nicotine e-cigarettes among the most effective cessation tools available, and, in countries such as the United Kingdom, their possible net population benefit is already under continuous scrutiny.

On dual use, they reject the idea of automatic failure. For some smokers, it may represent a transitional stage, not a destination. Here, the argument becomes more specific: biomarker studies suggest that dual users show lower exposure to toxicants than exclusive smokers. Even so, that reduction does not place them on the same footing as exclusive e-cigarette users.

The rhetorical strategy is consistent throughout. The concerns are not denied. They are stripped of veto power. The reader is asked to see an error of proportion: the new risk is feared too much, while the old one is tolerated out of habit.

The most politically effective part of the argument may lie elsewhere, in its distributive force. Harm reduction is not presented merely as an expedient for adult smokers who cannot quit. It is given a role in reducing inequality. That gives the proposal an added moral gravity. It would not simply accelerate average declines; it would help dislodge the cigarette precisely where it remains most deeply entrenched: among the poor, the vulnerable, the dependent, those most left behind by the field’s earlier successes.

This is the ground on which the clearest banner is raised: smoke-free 2040.
Less than 5% adult daily smoking prevalence by 2040.

Policy likes a slogan when it can condense a worldview. This one can. Its force lies not only in being measurable. It lies in establishing a new criterion of success. Not necessarily a world without nicotine. A world in which the cigarette no longer occupies the center. And the slogan comes with hard numbers: in 2024, global smoking prevalence among people aged fifteen and older stood at sixteen per cent to twenty-eight per cent among men and five per cent among women. If current trends persist, the world will fall to around ten per cent by 2040. Their target—below five per cent—would require more than doubling the current rate of decline.

The agenda is meant to travel beyond high-income settings. Low- and middle-income countries face a different reality: cigarettes are relatively more affordable, cessation services are scarce, regulation is uneven, markets are more opaque, and state capacity is weaker. Even so, the proposal is framed on a global scale. Its instruments are differential taxation, context-specific research, regulatory strengthening, and institutional innovation elements that the authors see as indispensable to adapting harm reduction to local conditions, especially where the state is weaker and the informal market more powerful.

There is also a note of state realism here that is hard to miss. A regulated transition affects revenue, health-care costs, and illicit trade, and those effects, the authors argue, will have to be actively managed, especially in countries where tobacco still carries fiscal weight. At that point, the debate stops being merely clinical or cultural. It becomes a matter of statecraft.

This is why the WHO ends up as the argument’s true addressee. The piece begins to read almost like an open letter. It asks for more than tolerance. It asks for legitimation. It wants harm reduction to stop occupying a gray zone and to be recognized as an explicit component of comprehensive tobacco control. It wants, in other words, to move the center of authority in the conversation.

That may be the fairest and most exact way to read Beaglehole, Bonita, and Pang: not as mounting a side defense of a set of products, but as trying to rewrite the code of an entire field. For a long time, tobacco control knew how to say clearly what it condemned. What is being asked now is whether the field is prepared to say, without embarrassment, what it would be willing to tolerate to defeat the cigarette.

Because, in the end, this is not only a request to revise the instruments. It is a request to revise the scruples. And it leaves hanging the question the field may be most reluctant to answer: what should count as success, the disappearance of nicotine, or the defeat of combustible tobacco’s relentless machinery of disease and death?

Beaglehole, R., Bonita, R. & Pang, T. Smoke-free nicotine products can accelerate the end of the smoking epidemic. Nat. Health (2026). https://doi.org/10.1038/s44360-026-00121-1

Rates have fallen, and cigarettes have moved out of the center of social life.

But tobacco control did not simply reduce smoking. It reorganized where smoking remains, concentrating it among those for whom quitting was never merely an individual choice.

Over the past several decades, few stories have been told with as much consensus as those of tobacco control. It runs through reports, treaties, and scientific papers as one of those rare victories public health likes to display without lowering its eyes: a widespread problem, deeply embedded in social life, gradually pushed to the margins until it seemed, at least on the surface, to be under control.

One need only look at the curves.

They slope downward with an almost pedagogical docility, as if they recorded not only what happened, but the proper way to read it: this is what works, this is the path, this is the proper way to govern risk.

In that sense, the curves do more than measure. They instruct. They organize perception. They indicate where the problem is assumed to lie, and, just as importantly, where it no longer appears to be.

In institutional presentations, those curves appear clean and noiseless.
Clear, steady lines, almost a little too persuasive.
But lines conceal things too.

Their clarity depends, in part, on what they leave outside the frame: who continued smoking after the cigarette had already been expelled from the center, under what conditions smoking persisted, and who came to bear, in body and in life, the residual weight of what came to be called success.

This narrative did not arise on its own. It took shape through experiments carried out in the United States—especially in California, a pioneer from the late 1980s onward in programs that combined tax increases, media campaigns, and, above all, a deliberate effort to dislodge the cigarette from the center of social life and push it toward its farthest edges.

Before long, what had once occupied the hands of movie stars and the tables of cafés was driven out of pubs, restaurants, offices, and airports, until often all that remained was the sidewalk.

More than a regional case, this process established a repertoire of strategies that would, over time, become a model. Governments and international organizations adapted and disseminated them until they were consolidated, in negotiating rooms and technical documents alike, as the very language of what it means to control tobacco. In the early 2000s, through successive rounds of meetings, delegations from dozens of countries began negotiating the terms of that consensus. It would take institutional form in the Framework Convention on Tobacco Control.

From a sufficient distance, this trajectory cannot be explained by any single measure, but by a rare convergence: robust, well-funded science; persistent policymaking; supportive media; and a measurable shift in collective behavior.

A success difficult to dispute. Especially when told this way.

But this story was not only about taxes, campaigns, and effective regulation. It also relied on something less visible and more far-reaching: the transformation of smoking’s social role. Denormalization did not simply reduce the acceptability of cigarettes. It recoded smoking as an increasingly awkward, discreditable, and publicly inconvenient practice. Smoking ceased to be only a risk; it became a sign of conduct to be displaced, corrected, and kept at a distance.

It is precisely here that the narrative of success becomes most persuasive—and most misleading. The decline in prevalence supplies its clearest marker; the reduction in morbidity and mortality, its public-health justification; regulatory consolidation, its institutional face; denormalization, its normative culmination.

And yet the narrative does not quite hold.

At a certain point, the very success recorded by the indicators begins to expose their limits. Aggregate decline does not dissolve the inequalities that structure tobacco use. In many settings, those inequalities persist; in others, they sharpen. As smoking recedes from the center of social life, it becomes increasingly concentrated among those with fewer material, social, and psychological conditions for leaving it behind.

The question, then, is no longer merely whether the interventions worked. It is what kind of success they produced, where smoking was made to remain, and who came to bear, more intensely and more visibly, the material and moral weight of what, in the aggregate, came to be called progress.

What the Averages Conceal

From Aggregate Decline to Social Concentration

Aggregate decline no longer suffices as evidence of effectiveness—much less of justice. The question can no longer remain sheltered within the technical language that once seemed able to contain it. It is no longer simply a matter of how many people smoke less, but of where smoking remains, who was better positioned to respond to policy, and who stayed more exposed both to tobacco-related harm and to the burden of the measures designed to combat it.

This shift changes the object itself. What once appeared as a collective trajectory now reveals a more uneven pattern: the social concentration of a practice that is increasingly abandoned by those with greater stability, support, and the room to comply. Tobacco control did not simply reduce smoking across a uniform population. It reorganized where smoking would remain, concentrating it along existing lines of inequality.

As Lapalme observes, the point is not to deny the overall effectiveness of tobacco control, but to recognize that it has long coexisted with persistent inequality from within. Smoking does not disappear. It is redistributed—and tends to settle precisely where the material and symbolic conditions for giving it up are scarcest.

A closer look at the map makes this visible. The global decline is uneven: in some regions, it barely moves; in others, it advances slowly; in still others, it shows signs of exhaustion. The Western Pacific region, for example, has seen the slowest decline—around 8 percent between 2010 and 2024—driven by high prevalence in countries such as China and Indonesia. In Europe, progress has been similarly sluggish, with rates among women more than double the global average. In several countries—including Indonesia, Egypt, Congo, and Jordan—prevalence has scarcely shifted over the past decade.

But these numbers do more than describe variation. They trace a pattern. Smoking is not distributed at random. It follows the fault lines of the societies in which it takes hold. Where inequality runs deeper, smoking becomes denser, more persistent, and harder to dislodge.

This gradient is now one of the most consistent findings in the epidemiology of smoking—and one of the least comfortable. The lower the income and the level of education, the higher the prevalence, and the more difficult cessation becomes. In countries with relatively low overall prevalence, the pattern remains: smoking becomes progressively more common the further one descends the social scale.

But inequality is not limited to who smokes. It appears even more starkly in who manages to quit.

Low-income smokers show significantly lower abstinence rates—often roughly half those seen in more advantaged groups. Lower adherence to treatment, cohabitation with other smokers, greater dependence, and weaker support networks help explain the gap. But the problem begins earlier: in precarious material conditions, unstable routines, persistent stress, and the scarcity of time and energy that make giving up tobacco harder to initiate and harder still to sustain.

Even so, to explain is not the same as to understand. These factors do not operate in isolation. They accumulate, overlap, and reinforce one another until quitting smoking ceases to be merely difficult and becomes, for many, improbable.

This accumulation is most visible in low- and middle-income countries, where roughly 80 percent of the world’s 1.3 billion smokers live. There, the distance between what works in clinical trials and what is possible in ordinary life becomes stark. Treatments such as nicotine replacement therapy or varenicline may cost between $100 and $500 a year—amounts beyond the reach of much of the population. In some settings, that cost can approach 20 percent of a smoker’s monthly income, while cigarettes remain relatively cheap. Public coverage is limited, and access to behavioral support remains uneven.

In that setting, what the indicators record as behavioral persistence begins to reveal itself as something else: the cumulative effect of social conditions that make quitting smoking not merely painful, but structurally improbable.

Taken together, these patterns point to something more unsettling than the narrative of success usually allows. Population-wide policies have been effective, but not neutral. They did not merely reduce smoking; they reorganized where it would remain, on whom its burdens would concentrate, and under what conditions that persistence would be lived.

The averages record fewer smokers, lower exposure, and greater social disapproval of cigarettes. The distribution tells another story: one of progressive concentration among those for whom quitting is more costly, more constrained, and less compatible with the conditions of everyday life.

What the curves show clearly, the margins quietly undo.

The Remaining Smoker

Class, Suffering, and Social Concentration

More often than not, someone lights a cigarette before even noticing that a decision has been made. The gesture emerges in an interval: between one task and the next, between one shift and the one to follow, between a worry that has just ended and another already beginning. It is a pleasure. But not only pleasure. Nor merely dependence. It is, above all, a way of organizing time—opening a pause where no pause has been given.

The global decline in prevalence has altered the epidemiological landscape—and with it, the figure of the smoker who remains. Persistent smoking is no longer diffusely distributed across the social body. It thickens. And it thickens, above all, where economic insecurity, political neglect, and accumulated suffering are already dense. The remaining smoker is not simply someone who failed to respond to public-health messaging. More often, he or she occupies the point where behavioral language encounters the limits of its own explanatory power.

Here, Hilary Graham remains indispensable. Persistent smoking is not merely a risky behavior, nor a simple residue left behind by successful policy. It is a situated social practice—interwoven with class, income, gender, and place—and deeply inscribed in suffering, constraint, and inequality accumulated over the course of a life.

That perspective unsettles one of the most comforting assumptions in tobacco control: that continued smoking is primarily a matter of ignorance, irrationality, or insufficient motivation. Quitting does not take place in a vacuum. It depends on predictability, support, access to care, and some degree of control over one’s own life—conditions that are unevenly distributed, and often scarce precisely where smoking remains most prevalent.

In contexts of economic insecurity, housing instability, and mental distress, the cigarette takes on functions that exceed chemical dependence. It operates as emotional regulation, as a fragile interval within exhausting routines, as a way of sustaining the body and the day when other forms of support are scarce. It can become an anchor in the day: something inscribed in breaks at work, in transit, in the intervals between domestic tasks—in those minimal moments when the act of lighting a cigarette offers structure, marks off a boundary, and opens a brief space to breathe. What appears, from the outside, as persistence may also be a form of maintenance: a way of holding together what would otherwise come apart.

Qualitative studies reflect this with unusual clarity. Many smokers describe the habit less as addiction than as a form of everyday support: relief from anxiety, time of one’s own amid overload, a resource for regulating emotions that might otherwise spill over. In these accounts, there emerges something like a precarious economy of care—the cigarette as a tool for enduring the unendurable.

Research conducted in Brazil points in the same direction. Smoking appears as a palliative for sadness, discouragement, and isolation. In routines marked by precarity, that function intensifies. The cigarette ceases to be merely a habit and becomes instead a mediator between the subject and an everyday life that offers few alternatives for pause, relief, or self-regulation.

This dimension becomes clearer still when one considers the broader landscape of suffering. Persistent smoking is strongly associated with mental distress and traumatic experience. People with histories of abuse, depression, or anxiety smoke more—and find it harder to quit. What appears, in epidemiological terms, as behavioral persistence begins to shift in meaning. It is not simply dependence, but the overlap between dependence, suffering, and structural inequality. Under these conditions, cessation is not merely difficult. It becomes, in many cases, scarcely viable.

This reveals a persistent mismatch. The field of tobacco control recognizes these inequalities, but struggles to reorganize its responses accordingly. Equity appears in the discourse; in policy, far less so. Instead, many strategies continue to treat smokers as a homogeneous public. National campaigns, standardized protocols, universal approaches—tools that scarcely register how radically the conditions for cessation vary across income, place, and mental health.

As smoking declines, another transformation takes shape. The smoker’s social position becomes more sharply defined—and more heavily marked. Denormalization does not simply reduce the acceptability of cigarettes. It also produces identities. The smoker ceases to be merely someone exposed to risk and becomes increasingly legible as someone who has failed—morally, socially, and individually.

