The Three A’s: Why Access Decides Who Quits Smoking, and Who Doesn’t

By Suely Castro, Founder, Quit Like Sweden

In December, I stood in a committee room at the UK Parliament and asked the audience a question I have carried for nearly two decades: if safer alternatives can save lives, what responsibility do we have to science, to fairness, and to the people we serve? I did not arrive at that question through theory. I arrived at it through my own family, watching what happens when someone who wants to stop smoking has nowhere real to turn.

That question is the foundation of everything Quit Like Sweden does. We describe Sweden’s success as a single model built on three conditions, not three separate ideas. Safer nicotine products have to be accessible: easy to find, sold where people who smoke already shop, rather than confined to a doctor’s office or a single counter. They have to be acceptable: available in the formats, strengths and flavours that adults actually prefer to cigarettes, not a clinical substitute nobody chooses to use. And they have to be affordable: priced so that switching is the easy, rational choice, not a financial sacrifice layered on top of an addiction. Remove any one of the three, and demand for the product does not disappear with it. It simply moves to whoever is still willing to supply it, regulated or not.

Sweden shows what happens when all three hold. Daily smoking fell to 3.7 percent in 2025, according to Sweden’s Council for Information on Alcohol and Other Drugs, a decline of more than two-thirds since 2012, against a roughly 4 percent decline across the European Union over the same period.^[1][2] Overall nicotine use in Sweden is close to the European average; what changed is its form. Snus and, more recently, nicotine pouches are sold in supermarkets and kiosks, taxed well below cigarettes, and available in enough variety that adult smokers treat them as a genuine substitute rather than a compromise.^[3] Pouches in particular have helped close a long-standing gap: Swedish men moved from cigarettes to snus decades ago, while women, who found snus less appealing, kept smoking at higher rates until pouches gave them a comparably discreet, smoke-free option.^[4] Measured against EU averages, Sweden now records 36 percent fewer lung cancer deaths and 21 percent fewer smoking-related deaths overall.^[5][6]

Australia shows what happens when accessibility exists in regulation but not in practice. Since October 2021, legal vapes have required a prescription; since July 2024, they can be sold only through pharmacies.^[7][8] In October 2024, the rules eased slightly, allowing pharmacists to sell lower-strength vapes to adults without a prescription. Few did. A nationwide survey of 305 pharmacies conducted that month found only four stocking these products for walk-in customers, with six more willing to order one on request; several major chains opted out of the scheme entirely.^[9][10] Demand did not wait for supply to catch up. Australia’s own Illicit Tobacco and E-cigarette Commissioner reported that 55 percent of tobacco and 95.7 percent of vapes sold in the country in 2024–25 were illicit, with the illegal market valued at up to AUD 8.5 billion and forgone excise reaching AUD 11.8 billion.^[11] Illicit tobacco and nicotine is now the fastest growing and largest illicit market, and organised crime groups have used arson to defend their share of it; in January 2025, an uninvolved bystander, Katie Tangey, was killed when a house was firebombed in a case of mistaken identity tied to the trade.^[11][12] What Australia built was access on paper. What it got, in practice, was a black market controlled by violent criminal gangs.

Brazil chose prohibition outright rather than restriction. Anvisa, the country’s health regulator, has banned the commercial sale of e-cigarettes since 2009 and reaffirmed that ban in 2024.^[13] The products did not leave the market; they left the part of the market that could have been regulated. A nationally representative survey found that adult e-cigarette use rose 600 percent between 2018 and 2023, the years the ban was fully in force.^[14] A 2025 study by the University of São Paulo estimated that Brazil now loses approximately US$2.63 billion per year in foregone tax revenue to the illegal trade in vapes and nicotine pouches, with roughly US$1.5 billion moving through unregulated, untaxed channels every year instead.^[15] The pattern is the same one Australia already demonstrates: close the legal channel, and the product does not vanish. It changes hands.

None of this is an argument for carelessness. Protecting young people has to remain central to any serious policy, including Sweden’s own. But the evidence from three very different countries, on two continents, under three different regulatory frameworks, points in the same direction. Restricting accessibility, acceptability or affordability does not reduce the underlying demand for an alternative to cigarettes. It only decides who meets that demand: a regulated market that governments can inspect, tax and hold accountable, or an unregulated one that answers to neither the law nor the consumer. Sweden did not arrive at the world’s lowest smoking rate by banning anything. It got there by building a market people actually wanted to use, legally. That, more than any single policy, is what the rest of the world should study.

References

1. Swedish Council for Information on Alcohol and Other Drugs (CAN) – Tobacco Habits and Consequences 2025 Report. Link
2. European Commission, Special Eurobarometer surveys on tobacco (385, 429, 506, 539); Public Health Agency of Sweden – Use of Tobacco and Nicotine Products. Link
3. Government of Sweden – press release on proposed reduced tax on snus and increased tax on cigarettes, April 2024. Link
4. Quit Like Sweden – “Protecting Women’s Progress in Tobacco Control,” 8 March 2026. Link
5. OECD/European Commission – Health at a Glance: Europe 2024. Link
6. Institute for Health Metrics and Evaluation – Global Burden of Disease. Link
7. Therapeutic Goods Administration – Changes to the Regulation of Vapes (regulatory timeline since 2021). Link
8. Therapeutic Goods Administration – “New Vaping Laws to Commence 1 July 2024.” Link
9. Australian Association of Convenience Stores – “Shock New Data Shows Just 1 Per Cent of Pharmacies Stock Vapes,” October 2024. Link
10. The Pharmacy Guild of Australia – “Vapes Officially Available in Community Pharmacy, but Not Everyone’s on Board,” October 2024. Link
11. Borland, R. “Has Australia Lost Control of Its Tobacco and Nicotine Markets?” Addiction, 2026 (citing Australia’s Illicit Tobacco and E-cigarette Commissioner, 2024–25 report). Link
12. The New Daily – “Clue in Hunt for ‘Lowlife’ Arsonists Over Deadly Attack,” April 2025. Link
13. Agência Nacional de Vigilância Sanitária (Anvisa) – RDC No. 855/2024. Link
14. Spinola, V.B. et al. “Weak Enforcement of Brazil’s E-cigarette Ban and the Expansion of a Dangerous Illicit Market.” The Lancet Regional Health – Americas, November 2025. Link
15. Escola de Segurança Multidimensional (USP) with Ipsos – 1º Levantamento Nacional sobre a Demanda de Bens e Serviços Ilícitos, October 2025, as reported by Folhapress/O Tempo. Link
16. Ministério Público Federal – civil public action on Brazil’s e-cigarette ban, January 2026 (as previously reported in Quit Like Sweden’s “Brazil’s Prohibition Strategy Under Scrutiny,” 12 February 2026). Link