How New Zealand Dramatically Cut Smoking Rates and What the World Can Learn From It

A new study in The Lancet Regional Health – Western Pacific documents one of the most striking public health reversals in recent memory — and the evidence points squarely at harm reduction.

For decades, New Zealand did everything right according to traditional tobacco control. It taxed tobacco heavily, banned smoking in public spaces, introduced plain packaging, and set one of the most ambitious smoke-free targets in the world. And for decades, smoking declined, slowly, stubbornly, nowhere near fast enough.

Then, almost without warning, the curve broke.

Thirty years of policy, one pivotal moment

New Zealand ratified the WHO Framework Convention on Tobacco Control in 2004 and spent the following years building one of the most comprehensive tobacco control frameworks in the Asia-Pacific region. By 2011, the government had formally adopted a Smokefree 2025 goal, setting a target of bringing daily smoking below 5% across all population groups.

It wasn’t working fast enough. By 2015/16, 15% of adults still smoked daily. Among Māori, the Indigenous population, the figure stood at 36%. Researchers calculated that at the prevailing rate of decline, New Zealand would not approach its Smokefree goal for several decades.

Something had to change. And it did.

A fivefold acceleration

A viewpoint published in The Lancet Regional Health – Western Pacific, authored by researchers from the University of Auckland and Action on Smoking and Health (ASH) New Zealand, applies joinpoint regression analysis to national health survey data running from 2002 to 2024/25. The method is designed to detect genuine structural breaks in a trend rather than noise, and the results are unambiguous.

From 2018/19 onward, the annual rate of smoking decline in the general adult population increased from 3.5% to 17.9%, a fivefold acceleration. Among Māori adults, the shift was equally dramatic: from 2.2% to 13.3% per year. Māori smoking rates halved in six years. By 2022/23, total adult daily smoking had fallen below 7%.

No tax increase, no new warning label, no packaging reform produced a change of this magnitude. What did change, around 2018/19, was the regulatory environment for vaping.

The vaping factor

A legal ruling in New Zealand clarified that existing bans on oral tobacco did not apply to vaping devices, opening the market. In 2019, the Ministry of Health went further, formally recognising vaping as a substantially less harmful alternative to smoking and endorsing it as a cessation tool, while making clear that protecting young people and non-smokers remained a priority.

What followed was a rapid uptake of vaping among adults who smoked. Daily vaping prevalence rose from under 1% in 2015 to approximately 12% across the general population by 2024/25. Among Māori, it reached approximately 28% by 2023/24. The groups where smoking had been most entrenched were the same groups where switching to vaping was most pronounced.

The authors are careful. Ecological data cannot prove causation, and they say so. But the temporal alignment is precise: the acceleration in smoking decline began when vaping became accessible and officially endorsed, and the pace of that decline is consistent with what diffusion of innovation theory would predict. Conventional measures introduced years earlier — higher taxes, plain packaging — had delivered only gradual progress. They cannot plausibly explain a structural break of this scale.

The youth question, answered honestly

Critics of harm reduction approaches often point to youth uptake as an argument against vaping access. The New Zealand data address this directly, and the picture is nuanced rather than alarming.

Youth smoking has been nearly eliminated among 15 to 25-year-olds. Daily smoking among 14 and 15-year-olds has halved to around 1% since 2015. At the same time, overall nicotine use among young people is higher than it would be without vaping: around 14% of 15 to 17-year-olds reported daily nicotine use, mainly vaping, in 2024/25.

Much of that youth vaping surge occurred before 2021, when there were no legislative controls on the market. After regulation was introduced, including age limits, restricted retail access, flavour limits, a ban on disposable products and reduced nicotine content, youth daily vaping fell from a peak of 10% in 2022 to 7% in 2025.

The adult smoking decline, in other words, happened alongside declining youth smoking and ultimately declining youth vaping. The feared gateway effect from vaping back to cigarettes has not materialised at the population level.

Who still smokes — and what that tells us

The plateau in smoking rates reached around 2022/23 is not a sign that progress has stopped. It is a sign that the composition of the remaining smoking population has changed fundamentally.

More than half of New Zealand’s remaining smokers are now over 45. Smoking has become increasingly concentrated among Māori, older adults, and people living in the country’s most deprived communities. These are people for whom population-wide measures have historically been least effective, and for whom targeted, equity-focused harm reduction strategies are not optional but essential.

The plateau, as the authors frame it, is not failure. It is the natural point at which rapid early gains give way to the harder, more concentrated work of reaching those left furthest behind.

Three lessons the world should hear

The paper’s conclusions are direct. Implementing the FCTC matters, but it is not sufficient on its own to reach very low smoking prevalence. Harm reduction, through regulated access to less harmful smokefree nicotine products, can complement conventional tobacco control and accelerate the decline in combustible tobacco use, particularly among populations carrying the heaviest burden of smoking-related disease. And crucially: adult smoking can fall rapidly at the same time that youth smoking and vaping decline, when regulation is calibrated to risk, enforced consistently, and guided by evidence.

For QLS, New Zealand’s experience adds another chapter to the same story. Sweden showed it was possible. New Zealand showed it could happen faster than anyone expected, and in communities where conventional approaches had failed for generations.

The question for policymakers everywhere is no longer whether this model works. It is how much longer they are willing to wait before applying it.

Source: Beaglehole R, Bonita R, Youdan B. “New Zealand’s accelerating smoking decline: lessons for tobacco harm reduction.” The Lancet Regional Health – Western Pacific, 2026. DOI: 10.1016/j.lanwpc.2026.101882