By Suely Castro
Uzbekistan is at a critical moment in public health. With over 2.5 million smokers and more than 18,500 deaths annually from tobacco-related illnesses, smoking poses a significant challenge to the nation’s health and well-being.
A proposed government ban on safer alternatives to cigarettes could make this challenge even harder to address, leaving millions of smokers without proven tools to quit and risking severe setbacks in public health.
Global experience shows that there is another way forward: one based on harm reduction, a strategy that focuses on reducing the risks associated with smoking rather than trying to eliminate all nicotine use at once.
The evidence is clear: harm reduction works. Sweden, a global leader in this area, offers a compelling example.
In Sweden, fewer than 4.3% of the Swedish-born population now smoke, the lowest rate in the world. This success was not achieved through prohibition or strict anti-smoking campaigns alone.
Instead, Sweden embraced safer nicotine alternatives, such as snus, nicotine pouches, and vaping products, and made them accessible, affordable, and acceptable to smokers.
As a result, the country has not only reduced smoking but also significantly improved health outcomes, with cancer rates 41% lower than the European average and smoking-related deaths less than half those of other EU countries.
Uzbekistan, by comparison, has a smoking rate of 10.6%, more than double Sweden’s. Without access to harm reduction tools, this rate is unlikely to decline significantly.
According to a recent Ipsos survey, two-thirds of nicotine pouch users in Uzbekistan rely on these products primarily to quit smoking or for health reasons. Alarmingly, most users said they would return to smoking cigarettes if these alternatives were no longer available.
The public in Uzbekistan understands the importance of safer alternatives. Nearly three-quarters of survey respondents believe nicotine pouches can help reduce smoking rates, and two-thirds support government policies that make safer options like nicotine pouches, vaping, and heated tobacco available. These perspectives underline the critical need to support harm reduction strategies rather than restrict them.
The Swedish experience shows that harm reduction policies succeed when they focus on the “Three A’s”: Accessibility, Acceptability, and Affordability. Smokers must be able to easily access safer alternatives wherever cigarettes are sold. The products must be acceptable, offering quality and options that make them viable substitutes for smoking. Finally, affordability is key: if safer alternatives are too expensive, many smokers will continue to use cheaper but far more harmful cigarettes.
A ban on cigarette alternatives in Uzbekistan would reverse progress and force smokers back to the most harmful options. Prohibition does not eliminate demand; instead, it often leads people to revert to behaviors or products that carry greater risks. In this case, it would mean higher smoking rates, more smoking-related diseases, and greater strain on the healthcare system.
Harm reduction is not about endorsing nicotine use; it is about minimizing harm for those who are unable to quit smoking immediately. It recognizes that millions of people struggle with nicotine addiction and offers them realistic, evidence-based solutions. Sweden’s success is proof that this approach works.
Uzbekistan now has a unique opportunity to follow Sweden’s lead and adopt harm reduction strategies that save lives. Countries like New Zealand and the United Kingdom have also demonstrated that embracing safer alternatives to cigarettes leads to significant public health improvements. By implementing similar policies, Uzbekistan can achieve better health outcomes while respecting the needs and choices of its people.
This is a critical moment. The choice is clear. The time to act is now.
Suely Castro is the founder and director of Quit Like Sweden.