Smoking kills more than 8 million people every year. It is the single biggest driver of preventable NCD deaths on the planet. And the global targets to reduce those deaths are not on track.

That is the bad news. Here is the part that should keep policymakers up at night.

The solution already exists. Some countries found it years ago. And most of the world is still ignoring it, or worse, actively restricting it.

Sweden has the lowest tobacco death rate in the world. Japan cut cigarette sales by more than half over the past decade. The UK halved its smoking rate. New Zealand’s young adults are effectively smoke-free. These countries did not achieve this through stricter regulation or bans. They gave smokers access to less harmful alternatives and let people switch away from cigarettes.

The results are not a coincidence. They are what happens when policy follows evidence instead of ideology.

Last month, three former senior WHO officials published a paper in Nature Health. These are not outsiders or industry voices. They spent careers at the centre of global health policy. Their conclusion is blunt: the current approach cannot drive smoking rates down fast enough to meet NCD targets, and less harmful alternatives need to be part of the response. They point out that tobacco harm reduction is already written into the Framework Convention on Tobacco Control. It has simply been left out in practice.

That gap between what the evidence supports and what policy delivers is costing lives. Every year that harm reduction is excluded from the global agenda, millions of smokers who could have switched do not.

The countries that got this right were not reckless. They maintained strict controls on cigarettes while making less harmful alternatives accessible and affordable. That is what risk-proportionate regulation looks like. What does not make sense is applying heavier restrictions to products that carry a fraction of the risk.

The evidence is not in question. The real-world results are not in question. What is missing is the political will to act on them.