That shift is not abstract. It materializes in everyday life: in the glance that condemns, the body that withdraws, the subtle experience of being out of place. In domestic space, it appears as silence, interruption, or reproach. In health services, it can take the form of judgment—and, at times, of retreat.

For those already living under conditions of disadvantage, that experience intensifies. Smoking becomes not only a stigmatized practice, but a marker of social failure—one that may be internalized as shame, guilt, and diminished self-worth.

What emerges from this convergence is one of the most difficult tensions in contemporary public health. Policies designed to confront a widespread behavior now act upon a population that is smaller, more concentrated, and more vulnerable. In that setting, smoking can no longer be read simply as a matter of individual risk. It condenses something larger: inequality, suffering, and the uneven distribution of the conditions required to abandon it.

At that point, the question changes. If persistent smoking is not merely a behavior but a situated practice—anchored in constraint and unequal access to support—then the problem can no longer be framed solely in terms of why individuals continue to smoke. It must also be asked how public-health interventions act upon this uneven terrain, and what happens when policies designed for a widespread habit come to bear upon a socially concentrated one.

Invisible Costs

Regressivity, Stigma, and Legitimacy

If smoking has ceased to be a widespread habit, the policies devised to confront it have, to a large extent, remained the same. Taxation, spatial exclusion, denormalization campaigns, and standard cessation protocols were designed to act upon relatively diffuse populations. But the terrain has changed. Once smoking becomes socially concentrated, these instruments no longer fall upon a broad and heterogeneous public in the same way. They bear down most heavily on those with the least room to absorb their effects.

This is not only a distributive problem in the narrow sense. It is also a moral one. Tobacco control does not merely regulate products and behaviors; it distributes pressure, legitimacy, and blame. And once smoking is concentrated among socially vulnerable groups, the burden of that distribution becomes harder to ignore.

Tax increases remain one of the most effective tools for reducing average consumption. But the same measure operates differently across unequal social worlds. For those able to quit, higher prices may function as an incentive. For those whose smoking is entangled with instability, dependence, and scarcity, the effect is often less cessation than compression: other parts of the household budget contract so that smoking can continue under more punitive conditions. Some shift to cheaper alternatives, including illicit ones; others absorb the higher cost by cutting elsewhere.

The harm does not disappear. It is redistributed.

What is no longer spent on other needs—food, health care, education—comes to sustain a habit from which it is harder to escape. A policy effective in the aggregate thus reveals its regressive face.

It is here that the consensus begins to creak, even within the literature. Raising the price of cigarettes is, at once, one of the most effective tools for reducing consumption and one of the clearest demonstrations of the inequality of its effects. For those who manage to quit, it works. For those who do not—and who often live under greater material and mental vulnerability—it becomes a form of continuous penalization.

But the costs are not only material. They are symbolic as well—and for that very reason, harder to measure. Policies do not merely regulate behavior; they also distribute responsibility. Among low-income smokers, smoking often comes accompanied by guilt, shame, and social judgment. These experiences are not peripheral. They shape one’s relationship to the habit itself—and often to the health-care system as well.

At this point, denormalization ceases to be merely a public-health tool and becomes a mechanism of social classification. Making smoking socially undesirable was central to the success of tobacco control. But that success had ambivalent effects. In reducing the acceptability of cigarettes, it also helped fix around the smoker an identity marked by reproach and devaluation.

Once smoking is concentrated among vulnerable groups, this process no longer operates only as prevention. It also intensifies experiences of exclusion.

The tension deepens because many persistent smokers live under conditions that make cessation especially difficult. When the institutional response relies chiefly on restrictions and symbolic sanctions—high prices, exclusion from spaces, moral condemnation—it may increase the weight of those difficulties without offering proportionate support for confronting them. The result is a structural mismatch: equity appears as a principle, but rarely translates into policy design.

At that point, the question can no longer be framed solely in terms of effectiveness. It becomes a question of legitimacy. Interventions capable of producing broad population-level benefits may still be justified even when they impose individual costs. But that justification grows more fragile when those costs fall systematically on the very people who already live under multiple forms of disadvantage.

To take tobacco control seriously, then, is not to reject it, but to judge it more rigorously: not only by how much prevalence has declined, but by how its benefits and burdens are distributed, and by who comes to bear, more intensely, the residual weight of its success.

An Imperfect Victory

Justice, Proportionality, and the Limits of Behavioral Rule

In light of this new configuration, the standard of evaluation must change. It is no longer enough to ask whether tobacco control worked. The more difficult question is what kind of political and moral rationality its success has relied upon, and whether that rationality remains defensible once smoking is concentrated at the social margins.

Classical indicators—prevalence, consumption, mortality—remain indispensable. But taken on their own, they reveal less than they seem to. They register aggregate movement while remaining largely silent about social concentration, unequal exposure to burden, and the moral classification of those who remain. It is in that silence that the problem of justice begins.

What is at stake, then, is not only whether public-health gains were achieved, but how they were achieved—and under what assumptions about responsibility, conduct, and the location of the problem itself. A policy may save lives and still remain normatively narrow. It may reduce risk while deepening shame. It may improve averages while consolidating, in practice, a way of governing that treats as failures of conduct what are also expressions of suffering, inequality, and unmet need.

At that point, the problem ceases to be only tobacco. It becomes a test of public health itself: of whether it can recognize the limits of a framework that reads socially rooted practices primarily through the language of behavior, discipline, and correction.

This tension offers no simple resolution. The point is not to abandon tobacco control, nor to deny its gains. The difficulty lies elsewhere: in recognizing that a policy may be effective and yet remain distributively unequal and ethically incomplete.

To take that tension seriously is to confront the rationality that guided this success. By privileging abstinence, discipline, and disapproval, tobacco control has often treated as a failure of conduct what is also a demand for care—what condenses, in practice, accumulated inequality, constraint, and suffering.

From this point on, certain positions within the field become harder to sustain as merely technical. When smoking is concentrated among vulnerable groups, insisting exclusively on the eradication of behavior—without expanding the repertoire of responses—begins to appear less as prudence than as a narrowing of what counts as a legitimate form of care.

Viewed in this light, tobacco control ceases to be only a success story. It begins to expose the internal tensions of public health itself. It shows that effective policies can transform the epidemiological landscape of a problem while operating through a grammar ill-equipped to engage those who remain at its margins.

When that happens, public-health success loses the innocence of averages. Counting lives saved is no longer enough. We must also ask what forms of care were legitimized, what forms of suffering went unanswered, and which subjects came to be treated less as people to accompany than as behaviors to correct.

In the end, the curves do not lie. But they do not tell the whole story either. They show decline, improvement, and measurable gain. What they cannot show is how that success is lived, how its burdens are distributed, and how its remainder is governed.

At that point, the problem ceases to be only tobacco.

It becomes control.

Notes and Sources

The consolidation of tobacco control as a public-health paradigm, often told as a story of success, can be traced through the Californian experience revisited by Roeseler and Burns in “The Quarter That Changed the World” (Tobacco Control, 2010), as well as through the institutional literature that followed.

Denormalization, which was central to displacing the cigarette from accepted social norms and driving its gradual marginalization, is discussed by Bayer and Stuber in “Tobacco control, stigma, and public health” (American Journal of Public Health, 2006), and by Bell in “Legislating Abjection?” (Critical Public Health, 2011) and “Tobacco control, harm reduction and the problem of pleasure” (Drugs and Alcohol Today, 2013). See also Bell et al., “‘Every space is claimed’” (Sociology of Health & Illness, 2010), and “Smoking, stigma and tobacco ‘denormalization’” (Social Science & Medicine, 2010).

The persistence of inequality within aggregate decline, and the progressive concentration of smoking among socially disadvantaged groups, is developed by Graham in “Why social disparities matter for tobacco-control policy” (American Journal of Preventive Medicine, 2009) and “Smoking, stigma and social class” (Journal of Social Policy, 2011), and succinctly synthesized by Lapalme in “Tobacco control’s effects on social inequalities in smoking” (European Journal of Public Health, 2020).

The ethical dimensions of tobacco control, especially when its effects are distributed unequally, are examined by Voigt in “Smoking and social justice” (Public Health Ethics, 2010); by Breton and Sherlaw in “Examining tobacco control strategies and aims through a social justice lens” (Public Health Ethics, 2011); and by Thomas et al. in “Population tobacco control interventions and their effects on social inequalities in smoking” (Tobacco Control, 2008).

The social and subjective consequences of denormalization—including stigma, withdrawal, and marginalization—are explored in Ritchie, Amos, and Martin, “‘But it just has that sort of feel about it, a leper’” (Nicotine & Tobacco Research, 2010), and in Stuber, Galea, and Link, “Smoking and the emergence of a stigmatized social status” (Social Science & Medicine, 2008) and “Stigma and smoking” (Social Service Review, 2009), as well as in Bell et al., “Smoking, stigma and tobacco ‘denormalization’” (Social Science & Medicine, 2010).

Recent debates about equity, legitimacy, and the limits of the so-called tobacco “endgame”, especially once smoking has become concentrated at the social margins, include Malone, “Justice, disparities and the tobacco endgame” (Tobacco Control, 2021); Mills et al., “Recommendations to advance equity in tobacco control” (Tobacco Control, 2022); Lund and Sæbø, “Challenges in legitimizing further measures against smoking…” (Harm Reduction Journal, 2024); and Meier and Shelley, “The fourth pillar of the Framework Convention on Tobacco Control” (Public Health Reports, 2006).

The shift in emphasis, from aggregate effectiveness to the social distribution of outcomes, is formulated with particular clarity by Lapalme in “Tobacco control’s effects on social inequalities in smoking” (European Journal of Public Health, 2020).

The social determinants of smoking including life conditions, support networks, and unequal access to cessation are discussed by Garrett et al., “Addressing the social determinants of health to reduce tobacco-related disparities” (Nicotine & Tobacco Research, 2015); Paul et al., “The social context of smoking” (BMC Public Health, 2010); and Boland et al., “‘I’m not strong enough…’” (International Journal for Equity in Health, 2017).

The understanding of persistent smoking as a situated social practice shaped by class, suffering, and accumulated inequality owes much to Graham, especially “Smoking, stigma and social class” (Journal of Social Policy, 2011).

The ethical and legal implications of “endgame” strategies, especially with respect to proportionality and legitimacy, are addressed by Thomas and Gostin in “Tobacco endgame strategies” (Tobacco Control, 2013), and further developed by Voigt in “‘If you smoke, you stink’” (2013) and in “Tobacco as a matter of public health,” in The Oxford Handbook of Public Health Ethics (2019).

The persistence of inequality within policies widely regarded as successful is also examined by Malone (Tobacco Control, 2021) and Mills et al. (Tobacco Control, 2022).

For a normative framework grounded in equity, proportionality, and dignity, especially relevant when the burdens of policy become concentrated, see Voigt (Public Health Ethics, 2010); Breton and Sherlaw (Public Health Ethics, 2011); and Voigt in The Oxford Handbook of Public Health Ethics (2019).

The ethical problem posed by denormalization, particularly when it becomes entangled with stigma and exclusion, is developed by Bell (Critical Public Health, 2011; Drugs and Alcohol Today, 2013) and by Bayer and Stuber (American Journal of Public Health, 2006).

The tensions among care, exclusion, and legitimacy, particularly visible when public health success coexists with the social concentration of harm, are evident in Malone (Tobacco Control, 2021), Lund and Sæbø (Harm Reduction Journal, 2024), and Meier and Shelley (Public Health Reports, 2006).

Atem und Wandel – Breathe for Change did more than name the conference.

It established its mood. “Breath” carried an obvious literal meaning, given Barmelweid’s close association with respiratory care. But it also carried a moral one, linking cessation, clean air, prevention, and behavioral change. The English subtitle, together with the presence of the WHO and the ENSP, placed the event in a familiar register: locally anchored, internationally legible.

The image of the clinic set against greenery, and the column of seals a few pages later, completed the effect. Before anyone spoke, the event had already been framed through care, order, certification, and authority.¹

The seals mattered. Barmelweid foregrounded its international Gold recognition within the network of tobacco-free healthcare services. At the same time, the network itself described certification not only as a mark of commitment but also as a valuable signal to insurers and referring physicians. The effect was not merely symbolic. Certification did not just affirm a principle; it helped place the institution within a hierarchy of credibility.²

The conference projected public health, certainly. But it also projected standing.

Its organizing core was local. It centered on Klinik Barmelweid, a Swiss specialty and rehabilitation clinic with a strong focus on pulmonology and nicotine-cessation counseling, and on the FNBS, which appeared in the program through Susann Koalick, head of the clinic’s nicotine counseling service and president of the forum. Barmelweid maintained a formal cessation structure; FNBS presented itself as a nonprofit platform supporting institutions and professionals in implementing evidence-based standards for nicotine prevention.¹˜³

A second layer came from transnational legitimation. By opening with José Luis Castro, the WHO Director-General’s Special Envoy for chronic respiratory diseases, and Cornel Radu-Loghin, secretary-general of the ENSP, the meeting placed itself under two established forms of authority: the WHO’s norm-setting role and the European tobacco-control advocacy represented by the ENSP. The conference presented itself not simply as training, but as part of a wider field organized around nicotine control. ¹˜⁸

A third layer came through practical translation. The program spanned oncology, dentistry, child and adolescent psychiatry, cardiology, addiction medicine, occupational health management, work psychology, and digital communication. In that arrangement, nicotine appeared not as a narrow clinical issue but as a cross-cutting problem touching cancer, mental health, youth, workplace culture, and public communication. The session on Rauchfrei-Kultur, featuring hospital managers and human-resources personnel, was especially revealing. The focus shifted from the individual smoker to institutional governance and the production of smoke-free and nicotine-free environments.¹

That shift matters. The conference did not simply ask how to reduce smoking. It also asked who would define the legitimate terms of prevention, which institutions would be recognized as exemplary, and how those standards would circulate.

