Taxes Can Save Lives
Fiscal policy could change the course of the fight against tobacco —but only if it breaks free from the old game of public policy, one that stubbornly replicates exhausted formulas in the face of a problem that demands nuance, evidence, and political courage.
The latest briefing paper from the Global State of Tobacco Harm Reduction (GSTHR) shakes the foundations of the ongoing debate on taxation and public health: what if the salvation of millions depended, precisely, on how nicotine products are taxed?
Far from being a mere tax reform, the document proposes an ethical —and profoundly necessary— reimagining of taxation as a tool for care.
The world remains trapped in smoke. And an uncomfortable question re-emerges with growing urgency in the turbulent landscape of tobacco and nicotine: what if the lives of millions ultimately depended on how taxes are designed and implemented?
This is the provocation —as pragmatic as it is ethically compelling— driving the latest briefing from the Global State of Tobacco Harm Reduction (GSTHR), an initiative led by the UK-based organization Knowledge Action Change (KAC).
Published in early April, the document issues an urgent appeal to governments worldwide to rethink taxation as a strategic instrument to support the transition of people who smoke toward potentially less harmful nicotine products—such as vaping devices and heated tobacco products, collectively referred to in the UK as safer nicotine products (SNP).
The report underscores that for decades, taxation has been the preferred weapon in tobacco control policy: raising cigarette prices to restrict access —and, in the process, bolstering state coffers.
Beyond the Binary: Toward a Science-Based Approach
The strategy has delivered results —at least partially— contributing to reduced tobacco consumption in many countries. But today’s challenges demand more than inherited formulas: they call for a rigorous scientific distinction between poison and palliative.
Under the expansive and revealing title Safer nicotine product taxation and optimal strategies for public health, the report warns of a silent threat: the recommendations of bodies such as the World Health Organization (WHO), which promote taxing SNP at the same level as conventional cigarettes.
Such equivalence, only seemingly reasonable, could —according to the report’s authors— constitute a strategic error with serious consequences. By eliminating the price gap between products with vastly different risk profiles, these policies not only discourage smokers from switching to safer options: they perversely encourage relapse among those who have already quit.
Authored by Georgian economist Giorgi Mzhavanadze of Tbilisi State University, the report focuses primarily on nicotine vapes and heated tobacco products —the most widely used and empirically supported categories of SNP. Nevertheless, its conclusions also extend to other safer alternatives, such as Swedish snus and nicotine pouches.
Instead of recycling exhausted formulas, the report proposes a new, more rational, and evidence-based approach: using taxation as a lever to accelerate harm reduction, aligning tax rates with the actual risk of each product.
An Incoherent Cartography
The global overview provided by the report reveals a fragmented and, in many cases, incoherent fiscal map.
In 2023, at least 54 countries —and 33 jurisdictions in the United States— had implemented excise taxes on electronic cigarettes in places where their sale is legal.
But tax burdens vary dramatically: from 88% in Belarus, to 85% in Portugal and 78% in Norway, compared to just 4% in Costa Rica and Paraguay, or a symbolic 3% in Kenya.
In Europe, countries such as the United Kingdom, France, Belgium, Austria, and Spain had maintained a zero percent tax rate on these products until recently —a stance now beginning to crack under mounting pressure for tighter, sometimes draconian, regulation.
Heated tobacco products show a similar pattern.
In 2023, at least 66 countries levied excise taxes on HTP. Palestine topped the list with a 79% tax burden, followed by Israel (75%), South Korea (58%), and Japan (55%). At the other end of the spectrum, Finland and Andorra applied just 3% and 2%, respectively.
Yet —the report reveals— the problem does not end with the tax table. It warns that lower taxation does not always result in more affordable prices.
This logic not only undermines fiscal effectiveness: it also corrodes equity. In many countries, the less harmful products are, paradoxically, the least accessible to those who need them most. The safest option becomes a privilege for the wealthiest —turning public health into a matter of status rather than a shared right.
Moreover, it is often the industry itself that absorbs the tax margin to increase its profits rather than passing savings on to consumers. In doing so, the intended impact of tax policies designed to support the use of SNP is neutralized, weakening the effectiveness of a strategy that could —potentially— save lives.
An Ethical Proposition
In light of this reality, the GSTHR sends an unequivocal message: even countries that rely economically on tobacco tax revenue must rethink their approach in view of long-term structural benefits.
Reducing smoking saves lives, relieves pressure on healthcare systems, boosts productivity, and—paradoxically—can result in substantial savings for states themselves.
Among the report’s boldest proposals is the direct subsidization of SNP for current smokers —a strategy that, while seemingly counterintuitive, could prove crucial in accelerating behavior change. As is already the case with nicotine patches and gums —subsidized in many healthcare systems— lowering the cost of access to these products could ease the transition and magnify the impact of public health efforts.
For Giorgi Mzhavanadze, the key lies in applying taxation with both intelligence and political courage. In his view, taxes have already played a decisive role in reducing smoking rates in many countries and could be even more significant if evidence-based approaches are adopted —ones that clearly distinguish between dangerous combustible products and significantly safer alternatives.
“This way,” he asserts, “we can accelerate the end of smoking and improve public health, both at the individual and collective levels.”
Ultimately, the report proposes much more than a tax reform. It calls for an ethical realignment: abandoning the comfort of binary solutions and embracing, with political responsibility, the complexity of harm reduction as a state policy.
In a landscape riddled with ideological resistance, lack of dialogue among opposing factions, and deeply entrenched conflicts of interest, turning taxation into a tool for care may well be the most concrete —and urgent— form of politics in the service of life.
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