The most visible interest was preventive and sanitary. The program framed nicotine as a matter of reducing tobacco and nicotine use, protecting young people, integrating cessation into cancer care, cardiology, mental health, and dentistry, and responding to the spread of newer products such as snus, pouches, and electronic cigarettes. But a second interest was also visible: the consolidation of a field. By convening the WHO, the ENSP, hospitals, clinicians, psychologists, prevention specialists, and communication professionals, the organizers were doing more than assembling a conference. They were assembling a network of authority.¹˜⁸

Two sessions made that especially clear: Nikotinindustrie und Sprache and Chancen digitaler Reichweite für Nikotinprävention. The struggle here was not only clinical or regulatory. It was also semantic. The program treated nicotine not simply as a substance to be governed, but as a narrative terrain to be occupied: the language of prevention had to compete with the language of innovation, lifestyle, and harm reduction. In that sense, the event did not merely communicate a position. It also worked to stabilize the vocabulary through which the problem would be understood.¹

The omissions helped define its character. On the publicly listed event page, no industry representatives, vape consumers, harm-reduction associations, or openly dissenting voices were visible. That fact alone does not invalidate the meeting. But it does clarify what kind of meeting it was. This was not a forum designed to test disagreement at its outer edge. It was a forum of alignment.¹

The same logic becomes clearer once one looks beyond the program and into the infrastructure behind it.

The network ran on both money and legitimacy. Revenue came from membership dues, certification fees, training revenue, project-related contributions, and the host clinic’s economic base. Legitimacy came through certification, international recognition, and alignment with cantonal programs and healthcare mandates. Together, those elements produced a more durable kind of standing within the health system: greater authority to speak in the name of prevention, greater value as a reference point, and greater credibility with insurers, referring physicians, and institutional partners.²˜³˜⁵

The clearest starting point is an official record. The 2nd Nikotintagung Klinik Barmelweid received 9,000 Swiss francs from the Swiss Tobacco Prevention Fund between April 2007 and May 2008. The project was framed not as a commercial activity, nor simply as an academic exercise, but as information and awareness-raising and as part of a broader effort in networking and creating favorable conditions for prevention. In the final report, the organizers described the conference as a platform for exchange, a means of expanding knowledge in research and practice, and a way of supporting the implementation of smoke-free measures in hospitals and healthcare institutions. From the beginning, then, the tagung appears less as isolated professional training than as an instrument for organizing a field.⁴

By 2026, that structure no longer looked experimental. The 11th Nikotintagung again placed Barmelweid at the center, with Koalick in a key role, explicit support from the FNBS, and a schedule populated almost entirely by actors from public health, prevention, hospital management, and preventive communication. Registration was set at CHF 300. What appeared in 2008 as a publicly supported effort to build exchange among specialists had, by 2026, become recurring infrastructure: a site where common language, professional visibility, and institutional alignment could be reproduced.¹˜⁴

Its financial base was mixed. The Swiss Tobacco Prevention Fund states that it receives 2.6 rappen per pack of cigarettes sold and disposes of roughly 12 million Swiss francs per year to finance tobacco- and nicotine-prevention measures. Part of this world, in other words, rests on a stable public revenue stream anchored in the very consumption it seeks to reduce.⁴

The statutes of the former FTGS, later renamed FNBS, make the association’s revenue structure explicit: membership fees, certification income, project-related contributions, contributions from the Confederation, cantons, and municipalities, donations, service revenue from activities such as training, and investment income. This was not a body sustained by a single grant. It was built to operate as a platform: part association, part service provider, part intermediary for public and institutional money. Even the membership forms point in that direction. Individual membership costs CHF 80 per year; collective membership requires a CHF 250 entry fee and CHF 450 in annual dues. These are not large sums. But they show that affiliation was not only symbolic. It also generated structure.³

The material center of this arrangement was Klinik Barmelweid itself. In 2024, the clinic reported CHF 80.1 million in total revenue, almost all of it from services and deliveries, including CHF 70.6 million from medical and nursing services. It also held positions on the hospital lists of Aargau, Basel-Landschaft, Basel-Stadt, and Solothurn. That mattered because its place in the system did not rest on reputation alone. It rested on cantonal mandates, payer recognition, and formal insertion into the Swiss healthcare infrastructure.⁵

Certification is where these strands converge most clearly.

FNBS offered three certification levels for healthcare institutions—Bronze, Silver, and Gold—with formal pricing, staged requirements, and periodic recertification. More important than the fees was what the standards covered: leadership, communication, training, identification and support for cessation, tobacco-free environments, workplace health, public engagement, and evaluation. Certification, in this sense, did not merely attest compliance. It organized a model of institutional conduct.⁶

The signets extended that logic into the visual environment. FNBS marketed registered “Smoke Free” and “Smoking Area” signage, linking prevention to signage, space, and institutional design. Prevention, here, was not only advice or counseling. It also took material form as an organizational product.⁶

The strategic value of certification was stated most clearly by the network itself. In an interview on the Barmelweid blog, Susann Koalick described certification as a valuable signal to insurers and referring physicians and as something that strengthened the institution’s standing in other quality-certification processes. Barmelweid likewise emphasized that it had been the first Swiss clinic to receive this international Gold recognition in 2020 and the first to be successfully recertified in 2024. Certification did not, on its own, create the right to bill the mandatory insurance system that still depended on hospital lists and cantonal mandates. But it improved its relative position within the healthcare field. It made the institution more legible, more reputable, and more useful within the circuits of referral, reimbursement, and accreditation.²˜⁵˜⁷

At that point, certification ceased to be a detail and became an instrument.

What emerges from these documents is not a conspiracy, and does not need one. The interest is visible enough without it. Public-health language, public funding, certification, clinical infrastructure, and professional events were not operating separately. They were reinforcing one another. The result was a network able not only to advocate prevention but also to define standards, circulate recognition, organize training, convene aligned actors, and strengthen its own centrality within the field.

What remains unknown matters too. Within the public material reviewed here, there is still no audited breakdown of FNBS revenue by category, no precise weighting of each income stream, no full financing breakdown for the Nikotintagungen, and no complete public map of cantonal contracts and projects linked to the network. Those limits should be stated plainly. But they do not erase the pattern already visible in the available record.

That pattern is straightforward. Public money helped build the network. The network helped produce standards. Standards helped produce certification. Certification helped produce a position.

And position, in this case, had effects. It shaped access to recognition, referrals, institutional trust, and public partnership. It helped define what counted as exemplary practice. It generated recurring services around assessment, recertification, training, and materials. It made the network a more plausible partner for policy implementation and more influential in setting the tone of the debate.⁴˜⁵˜⁶˜⁷

The Swiss Barmelweid/FNBS network did not operate in isolation. It operated within a broader field in which the WHO, the ENSP, and philanthropic actors contributed to the financing, coordination, and dissemination of tobacco-control norms, campaigns, and institutional agendas. But the core mechanism is already visible at a closer range. In Barmelweid, prevention appeared not only as a medical or ethical imperative. It also appeared as a way of building position inside the health system, and of turning that position into further influence.⁸

In that sense, the question is not only what prevention opposes. It is also what prevention organizes, what it rewards, and what kinds of authority it helps reproduce.

Notes / Sources

1. Event framing, listed speakers, target audience, registration, and publicly visible omissions on the official page for the 11th Nikotintagung (2026):

https://fnbs.ch/events/11-nikotintagung-atem-und-wandel-breathe-for-change/

2. Barmelweid and network communications on certification value, international Gold recognition, recertification, and certification as a signal to insurers and referring physicians:

https://blog.barmelweid.ch/die-barmelweid-ist-eine-echte-vorreiterin/

https://www.barmelweid.ch/news/artikel/die-barmelweid-erhaelt-erneut-gold-in-der-tabakentwoehnung-international

3. FTGS/FNBS institutional continuity, statutes, revenue structure, governance, and membership categories/fees:

https://fnbs.ch/wp-content/uploads/2023/09/FTGS-Vereinsstatuten-2023.pdf

https://fnbs.ch/wp-content/uploads/2023/09/Einzelmitgliedschaft_Antrag.pdf

https://fnbs.ch/wp-content/uploads/2023/09/Kollektivmitgliedschaft_Antrag_d.pdf

https://fnbs.ch/ftgs-heisst-jetzt-fnbs-praevention-weitergedacht/

4. Swiss Tobacco Prevention Fund support for the 2nd Nikotintagung Klinik Barmelweid, including project record, final report, and TPF funding logic:

https://tpf-livingdocs.bagapps.ch/livingdocs.php?cq=2004%3B2025%3B0%3B%3B%3B%3B%3B0%3B&id=94&lang=de

https://tpf-livingdocs.bagapps.ch/data/pdf/94-0.pdf?v=1566208714

https://www.tpf.admin.ch/de/der-tabakpraeventionsfonds

5. Klinik Barmelweid institutional and financial profile, hospital-list status, cantonal mandates, insurance recognition, and patient admission pathway:

https://www.barmelweid.ch/fileadmin/user_upload/Dokumente/GB2024/Jahresrechnung_Klinik_Barmelweid_AG_2024.pdf

https://www.barmelweid.ch/ueber-uns/portraet/leistungsauftraege

https://www.barmelweid.ch/barmelweid/ihr-klinikaufenthalt/anmeldung

6. FNBS certification model, standards, pricing, recertification, and signets/signage materials:

https://fnbs.ch/zertifizieren/

https://fnbs.ch/produkt-kategorie/signete/

7. Certification as institutional signal and relative advantage within referral, reimbursement, and accreditation circuits:

https://blog.barmelweid.ch/die-barmelweid-ist-eine-echte-vorreiterin/

https://www.barmelweid.ch/news/artikel/die-barmelweid-erhaelt-erneut-gold-in-der-tabakentwoehnung-international

https://www.barmelweid.ch/ueber-uns/portraet/leistungsauftraege

8. Wider international coordination and financing ecosystem involving WHO, ENSP, EU-supported ENSP activity, Vital Strategies, and Bloomberg-linked tobacco-control programs:

https://www.who.int/teams/health-promotion/tobacco-control/implementing/capacity-building

https://ensp.network/wp-content/uploads/2017/05/ENSP-20-Years-LOWRES-ilovepdf-compressed.pdf

https://www.parlament.gv.at/dokument/XXVII/EU/38925/imfname_11019376.pdf

https://cordis.europa.eu/project/id/681109

https://ensp.network/wp-content/uploads/2022/02/ENSP-Annual-Report-2019_final.pdf

https://www.vitalstrategies.org/resources/tobacco-control-initiatives/

https://fctc.who.int/docs/librariesprovider12/technical-documents/global-progress-report-who-fctc-2023.pdf?download=true&sfvrsn=bd10da90_16

https://www.who.int/teams/health-promotion/tobacco-control/implementing/capacity-building

https://www.tobaccocontrolgrants.org/s/01-Tobacco-Industry-Interference-Grants-Call-for-Proposals-R5-Jan-final-2026-47fj.pdf

https://www.bloomberg.org/public-health/reducing-tobacco-use/bloomberg-initiative-to-reduce-tobacco-use

That may have been why it passed through the room without friction: the absence of conflict did not signal agreement so much as delimitation—a quiet recognition of what could be said, what need not be defended, and what had already been settled in advance.

The framing did not begin with the speech. It was already embedded in the program. Throughout the day, the themes aligned with minimal deviation: nicotine prevention, smoke-free culture, the industry's language, the impact of new products on children and adolescents, and digital strategies designed to contain their spread.

This kind of organization is hardly unusual in contemporary public-health gatherings, where the convergence of research, advocacy, and policymaking tends to narrow the space for explicit dissent. The language of prevention helps organize action, but it also prefigures the terms of debate.

What emerged was not a confrontation between competing interpretations so much as the reiteration of a shared vocabulary from multiple angles. In that arrangement, the conference functioned less as a site of reflection than as a mechanism of stabilization: before asking how risks, uses, and contexts might be distinguished, it had already determined which distinctions would count as relevant.

Its coherence is derived from that.
And so did its limit.

In this context, Castro’s position ceases to be incidental and becomes part of the arrangement itself. He speaks not from a distance, but from within a role that blends formulation, mobilization, and the defense of agendas. As a WHO Special Envoy, his task is to amplify messages, build alliances, and sustain institutional priorities.

This does not diminish the weight of what he says. But it does change how the speech must be heard. It operates not as an arbitration between competing hypotheses, but as a situated intervention within a broader effort to organize perceptions, align interpretations, and stabilize frameworks in public debate.

To his credit, Castro does not conceal this shift. He says so plainly: policy alone is not enough, because it is often “downstream from culture.” The issue, then, is not that the speech disguises its priorities, but that it relocates the center of gravity of the debate—from differentiating risks to defining the cultural and narrative terms through which those risks will be understood.

At that point, the problem no longer appears solely as one of evidence or scientific uncertainty, but as one of perception: how nicotine is seen, interpreted, and absorbed into the social imagination. Castro marks this shift explicitly when he frames prevention not only as a matter of regulation but also as a matter of understanding “how products are positioned, how language is used, and how perceptions of risk are shaped.”

He goes further. If policy is often “downstream from culture,” then what matters is “the story we are telling in the culture.” In his formulation, the concern is that “the narrative around nicotine is being shaped elsewhere,” in the language of innovation, choice, and harm reduction —and that, if left unchecked, it may “take hold before we have had a chance to define our own.”

With that move, the dispute extends beyond what is known to include which languages are granted legitimacy to describe the problem. The question is no longer only what counts as evidence, but who defines the narrative terrain on which that evidence will be interpreted.

That shift alters the nature of the problem. What once appeared as a question of differentiating risk now operates at the level of authority: who defines categories, who names phenomena, who establishes equivalences.

As that axis shifts, conceptual precision no longer occupies the center of the scene. Distinct products begin to circulate under a shared designation, sharing language before they share properties.

“New nicotine and tobacco products” becomes less a description than a container. Within it coexist the regulated e-cigarette used by an adult trying to quit smoking, the illegal device designed to maximize youth appeal, occasional experimentation, regular use, initiation, substitution, and relapse.

This cognitive economy is not trivial. In conditions of high complexity, broad categories facilitate communication, decision-making, and coordinated action. But they also reduce the capacity to distinguish among risks of different kinds, scales, and consequences.

The differences do not disappear. But they begin to matter less. What remains intact is the continuity of the category—and the cognitive economy it makes possible.

That cognitive economy was on display throughout the day. But once one returns to the empirical level—to the available data on youth use—the picture becomes less uniform than the language suggests.

Youth use of electronic nicotine devices, for instance, is unevenly distributed and does not follow a single trajectory. In many cases, it takes the form of episodic experimentation, often entangled with other risk behaviors and specific social settings. Part of that variability can be traced to factors that precede contact with the product itself, patterns of risk, family context, mental health, peer networks, and that resist reduction to any simple logic of exposure or access.

More persistent use tends to cluster among groups already predisposed to nicotine use or other forms of risk, which complicates linear explanations based solely on product characteristics, marketing, or availability. At the same time, in several countries, youth use appears to have peaked before declining or stabilizing, often alongside steeper declines in combustible cigarette use.

None of this erases the problem. But it does make it harder to treat it as a single phenomenon, with a single cause and a uniform solution.

Once those distinctions become secondary, policy design tends to follow the same logic. Interventions begin to operate as though they were addressing a homogeneous phenomenon, even when patterns of use, motivation, and risk differ sharply. Measures guided by simplified causal models focused on product, access, or marketing may leave the underlying drivers of demand largely untouched.

In some contexts described in the recent literature, this not only reduces policy effectiveness but also opens the door to less intuitive outcomes: users migrate across products, parallel markets expand, and potentially less harmful alternatives lose ground to more established forms of consumption.

Where alternatives are regulated without differentiation, demand does not simply disappear. It reorganizes itself, often toward more entrenched and, in some cases, more harmful patterns.

The problem, then, is no longer only risk itself, but the way risk is distributed and, at times, redistributed by the very responses designed to address it. That is what becomes harder to see once a single vocabulary settles too quickly over heterogeneous realities.

In public health, there is an inevitable tension between the need to simplify and the obligation to distinguish. Simplification helps organize action; it makes communication, mobilization, and scale possible. But every simplification carries a cost: it erases differences that, in some contexts, are precisely what matter most.

Simplification is inevitable. But not every simplification is innocent.

In Barmelweid, that balance seemed to tilt in a particular direction—not through any obvious error, but through the force of a consensus that arrived already structured, with its categories prepared, its urgencies defined, and its limits barely visible.

The risk lies not only in what is said about nicotine, but in what can no longer be recognized once language stabilizes too soon.

What is lost in such cases is not only nuance, but the capacity to adjust responses to realities that do not fit within a single category.

If Before the Numbers examines how consensus was made to sound natural in Barmelweid, what follows turns to the structure that helped make it so.

Its decline is real. But this shift was not merely epidemiological. It was also a change in the moral code. Smoking ceased to be a banal habit and came to signify a lack of self-command, a source of discomfort, a failure of self-discipline.

The mistake begins when this retreat is read as a uniform victory, as though the problem had diminished equally for everyone. It has not. What happened was something else: smoking ceased to be diffuse and became concentrated. And when harm becomes concentrated, its political character changes.

According to a study by Sarah Jackson, Sharon Cox, Jamie Brown, and Vera Buss, published in Nicotine & Tobacco Research and based on data from 2022 to 2024 for England, Scotland, and Wales, average consumption among smokers reaches 10.4 cigarettes per day —the equivalent of 28.6 billion cigarettes a year.

But the most important finding is not the sheer volume. It lies in the social pattern of consumption. Cigarettes are no longer distributed in a relatively even way across social strata. They are concentrated —and concentrated, above all, among the poor.

In the C2DE social grades, smoking prevalence stands at 18.8 percent, as against 10 percent among higher-income groups. Daily consumption is also higher: 11 cigarettes, compared with 9.4. On an annual basis, the gap becomes sharper still: 755 cigarettes per capita among the most vulnerable, versus 343 among the wealthiest segments.

These figures do more than measure consumption. They show how harm is distributed. In practice, that means smoking is no longer a habit spread across the social fabric; it has taken root in specific territories—neighborhoods, routines, and bodies in which quitting is not merely a decision, but a more remote possibility.

In this landscape, smoking can no longer be read simply as addiction, habit, or individual choice. It begins to function as a marker of class. Not because the cigarette has changed in nature or acquired some new sociological essence, but because its persistence tracks the line of inequality. When the better protected are able to exit first, and the most vulnerable are left behind, what emerges is not merely the persistence of a behavior, but the social concentration of harm—and, at the limit, a form of social triage.

This shift in the pattern demands a shift in language and in approach as well. Public debate about tobacco still speaks as though it were addressing an undifferentiated population: “the smoker,” “the user,” “the consumer.” They are convenient terms.

They erase low income, territory, interrupted schooling, precarious or exhausting work, psychic suffering, gender, ethnicity, the presence—or absence—of a support network, irregular access to treatment. In short, they erase the concrete intersections where vulnerability takes shape.

Those who continue to smoke are no longer a statistical abstraction. They are, increasingly, the point at which different forms of disadvantage converge. And policies that pretend not to see this end up treating as universal subjects people who have never lived under universal conditions.

Abstraction serves moral rhetoric well because individual blame is always easier to manage than structural inequality. It serves public policy badly.

For a long time, those who contest, occupy, and direct the state have learned to govern less through open prohibition than through the inducement to self-management. Health came to be demanded not only as a right, but also as a moral duty: proof of responsibility, a credential of active citizenship.

Within this regime, the good subject is one who calculates risks, corrects habits, manages the body, and lives up to what is expected of it. Whoever fails no longer appears as someone constrained by material limits, but as someone morally wanting: someone who has failed to govern himself.

It is here that the rhetoric of individual responsibility meets its limit. It can produce severe campaigns, effective slogans, and the appearance of moral firmness. But it does not explain why smoking recedes faster among the better protected and persists where life is more precarious. It does not explain why certain groups smoke more—and smoke more heavily. Nor does it explain why, when the habit loses social legitimacy, it does not disappear: it concentrates where protection is weakest.

Smoking does not vanish. It is pushed to the margins.

This displacement reveals something else: the consolidation of a way of seeing that Kirsten Bell and Hilary Graham help identify as a discursive hegemony. Certain public-health ideas no longer circulate merely as arguments; they circulate as common sense. The image of the smoker as someone who persists in error despite all the available information has become so intuitive that it scarcely needs defending anymore.

That is where the debate grows impoverished: when a worldview presents itself as a neutral description of reality. At that point, policy ceases to ask who still smokes, and under what conditions, and instead returns to the moral demand for individual self-correction.

But smoking does not distribute itself through the air. It concentrates where other forms of vulnerability have already piled up: in regions marked by deindustrialization, precarious work, overburdened public services, deteriorating housing, recurrent mental distress, and a narrower social horizon.

In these settings, the cigarette ceases to be merely a public-health risk. It begins to function as a symptom of social compression. It is not, of course, the only response to suffering—but it is one of the most visible. Smoke no longer appears simply as a private deviation; it becomes a record of collective wear and tear.

There is, then, an unavoidable political consequence. If the cigarette has become a marker of class, universal and morally abstract policies are no longer enough. Not because the state should downplay the harms of tobacco. Quite the reverse: to confront them seriously, it must recognize where they have become concentrated.

Measures designed for “the population” tend to fail when the problem has already taken hold in a specific segment—above all, a social segment historically pushed into invisibility. In such a case, universalism risks becoming, at best, a form of blindness posing as neutrality.

That is the point that ought to reorganize the debate. The problem of tobacco today lies not only in the product, though it begins there. It lies in the way harm is socially distributed.

When that harm is concentrated among the most vulnerable, public policy must abandon the fiction that warning, punishing, and taxing are enough to elicit equal responses from unequal lives. People do not respond in the same way because they do not live under the same conditions.

To treat the unequal as though they were equal may produce a tidy discourse. It produces, however, an unjust practice.

None of this absolves the tobacco industry or minimizes the toll of cigarettes on public health. Quite the opposite: it compels us to shift the question and expose the limits of a mindset that still dominates tobacco control—the mindset that reduces the problem to individual failure, insists on correcting behavior, and pushes to the margins the social conditions in which smoking persists.

It is not enough to ask why people still smoke. We must ask who continues to smoke, where, under what pressures, and with what real possibilities of escape.

That means reckoning, without caricature, with the harm-reduction paradigm. In many of the societies where most smokers are concentrated—above all in low- and middle-income countries—lower-risk alternatives remain blocked by regulatory uncertainty, illegality, criminalization, and stigma, as though any departure from the ideal of abstinence already amounted to a form of moral surrender.

The result is a politics that speaks in the language of protection yet often fails to offer a response proportionate to the risk faced by the very groups most exposed to combustion. And it does so in the name of an ideal of sanitary respectability, heavily marked by class values, that itself produces marginalization.

Smoking no longer sketches a general portrait of society. It draws a border. And, as Hilary Graham has shown, that border separates not so much smokers from non-smokers as those who were able to move away from harm and those who remained more exposed to it.

She counts the coins twice.
The first time is the gesture of someone who already knows the outcome.
The second is for someone who still hopes, against all evidence, that the numbers might have changed.

They haven’t.

The lighter fails twice; on the third, the flame comes up unsteady.
She lifts a leaflet from the health clinic as a shield.
On it, a darkened lung wavers in the wind.

“I keep borrowing from the future,” she says, to no one.
“I never know when it comes due.”

The sentence isn’t a metaphor; it’s a household budget.

Anna, twenty-eight, in a supermarket uniform, lives in the gap between what comes in and what runs out.

Here, the cigarette is not the abstract vice of anti-smoking campaigns. It is a small technology of survival: it structures waiting, marks a pause, holds open the distance between one bus and the next.

For decades, public health spoke in the language of the future: stop now to live later, defer pleasure in the name of a reward still to come.

Prevention rested on a quiet premise: that tomorrow was a credible horizon, something worth investing in.

But for millions, the future has lost weight; the horizon has shortened.

Between precarious work, fatigue, instability, and urgency, life is no longer organized around the promise of improvement, but around the management of the day.

It is on this terrain that prevention begins to lose its grip, not because people have become more ignorant or irresponsible, but because the logic of postponement requires a pact not everyone can enter into. When the present fills with exhaustion, fear, and improvisation, the long term no longer governs behavior with the same force.

The bus arrives. The doors open.
Anna steps on, drops in her coin, and moves toward the back.

The future is the interval between this cigarette and the next.

In a yellow-lit kitchen, an old fan turns without cooling the air.

August, seventy-three, shirt open at the chest, coughs over the sink; an old cough, one that already knows the way.

On the table, a full ashtray and a cup of cold coffee. On the refrigerator, a child’s drawing held by a magnet: a crooked sun, a house, three stick figures.

August picks up a pack. He begins the motion of lighting and stops. He looks at the drawing. He places the cigarettes in a glass jar, one by one, unhurried, as if storing something dangerous. Then he sets the jar on top of the cabinet, out of a child’s reach. His hand comes down slowly.

The scene belongs to the past, but it still pulses in the present. August is Anna’s grandfather. The interrupted gesture, the almost-lit cigarette, the jar lifted out of reach, condense something larger than an individual decision. The will was there. What was missing was ground.

For much of the twentieth century, the promise of progress was also a promise of time: present sacrifice would yield returns later on. To a large extent, collective life was organized around the idea that the future was worth the investment.

That arrangement has worn down in recent decades. Not all at once, but through erosion: successive crises, persistent precarity, accumulated distrust. Historians have called this narrowing of temporal experience presentism. Outside theory, though, the phenomenon is easy to recognize. When work is unstable, housing is uncertain, and rest is scarce, the long-term loses density. Planning ceases to be a habit and becomes a wager.

In Brazil, this contraction of the horizon is also distributed across territory and class. In São Paulo, the gap in average life expectancy between districts exceeds twenty years. It is as if two countries occupied the same space: one in which tomorrow stretches far enough to justify sacrifice, another in which it collapses from within. Smoking does not produce this divide, but it settles inside it.

The waiting room is a limbo of plastic and cold light.

An electronic display flickers numbers that don’t move.

On the wall, a blackened lung.
Next to it, a faded slogan:

“SUFFER NOW TO LIVE BETTER LATER.”

Someone coughs. Someone checks their phone. Anna holds a handful of coins inside her bag, as if she could protect them.

The doctor doesn’t look up from the chart.
“How long have you been smoking?”

Anna opens her mouth. “Since—”

She doesn’t finish. The doctor has already checked a box: training, neutrality. He slides a leaflet across the table, illustrated lungs, benefits, and a phone number.
Anna takes the paper with both hands, like someone receiving a promise she isn’t sure she can keep. She signs where she’s told. She doesn’t read.

For decades, public health has proposed the same bargain: give something up now — a pleasure, an immediate relief — in exchange for benefits later. Eat better, move more, quit smoking, adhere to treatment.

The exchange feels fair when the future is a livable horizon, when tomorrow still inspires trust. But prevention is not only a calculation of risk; it is also a moral contract, and that contract presumes stability. Above all, it presumes that delay is worth it.

In the waiting room, that contract already appears worn.

Anna signs without reading — not out of carelessness, but because the gesture of compliance has, for many, become an empty ritual, a formality that life quickly contradicts. Here, prevention fails not because of ignorance. It fails because it requires a kind of material and subjective ground that not everyone has.

There is a mismatch between the temporality of prevention and that of precarious life. The first operates in the long term: years without smoking, disciplined routines, benefits accumulated quietly. The second in the short: the money that runs out at the end of the month, the exhausted body that demands relief now, the urgency that does not wait.

As the public-health literature shows, quitting smoking is strongly associated with income, education, mental health, and access to support. Not because low-income smokers know less or want less, but because cessation is not simply an act of will. It requires time, care, margin, and protection against extreme stress, resources that are deeply unevenly distributed. On its own, will does not carry a person across a compressed present.

At the factory gate, the sky hangs low and dirty.

Damian, forty-two, his uniform stitched at the chest, wears a stopped watch on his wrist. He looks at it not to tell the time, but to confirm there is no time left.

The lighter fails twice; on the third, the flame comes up unsteady.
He cups his hand around it, shielding the fire from the wind.

The first drag is short, almost tentative. He coughs once, dry, then swallows it, glancing sideways, as if coughing were a minor fault.

Later, in another kitchen, another night. Anna is in sweatpants, her hair fallen loose with exhaustion. She washes a pan quickly, trying not to make a noise. She opens the window just enough to slip her arm through. The flame wavers, then catches. She inhales and holds the smoke for a second. It is not a pleasure. It is a suspension.

From the bedroom comes the sound of a child breathing.

In the hallway, a toy on the floor.
She almost trips. Stops. Looks.
Love, irritation, fatigue, all at once.

She exhales the smoke outward, trying to make it disappear before it can exist inside.

In both gestures — Damian at the factory gate, Anna at the window — the cigarette appears not as an abstract habit, but as a small everyday technology. It does not resolve suffering; it gives it shape. It marks an interval, introduces a ritual, and offers a brief, predictable reward in a day without contour. In lives where work, sleep, time, and care have lost their regularity, it functions as a minimal tool of self-regulation.

What appears irrational from a public-health standpoint becomes legible when one looks at what the cigarette provides in return. It is cheap, portable, and immediate. It requires no appointment, no line, no consultation, no free time. It is at hand. And for that reason, it often takes the place of other forms of relief and care that, for many, are expensive, scarce, or simply unavailable.

But its function is not only chemical.

The cigarette also organizes time: it marks the beginning and end of a pause.

In fragmented routines, irregular shifts, and schedules that disregard sleep, the minimal ceremony of lighting it opens an interval that still belongs to the smoker, however brief, however paid for with their own health.

In unequal contexts, smoking is more heavily concentrated among those pushed into precarious paths of income and schooling.

This difference does not stem only from unequal knowledge; it also reflects how rest, pleasure, and care are socially distributed.

In conditions of greater vulnerability, the cigarette takes the place of forms of listening, relief, and protection that are scarce, inaccessible, or simply nonexistent.

There is also a relational dimension.

The cigarette accompanies waiting, solitude, and the exhaustion of alienated work. It becomes a pretext to step out of a stifling room, a license for a minute away from children, bosses, and the demands that do not cease. For those who spend the day caring for others — children, the elderly, clients, patients — or converting their own time into income for others, it can become the only gesture that still feels like it belongs to their own body, even as it exacts a destructive cost.

On the ground, a faded yellow rectangle.

Inside it, a man lights a cigarette.
Clara approaches with grocery bags. She slows. Looks at the blue sign:

“SMOKING AREA.”

Looks at the rectangle.
She makes a small detour, as if the ground there were contaminated.
As she passes, she holds her breath for half a second.
Adjusts her coat with her fingertips.

Two steps later, she exhales. Her face does not register relief. It simply confirms.

In the elevator, the man steps in right after her. Clara presses the button for her floor. Without looking, she also presses the fan. The light comes on. A young woman pulls her backpack to her chest, like a shield. Someone shifts back an inch. No one speaks.

Later, in the building’s group chat, Clara writes: “Hi everyone, smoke has been coming up into my apartment. There are children and elderly people here. Please be considerate.” The reactions arrive within seconds: hearts, thumbs up, an “exactly.”

Clara is not a villain. She is someone who has internalized the moral language of public health as an almost natural extension of good manners.

In her gestures — the detour, the held breath, the press of the fan — there is no explicit cruelty. There is a boundary being drawn.

The smoker no longer appears as a subject with a history, a routine, an exhaustion. He becomes odor, nuisance, a failure of care.

Anti-smoking policy has produced real gains. The decline in smoking in Brazil, for example, is one of them. But part of its public language has remained tied to a moralizing imagination, in which the smoker appears as a deviation, a failure of will, and irresponsibility.

The social structure of suffering recedes from view; individual behavior takes over the entire stage. The result is the predominance of a pedagogy of shame.

This pedagogy does more than communicate risk; it teaches the smoker to feel out of place. The yellow rectangle on the ground, meant simply to contain harm, also marks an exception: one may remain there, so long as one remains apart.

The smoker’s body becomes a suspect body, polluting, displaced.

The phrase on the waiting-room wall — “SUFFER NOW TO LIVE BETTER LATER” — condenses this imperative. To suffer in the present appears as virtue; to refuse that suffering, as weakness. The problem is not informing people about harm, but turning the difficulty of quitting into a failure of character, as if smoking were merely an individual choice, rather than a socially produced condition, often shaped by exhaustion, precarity, and inequality.

There is also an economic dimension to this arrangement. Tobacco is heavily taxed, and the burden falls more heavily on those with less. The state regulates, collects, and warns; care, however, does not reach with the same breadth. For many, the equation looks like this: smoke, pay dearly, fall ill, carry the blame.

The effect of this combination — stigma, regressive taxation, uneven support — is the individualization of suffering. Not smoking ceases to be only a matter of health and becomes a marker of discipline, self-control, and belonging. What is at stake, then, is not only care. It is also status, distinction.

The nurse peels back the seal on the package.

The plastic snaps.

Anna sits with her hands in her lap; short nails, a pen mark on her finger.
She pulls up her sleeve without ceremony.

Cotton on the arm.
A dry touch.

The nurse applies the patch and smooths it with two fingers, counting silently. Anna watches the gesture: the way something is sealed that wants to come loose.

Days later, in the middle of the night, she is alone in the kitchen.

On the table, the box of patches and the crumpled leaflet. She pulls up her sleeve. The old patch is still there, one edge lifting. She removes it slowly.

The skin beneath holds the mark: a pale rectangle at the center of her arm.

She opens another. The plastic snaps softly. Applies it. Smooths it with two fingers. Presses the edge until it holds. Pulls her sleeve back down.

She stands there for a moment, as if waiting for her body to agree.

Later, at the bus stop, she takes a cigarette from the pack. Stops.

Her arm hangs suspended.
She puts the cigarette back.

From her bag, she takes a dark object, worn from use. She brings it to her mouth. A short pull. A small light flickers on and off.

The vapor dissolves into the cold air.

What these scenes show is not the redemptive victory of abstinence. It is something else: a movement of substitution, hesitant and imperfect, but guided by a logic that traditional public health takes too long to recognize. When someone cannot, or does not manage to stop immediately, care cannot simply withdraw.

Not everyone will interrupt harmful practices in the short term, and the conditions for doing so are unevenly distributed. Faced with that, the response is not to abandon those who continue to use, but to reorganize care around what is possible: to reduce risk, to lessen suffering, to widen the margin for breathing.

This is the moral turn of harm reduction. It replaces the question “how do we make someone stop?” with another, more modest and more concrete: “how do we make it so that, while they do not stop, they are harmed less?” It is not surrender. It is a refusal of the all-or-nothing logic. Care no longer demands purity in order to begin.

In the case of tobacco, this includes intermediate strategies: nicotine-replacement therapies, gradual reduction, and, for many, a shift to non-combustible forms of use. None of this eliminates risk. But for smokers who have repeatedly failed in attempts at complete cessation, these alternatives may mean less harm than continuing to smoke conventional cigarettes.

Resistance to this approach is not only technical. Part of it rests on some legitimate concerns: the long history of manipulation by the tobacco industry, uncertainty about the long-term effects of certain products, the risk of displacing, rather than dissolving, dependence, and the fear that intermediate strategies may reopen markets, normalize new forms of harm, or weaken decades of hard-won regulation.

But the resistance does not end there. It also arises from a moral discomfort with the idea that care might coexist with imperfection, with continued use, with bodies that do not purify themselves all at once.

Anna, at the bus stop, the vapor dissolving into the cold air, is not a success story by conventional standards. She still performs the gesture. She still depends on nicotine. But she no longer burns the clinic leaflet to light her cigarette. The change is ambiguous, negotiated, and still, it is the change that is possible.

In a well-kept garden bed, the leaves gleam with moisture.

A gardener, in thick gloves, trims the shrubs.

Snip. Snip.

Branches fall. Leaves fall.

He gathers everything with a shovel and pushes it into a black bag.

Two meters away, almost out of frame, a man sleeps wrapped in a thin blanket. From inside it comes a cough — small, persistent. The gardener does not look. He picks up the sprayer. Presses. The leaves take on a fresh shine. The man keeps coughing.

The scene is brief, but it condenses a question: What is the point of pruning dry leaves if the soil remains the same?

Harm reduction is an ethical and practical achievement. It allows care to continue where abstinence cannot begin. But it carries a risk: detached from structural transformation, it can become the humanized management of ruin.

The gardener tends to what is visible; what can be contained, trimmed, and made presentable. He does not alter the conditions that produce that body on the pavement. He does not alter the cold. He makes the garden appear habitable, while its actual inhabitant remains at the margins.

In health care, this logic reproduces itself easily. A patch, a brief consultation, an intermediate strategy — all of it is better than nothing. It reduces suffering, prevents greater harm, and widens the margin for survival. But if the social conditions that produce exhaustion, anxiety, and illness remain untouched, care risks being reduced to maintenance: it keeps the body functioning, however precariously, while leaving intact the ground that makes it ill.

The critique, then, is not of harm reduction but of what happens when it is stripped of its political dimension and returned to mere management. At that point, care ceases to be an opening and begins to function as containment: it intervenes on isolated bodies, manages symptoms, prolongs survival, but does not touch the world that distributes exhaustion, inequality, and illness. The collapse of the precarious is averted, without interrupting the order that produces it.

Anna, with the patch under her sleeve and the vapor dissolving into the cold air, has managed to exchange one technology for another. She has reduced the harm. But she remains at the same bus stop, with the same coins that don’t add up, the same faded uniform, the same endless waiting. The care she received has helped her not to worsen. It has not moved the world that keeps her there.

The bus sways.

Bodies lean together, in silence.

Anna rests her head against the fogged glass.
She wipes it with her sleeve, opening a small circle of visibility.

Outside, the street is coming into morning: people walking fast, a dog nosing through trash. In here, the silence of those already tired.

Anna’s hand goes to her arm by instinct.
She presses the patch, as if needing to confirm that it is still there.

Later, in the dark kitchen, she sits at the table.

The box of patches. The crumpled leaflet.

She pulls up her sleeve. The edge of the patch holds firm now. She smooths it once with her thumb. Opens the drawer. The crumpled pack is there.

She looks. Closes the drawer.
She rests her forehead against the cabinet for a second.

Breathes in through her nose. Lets the air out through her mouth, without a sound. Turns off the light.

There is no redemption in this scene: no heroic gesture, no solemn farewell.
Only a woman who looks at the pack and does not light it.

A hand that presses the patch, to feel that it is still holding.

The politics of the “still” is made of these minimal gestures. It promises no cure, demands no purity, expects no redemption. It works with what remains, insisting on doing something with that remainder.

Still alive. Still breathing. Still with some margin. Still capable of care.

It is a modest ethic, but not a minor one. In a time when the future has lost its density, it offers a form of care equal to exhausted lives: not the kind that abandons when someone fails, but the kind that remains, reduces harm, and sustains what is possible.

The politics of the “still” does not replace social justice. It does not make the coins add up, does not restore length to a horizon that has shortened. But it prevents the absence of social justice from becoming an alibi or a license for abandonment. While the ground does not change, it sustains those who are still standing on it.

Anna, in the dark kitchen, with the pack in the drawer and the patch on her arm, is not a success story. She is a case of persistence. And when the horizon contracts, persistence may be the only form of future that remains.

The bus moves on.
The glass fogs again.
Anna leans her head.
Her hand goes to her arm.

The patch is still there.

Note:

This essay began with a question: why does smoking remain so persistent among the poor?

Over time, the answer drifted away from the usual explanations: personal choice, lack of information, weak willpower. It began to emerge elsewhere: in exhaustion, in the brief pauses during precarious work, in money counted down to the last coin, in the constant pressure to get through the day, and in the difficulty of imagining a future that could justify sacrificing the present. In other words, in a life where both present and future have been compressed.

In that setting, smoking seems less like an abstract vice and more like something immediate and functional: a cheap anesthetic, a way to structure waiting, a small, reliable break. A minimal form of control in a world where almost nothing feels managed.

Between Breaths, a short-film script I wrote before this text, was an early attempt to explore that world from within, rather than from a distance of argument. The scenes are not reportage, but they are shaped by many real lives. They helped bring my attention closer to the concrete rhythm of those lives: fractured time, accumulated fatigue, and the small gestures through which a day is managed.

If the fiction attempts to stick with those gestures and pauses, this essay tries to make sense of what they reveal.

The deadliest nicotine product ever invented remains legal, visible, and routine. It is there in convenience stores, in the crumpled packs carried in a pocket, in the break during the workday, on the corner, in the habit itself. Almost everywhere, the combustible cigarette remains so readily available that its chemical violence nearly dissolves into the landscape.

The paradox requires no rhetoric. Around it, however, the language of prudence shifts in tone. Nicotine products that are substantially less dangerous, though backed by different kinds and degrees of evidence, such as vapes, snus, nicotine pouches, and heated tobacco, circulate in many countries under a regime of suspicion denser than the one reserved for the cigarette itself. In some places, they are banned. In others, they are tolerated grudgingly, hemmed in by restrictions or described in a public language that treats gradations of risk as though they were morally intolerable concessions.

This is where the Global Forum on Nicotine stops seeming like merely a niche conference. Since 2014, the gathering in Warsaw has become one of the clearest places in which this contradiction is examined without the easy protection of ready-made formulas. Researchers, physicians, regulators, consumers, industry representatives, web activists and harm-reduction advocates come together there not as a harmonious community but as a dissonant assembly, drawn by an impasse the global debate has yet to face with much honesty: how to lessen the deadly burden of smoking in a field where, for many institutions, distinguishing degrees of risk remains more uncomfortable than pretending they do not exist.

The question begins, in part, with Gerry Stimson, the British public-health social scientist and one of the defining figures in the history of harm reduction. In 2013, after years of watching part of the European debate treat tobacco and nicotine as though they belonged to the same moral order, Stimson arrived at a diagnosis almost too plain to be palatable: public health was failing to distinguish between what creates dependence and what, in combustion, causes death.

“We have known for a long time that people smoke for nicotine and die from the gases and tar.”

The line, which Stimson brought back at the Forum’s first gathering, needed no embellishment. It revealed a fault line. On one side stood the possibility of thinking in terms of relative risk, harm reduction, and regulatory innovation, without treating every nicotine product as if it were the burning cigarette. On the other stood a stubborn public grammar in which nicotine, combustion, and harm are still fused into the same condemnation.

From that fracture came the first Global Forum on Nicotine, held in Warsaw in June of 2014, with support from collaborators including Paddy Costall and Andrzej Sobczak. Some 220 participants from 26 countries attended the first gathering. The meeting was small. The problem was not. The Forum’s purpose was already clear: to create a space in which that distinction could be examined before it was moralized, flattened, or consigned to silence.

Since then, the GFN has become something more than an annual conference. It has served as a seismograph for the tensions reshaping the debate over nicotine, smoking, and harm reduction. With each edition, what returns is not simply a new theme but the same conflict particles in altered form: between evidence and orthodoxy, between the lived experience of people who smoke and the institutional languages that presume to speak for them, between the possibility of reducing harm and the persistent temptation to treat nuance itself as a form of weakness.

Over the years, the GFN began to take shape as a kind of recurring map of the tensions, shifts, and impasses reorganizing the debate over nicotine and smoking. Each edition captured less an isolated theme than the momentary state of a larger dispute.

In 2015, the dispute came into sharper focus. With “A Different Kind of Endgame” as its theme, the Forum began asking not only how smoking might end but also what sort of ending was being imagined. For years, the prevailing assumption had been that the cigarette would be defeated chiefly by ratcheting up pressure on people who smoke and on the industry. What the GFN began to frame more clearly at that point was another possibility: that lower-risk nicotine products might speed the cigarette’s decline by a route many still resisted recognizing, especially within public health itself.

The opening of the conference already made clear the axis of that shift. In the Michael Russell Oration, Derek Yach warned that the WHO Framework Convention on Tobacco Control would need a radical shift in emphasis to remain relevant. The point was straightforward: separating nicotine from tobacco-control policy was no longer some marginal provocation; it was becoming a precondition for thinking about the end of the cigarette itself without the usual rhetorical reflexes. By 2015, the GFN was beginning to show that the dispute was not just about products. It was about who would claim the authority to define the public-health horizon of the endgame.

By 2016, the ground was already beginning to shift. Under the banner Evidence, Accountability and Transparency, the Forum addressed a fast-changing landscape in which new nicotine-delivery systems were advancing faster than institutions could assess them without reverting to habit. The problem was no longer simply the arrival of new products, but the asymmetry between the speed of innovation and the slowness and, in some cases, the reluctance of regulatory response. In that setting, transparency and accountability referred not only to the data themselves. They also referred to the institutional and personal positions through which those data were being interpreted.

In his opening remarks, David Sweanor summed up the scale of the dispute: hundreds of millions of lives were at stake, along with hundreds of billions of dollars and the reputations of entire groups and individuals, all of it unfolding in an environment saturated with beliefs that were at once deeply entrenched and badly misinformed.

That year, the GFN was beginning to show that the debate over nicotine would be fought not only over evidence, but over who could be trusted to interpret it honestly and to expose, without pretense, the interests bound up in it. The European premiere of Aaron Biebert’s A Billion Lives pushed that shift further: the conflict was no longer calling only for regulation. It was also calling for a narrative.

By 2017, the Forum was speaking more plainly. With the theme Reducing Harm, Saving Lives, a sharper conviction was coming into view: ignoring lower-risk alternatives was not a way of preserving neutrality, but a way of consenting, through omission, to avoidable harm. As the science advanced and the regulatory landscape shifted by degrees, it became harder to keep treating harm reduction as a marginal hypothesis or a rhetorical concession. What was at stake was beginning to be stated with greater candor: if products less dangerous than the combustible cigarette exist, then rejecting them outright is also a choice, and one with a human cost.

That year’s Michael Russell Oration carried the shift further by another path. In “Drug Control and Tobacco Control: Parallels, Reform and Advocacy,” Ethan Nadelmann suggested that the debate over smoking had something to learn from the history of drug policy, particularly from the repeated failure of models that leave consumers out of the process and confuse protection with tutelage.

The first edition of the International Symposium on Nicotine Technology (ISoNTech), brought into the Forum that same year, extended the movement: the dispute was no longer only regulatory or epidemiological. It was also lodged in the material reality of innovation—the devices, their engineering, their evolution—and in the way technology might, in practice, reconfigure the possibilities of moving away from the cigarette.

With each edition, the same dissonance reappeared in a different form. On one side was a growing body of data, studies, successful regulatory experience, and testimony from consumers who had shifted away from cigarettes using noncombustible products. On the other hand, there was the persistence of a political culture hostile to nuance, in which distinguishing degrees of risk seemed more dangerous than preserving a single moral pedagogy.

By 2018, under the banner Rethinking Nicotine, the Forum was no longer arguing only about how to interpret the evidence, but about the very language in which the debate was conducted. The point was to rethink nicotine’s place in public health without falling back, by force of habit, on the inherited grammar of tobacco control as if every form of use had to bear, untouched, the cigarette’s historical guilt.

The growing presence of consumers, the creation of the Michael Russell Award, presented to Lars Ramström, and the launch of the Tobacco Harm Reduction Film Festival all suggested that the field was widening: it was no longer enough simply to produce data; it was necessary to contest the images, symbols, and narratives through which those data would be made legible.

In 2019, the forum returns under the theme “It’s Time to Talk About Nicotine.” It was no longer just a matter of rethinking nicotine, but of bringing it out of the regime of silence, discomfort, and simplification that public debate had built around it.

To talk about nicotine, in that context, was to reopen distinctions that much of the language of public health had learned to suppress: between the cigarette and nicotine, between combustion and consumption, between the ideal of abstinence and the possible reduction of harm.

It was meant to compel public health to recover a language capable of recognizing degrees of difference. And, with them, differences in fate.

The growing interest in that shift was already evident in the scale of the gathering: nearly 600 participants came to Warsaw that year, a significant increase over previous editions.

In accepting the Michael Russell Award, David Abrams distilled one of the crucial points the Forum had been trying to restore to the center of the debate: the issue was not only one of product, risk, or regulation, but whether people trying, in concrete ways, to change their relationship to nicotine would be met with acceptance, understanding, and compassion. “It’s about the people, the people and the people,” he said.

By 2019, the GFN was showing that the dispute over nicotine was not only about toxicology or policy. It was also about the moral imagination through which public health chooses to regard people who smoke.

Then the pandemic arrived, and with it a new kind of test.

In 2020, like nearly every international gathering, the GFN was pushed online. In its case, though, the shift did not reduce it to a digital replica. In some respects, it enlarged it. The need to build its own broadcast platform enabled the Forum to reach more people, launch GFN TV, and give its debate ecosystem a more continuous and visible form.

That year’s edition, with more than two thousand participants from over a hundred countries, made plain what had been visible for some time: the discussion around nicotine and tobacco was not only scientific or regulatory. It was also ethical, political, and deeply bound up with the language of rights and the everyday lives of ordinary people.

In a year defined by the theme “Nicotine: Science, Ethics and Human Rights,” the meeting brought together more than thirty speakers over two days to examine not only the growing body of evidence in favor of harm reduction but also the intensifying attacks on researchers, academics, and professionals associated with the field.

Entire organizations were being discredited; real or alleged ties were used as a mechanism of disqualification; and public debate seemed increasingly willing to descend into ad hominem attack.

It was in that atmosphere, saturated with fear, misinformation, and narrative struggle, that issues such as the lung-injury crisis known as EVALI took on particular weight, along with its mistaken attribution to nicotine vaping rather than to illicit THC products, the moral panic around youth use, and the influence of major philanthropists on the language and priorities of public health.

By 2020, the GFN was showing that the conflict no longer turned only on disputes over the evidence. It also turned on the very conditions that made debate possible.

In 2021, still under the shadow of the pandemic, the GFN began to press a question that carried the debate beyond the immediate crisis: what is the future of nicotine?

The formulation sounds abstract only at a distance. Up close, it drags behind it questions of science and investment, global inequality and consumer behavior, regulatory capacity and control policy, and at the center of it all, the persistent friction between orthodoxy and innovation.

Organized around The Future for Nicotine, that year’s program examined both the advances already visible in the world of lower-risk products and the often abrasive relationship between science and policy, the impact of technological innovation on public health, and the repeated failure of international bodies to hasten the end of the cigarette.

The Forum had not yet fully returned to an in-person format. The 2021 edition adopted a hybrid model, with a small core of speakers and attendees on site and broader participation online.

But that constraint revealed something else: the GFN was no longer functioning only as a gathering but as a platform for mediation, commentary, and archiving.

The creation of the GFN Commentary Team and the introduction of #GFNFives, which replaced academic posters with short videos submitted by participants, pointed to that change in scale.

By 2021, the Forum was making it clearer still that the dispute over nicotine would not be decided solely by the production of evidence or the drafting of rules. It would also depend on who managed to interpret, translate, and circulate that evidence in an increasingly fragmented public sphere.

When the Forum returned to Warsaw in person in 2022, it no longer made sense to think of it as merely an annual conference. The GFN had become an infrastructure for debate: a machine for producing, recording, translating, and circulating controversy.

The hybrid format, the broadcasts, the #GFNFives shorts, the GFN TV commentary, and the simultaneous translation expanded the Forum’s reach and altered its nature. What was at stake was no longer simply bringing people together in one city, but creating the conditions for certain ideas to travel beyond the room, cross borders, and remain open to public scrutiny. In a field so shaped by caricature, silencing, denial, and moral simplification, that was no mere technical detail. It was a form of intellectual intervention.

That year’s program gave real substance to the shift in scale. The Forum confronted misinformation around harm reduction head-on, examined the role of philanthropy in the field, returned to the uncomfortable question of the Framework Convention’s failure to bring smoking down in any meaningful way, debated the transformation of the industry without the usual comfort of ready-made formulas, and insisted that the problem was not exhausted by vaping, but pointed instead to an entire continuum of risk and displacement away from the combustible cigarette.

Other questions were also returning, now in sharper outline, questions that would no longer be marginal from that point forward: academic freedom in the field of tobacco control, and the question of whether regulation was actually helping to reduce smoking or simply narrowing the alternatives available.

The Michael Russell Award, given that year to Brad Rodu in recognition of more than two decades of research and advocacy for access to safer products, confirmed the sense that the GFN was no longer content merely to observe the dispute. It was becoming more and more one of the places where that dispute found language, contour, and public force.

The Forum’s tenth edition, in 2023, offered a rare chance to look back on its own trajectory without succumbing to self-congratulation.

A decade after its debut, the GFN could credibly claim a singular place in shaping the global debate over tobacco harm reduction. Over those years, it had helped draw researchers and advocates closer to one another, as well as regulators and consumers, voices from the Global South, and academic circuits still caught in the North’s gravitational field.

Above all, it had preserved a space for substantive disagreement, something that, in an age of performed polarization, had become not just rare but structurally at risk.

The anniversary, though, hardly warranted any naïve celebration. On one hand, the global use of vapes, snus, heated-tobacco products, and nicotine pouches continued to grow, as tens of millions of people sought out less risky alternatives. On the other hand, a persistent fog of regulatory and political confusion remained capable of blunting part of that movement.

The tenth edition unfolded in the shadow of a harder question: what happens when public uptake outpaces institutional imagination? The approach of the Framework Convention’s COP10, held later that same year in Panama, brought that tension into sharper relief.

In response, the GFN sought to broaden not only the debate itself, but also access to it. Alongside free streaming, live and on demand, came simultaneous interpretation into other languages, initially Spanish and Russian, and a more deliberate effort to open the space to people who had long orbited the debate without ever quite entering it.

The Michael Russell Oration, delivered by Professor Roberto Sussman and devoted to a rigorous critical assessment of the science around tobacco and nicotine, neatly captured the spirit of that moment: ten years on, the question was no longer simply how to produce more evidence, but who gets to interpret it, within what frame, and in service of what kind of future.

By 2023, the GFN was showing that it was no longer peripheral. It had become a force in the debate.

In 2024, under the banner Economics, Health and Tobacco Harm Reduction, the Forum pushed to the center a dimension that had long shaped the debate but had seldom been acknowledged as its organizing core: economics.

It was no longer enough to argue over evidence, relative risk, or regulatory design. The harder question was what it costs—in lives, money, and historical time—to regulate badly, or to prohibit, alternatives less dangerous than the combustible cigarette.

At that point, harm reduction had ceased to be merely a public-health or moral controversy. It was also revealing itself as a dispute over prices, access, taxation, incentives, and technological innovation. To talk about health without talking about political economy was to remain on the surface of the problem.

That year’s program made the point hard to ignore. What are the effects of overly restrictive regulation? Is it possible to quantify the health-care savings associated with the availability of safer products? Does the decline in tobacco-tax revenue, or the state’s dependence on that revenue, shape the regulation of alternatives? And to what extent do badly calibrated rules drive independent manufacturers out of the market and discourage the shift away from combustion?

The presence of figures such as Professor Andrzej Fal and the analyst Vivien Azer gave substance to that widening of perspective. The introduction of #ScienceLab, meanwhile, reinforced the effort to bring emerging research closer to public debate.

And the Michael Russell Oration, delivered by Cliff Douglas and centered on global action to end smoking, helped distill the impasse of that moment: the future of the combustible cigarette would no longer be decided only in the laboratory or the regulator’s office, but also on a less visible, and often less openly acknowledged terrain: that of markets and their asymmetries.

By 2025, the banner Challenging Perceptions: Effective Communication for Tobacco Harm Reduction read like a diagnosis of the times. The dispute was no longer unfolding only on the level of evidence, but in the realm of its public circulation, in whether it reaches people, or fails to reach them at a moment when journalistic rigor was losing its central place and social media, platforms, and the attention economy were beginning to shape collective perception through simplification, moral panic, and low-resolution truths.

Challenging perceptions had become the central task. Not because the science offered easy answers, but because the public sphere seemed less and less willing to tolerate nuance, context, and contradiction.

The paradox could no longer be dismissed as noise: as the scientific case for harm reduction grew more substantial, its public reception, in many places, was becoming murkier. Lower-risk nicotine products continued to erode the cigarette’s centrality. But that movement was advancing in an atmosphere of caricature, suspicion, and simplification that could delay, if not altogether block, the translation into policy.

That was the point at which communication ceased to be merely an adjunct to science. It became part of the conflict itself. It was no longer enough to produce evidence; it was necessary to contest the frame, correct enduring distortions, and ask who was still being left out of the conversation.

In an environment where discourse itself is an instrument of power, perception functions as a regulatory field, and institutional caution can serve as an alibi for inertia, the problem came to lie less in the absence of data than in the difficulty of making those data legible before they were immediately absorbed by the machinery of moral panic.

The choice of Fiona Patten for the Michael Russell Award distilled the spirit of that year with unusual clarity. An Australian politician, consumer, and longtime advocate of harm reduction, she brought together in a single figure lived experience, regulatory conflict, and the public struggle over language. By 2025, the GFN showed that the battle was no longer fought only over what science knows, but over what a society allows itself to hear.

That may be why the GFN provokes such strong reactions: the Forum inhabits a particularly uncomfortable corner of contemporary debate, where scientific evidence, lived experience, industrial interest, regulatory calculation, and moral judgment intersect without ever settling into ease.

Its critics surround it with suspicion; its defenders treat it as an indispensable space. In opposing registers, both recognize the same fact: the GFN is not peripheral. It carries weight in the debate.

It carries weight because smoking remains among the leading preventable causes of death in the world. It carries weight because millions of people continue to smoke not in the abstractions of the laboratory, but in lives marked by inequality, habit, pleasure, dependence, misinformation, and precarious access to alternatives. It carries weight because policies that fail to recognize relative risk can end up protecting the combustible cigarette in the name of regulatory purity. And above all, it carries weight because when public health loses its sense of nuance, it begins to drift away from the very people it most needs to reach.

With 2026 now underway, the trajectory of the GFN reads less like the history of a conference than like the portrait of a larger dispute. Since 2014, the Forum has returned, year after year, to a question that global policy still has not managed to resolve: what, exactly, is being protected when the deadliest product remains available while significantly less harmful alternatives are treated as a threat?

That is the question the thirteenth edition, under the banner Prohibition and Public Health, places once again at the center. Not as a doctrinal abstraction, but as a material, regulatory, and moral problem. If the combustible cigarette remains legal and widely accessible, why do successive waves of prohibition fall on lower-risk products across much of the world?

By insisting on that paradox, the GFN shifts the debate from the object to the logic that organizes it: examining how policies formulated in the name of protection can end up preserving, and even encouraging, exactly the harm they claim to want to reduce.

That might be the Forum’s strength: offering a space where facts can be examined with complexity before being overtaken by rhetoric. The question isn’t whether every alternative should be celebrated, but whether current policies, discourses, and mentalities accurately differentiate among products, use contexts, and actual risks. At that point, the GFN helps move the debate from the doctrinal to the public sphere.

* Photos: GFN/Gerry Stimson

Reader’s Note

This isn’t the screenplay of a film that already exists. It’s the screenplay for a film that might briefly exist, privately, in the reader’s mind.

It starts with a straightforward, uncomfortable question: when we talk about “good habits,” are we referring to health or to control?

The directions on these pages are not meant for a crew. They serve the narrative: what is seen, what is heard, what the body does, often without noticing itself.

The short film unfolding here is composed of movements, like irregular breathing. Sound—the hum, beeps, coughing, and crackle of plastic—builds the invisible landscape of everyday pressure. The camera stays on small gestures: a thumb turning a wedding band, fingers smoothing a nicotine patch, a hand covering the warning image as if hiding something private.

If you can, read this aloud, even quietly. See the peeling yellow rectangle on the ground. Hear the lighter fail. Feel, on your own arm, the edge of the patch starting to lift.

Cinema, here, is simply this: a discipline of attention.

* CHARACTERS: Anna, August, Damian, Clara, the Smoker, the Clinician, the Doctor, the Groundskeeper, the Man Under the Blanket, the Child, and many others who go unnamed.

I. The Promise, Undone

1 INT. WAITING ROOM — MORNING

Cold light. The HUM of a fluorescent fixture vibrates in the low ceiling.
Plastic chairs. A water cooler DRIPS.

A delayed electronic display blinks numbers that don’t advance.
On the wall: a blackened lung.

“STOP SMOKING.”

Beside it, crooked and peeling: “SUFFER NOW TO LIVE BETTER LATER.”

Someone COUGHS. Someone clears their throat.
A phone starts to ring and dies halfway.

ANNA (28), in a supermarket uniform, with a worn name badge, holds a crumpled bag. Her shoulder strap has carved a groove into her skin.

The mark stays.

She opens her bag. A thin wallet.
Coins. Not many.
She counts them with her thumb, slowly, one by one.
The display BEEPS.

METALLIC VOICE (O.S.)
Number forty-seven.

Anna stands.
The chair emits a damp, suction-like sound from the floor.

2 INT. EXAM ROOM — CONTINUOUS

A cluttered desk. Stacks of paper. A worn rubber stamp.
An old computer takes its time responding.
The printer CHOKES—metallic whine, like teeth chewing.

THE DOCTOR (50), white coat, a pen in her pocket, writes without looking up.

DOCTOR
How long have you been smoking?

Anna opens her mouth.

ANNA
Since—

She stops. Doesn’t finish.
The doctor has already checked a box —trained neutrality.

DOCTOR
Breaking the cycle lowers cardiovascular risk.
You’ll see benefits within weeks.

She slides a tri-fold pamphlet across the desk.
Illustrated lungs. A list of “benefits.” A phone number.

Anna takes it with both hands, as if it were a letter she isn’t allowed to crumple. She holds it the way one holds a promise.
A small nod—to herself, not to the doctor.
The doctor indicates a line.

Her short nail comes down to the paper and stays there.

DOCTOR
Sign here.

Anna signs without reading.
The printer SPITS out another sheet.
The doctor STAMPS

TACK.

Anna takes the paper and stands.
The chair scrapes the floor.

3 EXT. BUS STOP — MIDDAY6

Heat without shade. Asphalt gleaming like metal.
A bus speeds past. Doesn’t stop.
A cloud of DIESEL cuts the air.

Anna leans sideways against the bus stop pole, keeping herself from tipping into the street.

She opens her bag. Takes out the coins.
Counts.
Puts them away.
Counts again.
The numbers don’t match.

The pamphlet surfaces among her things—a white corner, insistent.
She pulls it out and folds it in half to make it fit her hand.

CRACK.

She folds harder. The paper resists. She insists.
As if the paper has to learn how to fit her life.

Anna takes a cigarette from the pack. The pack is soft, tired.

She tries the lighter.

CLICK. Nothing.

She shakes it.

CLICK. A brief spark. Dead.

Her mouth tightens—an old, learned gesture.

She uses the pamphlet as a shield, an improvised wall against the wind.

Tries again.
The flame catches. Flickers.
The paper trembles in her hand.
The cigarette lights.

A short drag.
She holds it.
Releases.

ANNA (V.O.)
I keep borrowing from the future.
I never know when it comes due.

A bus finally stops.
The doors open with a pneumatic SIGH.

People push off. People board without looking.
Anna steps on, the crumpled pamphlet in her hand.

The turnstile CHOKES on a coin.
Another slips free and ROLLS down the aisle.

Anna bends and retrieves it quickly.
Doesn’t complain.
Moves toward the back.

Doesn’t look behind her.
She’s done this before.

4 INT. KITCHEN — NIGHT (PAST)

Yellow light. An old fan creaks, useless.
On the refrigerator: a child’s drawing held by a magnet.

A crooked sun. A house. Three stick figures.

AUGUST (73), shirt unbuttoned at the chest, coughs into the sink.

A deep cough. An old one.

On the table: a full ashtray. A cup of cold coffee.
And a pamphlet identical to Anna’s—creased along the same folds.

August picks up the pamphlet. Unfold it carefully.
The paper makes a dry sound—

CRACK—

as if it were still alive.

Dried coffee stains the illustrated lung.
In the margin, a phone number was scribbled in pen.
Beside it: an OLD LIGHTER, heavy, scratched.

Worn metal. A tired spring.

August looks at it as if it belonged to someone else.
Picks it up.
Weighs it in his hand.

He opens a drawer.
Pushes the lighter to the back, behind the cutlery no one uses.
Closes the drawer with too much care.

He takes a cigarette.
Stops halfway through the gesture.
Look at the drawing on the refrigerator.
His hand lingers in the air a beat too long.

He opens another drawer. Takes out an empty glass jar.
Begins placing the cigarettes inside, one by one.

No hurry. No relief.

Contained violence, as if storing something dangerous.
The lid closes.

CLOC.

A child (Anna) runs past the hallway in the background, glancing in.
We only see her hair. A short laugh. Light footsteps.

August holds the jar for a moment, still.
Looks upward, as if measuring a distance.
He stretches his arm.
Places the jar on top of a cabinet.
Stands motionless.

His hand lowers slowly.

5 INT. SMALL BEDROOM — NIGHT (PRESENT)

A cramped room. Stained wall.
A fan that doesn’t help.
A box of clothes. A mattress on the floor.

On the bedside table: a past-due notice, folded and opened again.
Anna opens a drawer.
Inside: the OLD LIGHTER—heavy, scratched, worn metal.

The same tired spring.

A creased passport photo of August.
Anna picks up the lighter.
Doesn’t light it.
Just press the mechanism.

CLICK.

She lets go as if she’d burned the tip of her finger.
She touches the photo with her fingertips, as if it might tear.

From somewhere far off, the neighbor’s TV: canned laughter, outsourced joy.
Anna puts the photo back.
Closes the drawer.

6 FLASHES:

Coins clinking (a thin metallic chime) / The pamphlet trembling in the flame (CRACK, a faint hiss) / The glass jar filling (CLOC) / August’s cough / A coin rolling down the bus aisle / The passport photo / A coin rolling again / The CLOC of the jar lid.


SMASH CUT.

7 EXT. BUS STOP — NIGHT (PRESENT)

A different street. The same gesture.
Anna leans against the shelter wall.
Lights a cigarette. The flame flickers—holds.

Behind her, on the glass, a torn poster.
All that remains: “…OP SMOKING.”

She inhales. Air in. Air out. The cycle continues.

The bus arrives.
Doors open.
Anna steps on.
The doors close.

The engine sound pulls away, taking with it the little air she had.
What’s left is emptiness—and the city’s distant hum.

II. The World on Shift


8 EXT. FACTORY GATE — DAWN

Low sky, a dirty gray.
Wet ground. Puddles slicked with old oil.

A bus brakes—a long metallic hiss.
The doors open with a pneumatic sigh.

People step down in silence.
Footsteps. Turnstile clicks. Handrails. Backpacks scraping.

A metal gate.
A faded sign.

In the guard booth, a digital clock blinks the wrong number.

DAMIAN (42), name stitched across his uniform.
On his wrist: a stopped watch.
He looks at it—
not to check the time,
only to confirm there is none.

On his finger: a worn wedding band, deeply scratched.
He turns it once with his thumb.
A small rotation. Unnoticed.
He holds a plastic lunch container—lid warped.
And a crumpled pack of cigarettes, damp at the corner.

He leans against the wall.
Takes out a crooked cigarette, the tip bent.
Searches his pocket for the lighter. Impatient. Automatic.

CLICK. Nothing.

He shakes it.

CLICK. A brief spark. Dead.

Wind.

He cups his hand around it.
His hand trembles—cold and hurried.

CLICK.

Now it catches—a small, unstable flame.
The paper sticks slightly to his lip in the damp.
He adjusts it with his teeth, careful not to bite.
First drag—short. A test.

He coughs once—dry, contained—
and swallows it, glancing sideways,
as if coughing were a minor offense.

On the pack, the warning image is shown.
His thumb covers it without thinking.

Inside: a forklift BEEP, metal clanging, a short alarm.
Out here: the sound of his own lungs working.

His phone vibrates in his pocket.
He doesn’t take it out. Just feels it.
Another drag—deeper now—
as if pulling his body back into itself.

Ash falls into a puddle.
Turns to gray mud.
He crushes the cigarette underfoot, hard.
And goes in.

The sound of the factory swallows everything.

9 EXT. BUS STOP — MORNING

A scratched acrylic shelter.
An old advertisement peeling at the edges.
Light rain. Diesel in the air.

ANNA (33), supermarket uniform, badge crooked.
A bag with bread and a pack of diapers.

The heavy purse digs into her shoulder.
She steps two paces away from the group—
as if asking the air for permission.

The hand holding the cigarette is drier now, more worn.
A pale ring on the skin—
a mark where something once was.

She takes out a cigarette carefully.
Not from delicacy.
Because the pack is nearly empty and the cigarette breaks easily.

The lighter fails.

CLICK. CLICK.

A flame appears. The wind kills it.

A short exhale through her nose.
No broad gestures.
There’s no room for that.

CLICK.

This time it catches.

She inhales, watching the far end of the street—
where the bus should be.

The smoke slips from the corner of her mouth.
Not for elegance.

So it won’t drift toward the baby beside her.
The baby cries.

Someone rocks the stroller with a foot, without looking.
Eyes fixed on a watch.

A bus speeds past, sending up a gust of wind and dirty water.
The gust slaps the smoke from Anna’s mouth.
She closes her eyes for half a second.
Opens them quickly, as if rest were dangerous.

A deeper drag.

The filter nears her fingers.
Her hand carries the smell.

10 INT. SMALL APARTMENT — NIGHT

Old-building silence: pipes ticking, a neighbor walking,
a low television somewhere far off.
Cold kitchen light.
A full sink. A damp dish towel left out.

Anna is in sweatpants, hair loose with exhaustion.
She washes a pot quickly—so it won’t make too much noise.
The sponge scrapes the metal.

She opens the window only as far as her body needs.
Air comes in: distant frying grease, rain that’s been sitting around.

She lights a cigarette on the sill.
The flame flickers. Catches.

She inhales and holds the smoke for a second.
Not pleasure.

Suspension.

From the bedroom: a child’s breathing.
In the dark hallway: a toy on the floor.

Anna nearly trips.

Stops.

Looks.

Just a second—love, irritation, fatigue, all at once.

She doesn’t pick it up.
Keeps going.

She exhales the smoke outside,
trying to make it disappear before it can exist inside.

Ash falls onto the sill.
She runs a finger through it.
The ash sticks to her skin.

She wipes it on the dish towel.
A new stain.

She puts out the cigarette in a chipped saucer.
Slowly. Without sound.

Closes the window.

The glass makes a small *toc* against the frame.
In the quiet, it sounds loud.

She switches off the light.
Dark.

Only the dish towel was left on the edge of the sink.
Old stains.

The new one, still fresh.

In the dark, Anna braces her hands on the sink.
Still.

She presses the finger where a ring should be,
as if checking whether it still exists.

She rests her forehead against the cabinet for a moment.
Breathes in through her nose.
Lets the air out through her mouth, without a sound.
And walks away into the dark.

11 FLASHES:

Damian’s stopped watch / A thumb covering the pack’s warning image / Ash turning to sludge in an oil puddle / The strap gouging a groove into Anna’s shoulder.


SMASH CUT.

III. Good Habits


12 INT. OFFICE BREAK ROOM — MORNING

The coffee machine: PSHHT.
Paper cups lined up.
Napkins folded with care.

On the wall, a motivational poster:
GOOD HABITS, GOOD LIFE.

CLARA (35), impeccably dressed, opens a “clean” lunch:
salad cut evenly, fruit in a container, and her own utensils.

Before she touches a cup, hand sanitizer.

She rubs slowly until it dries—like a rite.
Her phone vibrates.

Group: “Condominium / Block B.”

She reads without changing her expression.
Only her eyebrow lifts a millimeter.

She puts the phone away with the same precision she used to snap the lunch lid shut.

A sip of coffee.

An inhale.

As if beginning the day “right.”

13 EXT. BUILDING ENTRANCE — LATE AFTERNOON

A blue sign:
SMOKING AREA.
On the ground, a peeling yellow rectangle.

A SMOKER stands inside the yellow boundary, leaning back.
The flame flickers. Holds. He inhales.
Clara approaches with grocery bags.

Slows.

Looks at the sign.
Looks at the rectangle.
She makes a small sidestep, avoiding the yellow.
Avoids it the way one avoids something that stains.

As she passes, she holds her breath for half a second—
without realizing she has.

She adjusts her coat with her fingertips,
as if protecting the fabric.

Two steps later, she exhales.

A brief, private relief.
Her face doesn’t celebrate.
It simply confirms.

14 INT. LOBBY / SANITIZER DISPENSER — CONTINUOUS

Automatic doors: PSHHT.
A steady hum of air-conditioning.
Clara steps inside.

The smell of the street stays behind; the smell of smoke tries to follow.

A MAN stops at the sanitizer dispenser.
Two pumps.
He rubs his hands methodically, staring ahead,
as if observing a rule no one needs to state.
Clara passes him

a little more upright than before.

15 INT. ELEVATOR — ASCENDING

A crowded elevator.
Clara steps in and takes her place near the doors,
hand on her bag.

The SMOKER enters right after.

A YOUNG WOMAN pulls her backpack to the front of her chest,
like a shield.

Farther back, someone retreats a centimeter:
a foot shifts, a knee locks—and holds.

Clara presses her floor button.

Without looking, she also presses the fan button.

The fan light comes on.
A neighbor steps in.
Clara smiles at him.
A clean, quick, competent smile.

The display climbs: 3… 4… 5…

No one speaks.

16 INT. HALLWAY — CONTINUOUS

White light.
Carpet that swallows footsteps.
Clara walks to her door.

Before going in, she takes a small spray from her bag.
Two bursts:
PSSHH. PSSHH.
She inhales.

Her face relaxes a millimeter.
She enters.

17 INT. LIVING ROOM / SOFA — NIGHT

TV low.
On the table, a glass with melting ice.
Clara scrolls.

A short video: someone smiling into the camera.
Caption: “Discipline is self-love.”

She likes it.
A heart appears.

Another video.
Another tip.
Another “good habit.”

She likes that one too, unhurried.

A notification from the building group chat.
Clara opens it and types:

CLARA (TEXT)
Hi, everyone… Please, the smoke has been drifting up into my apartment.
There are children and an elderly person here. Thank you.

She sends it.

Within seconds: reactions, little hearts, “agree,” “exactly.”
Clara holds the phone as if receiving a small certificate.

She rests her head against the sofa back.
Closes her eyes for a moment.
Breathes.

18 EXT. SMOKER’S WINDOW — NIGHT

A window opens just a hand’s width.
The SMOKER leans halfway out,
trying to be invisible.

He smokes quickly.
Short drags.
His phone vibrates.

On the screen: “Condominium / Block B.”
He looks.
Doesn’t open it.

He stubs the cigarette out halfway in a saucer.
His hand lingers in the air for a second,
uncertain what to do with the rest of the gesture.

He closes the window.

19 INT. HALLWAY / NOTICE BOARD — NEXT DAY

Clara comes out with a folder.
Stops at the notice board.
She tapes up a printed sheet:

REMINDER:
SMOKING ONLY IN THE DESIGNATED AREA.
PLEASE RESPECT THIS.

She smooths the paper with her palm, pressing out the bubbles.
Smooths it again.
Once more.
As if closing the matter.

20 INT. LIVING ROOM — NIGHT

Clara’s phone lights up: more reactions,
more “thank you for the notice.”

She turns the phone face down on the table;
a gesture of closure.

Takes a sip of water.
Breathes.

A micro-smile, meant only for herself.

SMASH CUT.

IV. The Garden and Its Limits

21 INT. SMALL EXAM ROOM — LATE AFTERNOON

White light. A noisy fan.

A Formica table scarred with old marks.
A jar of cotton balls. A box of patches.

The CLINICIAN opens a drawer.
The plastic packaging gives a dry sound.

Anna sits with her hands in her lap.
Short nails. A pen mark on one finger.
She pulls her sleeve up without ceremony.
Cotton on her arm.
A dry touch against skin.

The clinician applies the patch and smooths it with two fingers,
counting without speaking.

Anna watches the gesture.
The way one watches a wound being sealed from the outside.

The clinician points with a finger, no drama:

CLINICIAN
If you get dizzy, take it off. Water. Sleep without it.

Anna nods.
She puts the box and the pamphlet into her bag,
pushing to make it fit.

In another room, a phone rings.
Someone answers.

A baby cries somewhere far off. Stops.
Anna stands.
The plastic chair squeaks.

22 EXT. CLINIC EXIT / SIDEWALK — CONTINUOUS

The door closes with a tired click.
Traffic. Dust.

A bus roars past.
Anna steps down from the curb.

For a second, the white edge of the patch shows beneath her sleeve.

She crosses the street, avoiding a pothole filled with dark water.

On a pole, a street sign:
CHICO MENDES STREET.

The sign hangs crooked, bent at one corner.
Anna doesn’t look.
Her body is already elsewhere.

23 EXT. PLANTER IN FRONT OF A BUILDING — NIGHT

Streetlight.
A carefully designed planter,
contained by concrete borders.

Leaves shine with moisture.

A GROUNDSKEEPER, thick gloves on, trims the shrubs.

SNIP.

SNIP.

Branches fall. Leaves fall.

He gathers them with a shovel
and pushes them into a black trash bag.

Two meters away—almost out of frame—
a man sleeps curled beneath a thin blanket.

A cough comes from inside the blanket.
Small. Persistent.

The groundskeeper doesn’t look.
He takes a spray bottle.
Squeezes.

PSSHH.

The leaves take on a new shine.

24 INT. ANNA’S KITCHEN — NIGHT

Dim light. A sink full of dishes.
A damp dish towel left out.

The neighbor’s television bleeds through the wall.
Anna enters and drops her bag on a chair.
The chair creaks.

She takes out the pamphlet and leaves it unopened on the table.
Her sleeve rises: the patch is there— one edge lifting from sweat.

She presses it down with her thumb, firm,
|as if holding something that wants to slip away.

From the bedroom: a child’s breathing.
Anna opens the refrigerator.
Almost empty.

Closes it.

Sits.

For a moment, her hand rests on her arm,
feeling the patch through the skin.

Her phone vibrates.
She reads the message.
Doesn’t answer.

She takes a cigarette from the crumpled pack.
Stops halfway through the gesture.

Looks at the patch.
Looks at the window.
Searches for the lighter.

CLICK.

Nothing.

CLICK.

A brief spark. Dead.

CLICK.

It catches. The flame wavers.

She lights it.
A short drag.

She exhales quickly out the window,
as if erasing a trace.

Outside: a distant siren.
A dog barking.
An engine is climbing the street.

25 EXT. PLANTER — NIGHT (RETURN)

The groundskeeper ties the black trash bag.

He pulls.
The bag drags across the pavement—
a rough, scraping sound.
He walks away.

The planter remains immaculate.
Still.
Shining.

The coughing beneath the blanket continues.

26 INT. ANNA’S KITCHEN — NIGHT (RETURN)

Anna stubs out the cigarette in a chipped saucer.
Her nail scrapes the ceramic.

She rests her forehead against the cabinet for a second.
Breathes in through her nose.

Lets the air out through her mouth, without a sound.
Her hand returns to her arm.
Presses the patch down once more.
As if trying to hold something in place.

She switches off the light.

Dark.

V. The Still

27 INT. ANNA’S KITCHEN — PRE-DAWN

Blue darkness.
Her phone vibrates.

Anna silences it without checking the time.

From the next room: a child’s breathing.
She walks barefoot.
The floor is cold.

On the table: the box of patches,
the folded, crumpled pamphlet.

Anna pulls up her sleeve.

The old patch is still there; one edge lifted.
She peels it off slowly.
The skin beneath is marked:
|a pale rectangle, clean in the middle of her arm.

She opens a new one.
The plastic crackles softly.

Applies it.
Smooths it with two fingers.
Presses the stubborn edge until it holds.

Anna lowers her sleeve.

She stands still for a moment,
as if waiting for her body to agree.

28 EXT. BUS STOP — DAWN

Cold.
A streetlamp was still lit.
People are waiting with backpacks and coats.
No one looks at anyone.
Anna arrives.

Leans against the pole.
Her bag is heavy.
She takes a crumpled pack from her pocket.
Takes out a cigarette.

Stops.

Her hand hangs there for a second.
She puts the cigarette back in the pack.
Slips it away.

From her bag, she takes a small, dark object, worn from use.
Raises it to her mouth.

A short pull.
A small light glows, then disappears.

Vapor drifts out, faint, dissolving quickly in the cold.

The bus arrives.
Doors open.
Anna steps on.

29 INT. BUS — CONTINUOUS

The ticket reader BEEPS.
Bodies swaying.
Anna leans into the window.
The glass is fogged.

She wipes it with her sleeve,
clearing a small circle of view.

Outside: the street waking up,
people walking fast,
a dog nosing through trash.

Inside: the silence of tired people.

Her hand goes to her arm by instinct
and presses the patch,
as if confirming it’s still there.

The bus drops into a pothole.

JOLTS.

Anna closes her eyes
for half a second.
Opens them.

30 EXT. BUILDING ENTRANCE / SMOKING AREA — LATE AFTERNOON

Blue sign.
A peeling yellow rectangle on the ground.

The SMOKER stands inside the boundary.
Cigarette lit.
Shoulders slumped.

The wind pushes the smoke toward the entrance.

CLARA (the woman from the condominium) approaches with a grocery bag.
She makes her usual detour:
circles the yellow as one circles a habit.

She is about to keep walking.
Stops for a second.

Looks at the man—
not quite at his face,
more on the outline of him.

Then looks at her own hand gripping the bag,
as if remembering its weight.
She moves on.

31 INT. ANNA’S KITCHEN — NIGHT

Dim light.
A sink full of dishes.

The damp dish towel is in the same place.
The neighbor’s TV bleeds through the wall.
Anna comes in and drops her bag.

The chair creaks.

She rests her forehead against the cabinet for a second.
Breathes in through her nose.
Lets the air out through her mouth, without a sound.

She takes the small object from her pocket
and sets it on the table
as if setting down a key.

She pulls up her sleeve: the edge of the patch is firm now.
She smooths it once with her thumb.
She opens the drawer.

The crumpled pack is there.
She looks.
Closes the drawer.

She rests her forehead against the cabinet again.
Breathes in through her nose.
Lets the air out through her mouth, without a sound.

She switches off the light.
Dark.

The distant HUM
of a fluorescent lamp.

THE END