Quit Like Sweden: Hope for smoke-free future

• The crisis: Sri Lanka’s tobacco burden
• A regional call to action

By Amira Cader

Quit Like Sweden Director Suely Castro

Sweden currently records the lowest smoking rate in Europe—just 5.4%, positioning it to become the continent’s first smoke-free nation. Its approach combines prevention, cessation and harm reduction strategies that provide smokers with safer alternatives such as nicotine pouches, vaping products and heated tobacco. These products are accessible, acceptable and affordable, allowing smokers to switch instead of quit abruptly.

Quit Like Sweden Director Suely Castro said, “Sweden’s approach is unique. It demonstrates what’s possible and how other nations can save lives by adapting this model, Money spent treating smoking-related diseases could instead be directed toward essential social priorities. Our mission is to share this experience globally.”

65% of the world’s tobacco users live in South Asia, making the region the epicentre for tobacco-related diseases. This alarming figure highlights the urgent need for coordinated public health action and risk-proportionate regulation.

 As Sri Lanka faces one of the highest tobacco-related disease burdens:

• 17.7% men are smokers 
• 12 000 deaths a year 
• 22% of adults currently use tobacco
• £ 400 million in yearly healthcare costs
• 3,000 oral cancer cases annually
• Tobacco directly contributes to cardiovascular, respiratory diseases and premature deaths among working-age adults

SOMHRA Founder/Director and Senior Consultant Cardio Metabolic Physician Dr. Rohan Savio Sequeira emphasised that integrating harm reduction into Sri Lanka’s tobacco control strategy could dramatically improve public health outcomes.

Implementing a comprehensive tobacco harm reduction (THR) strategy could save lives and deliver billions in healthcare savings.

• Forming a multi-stakeholder working group – To guide THR policy development across ministries and public health bodies
• Conducting a regulatory impact assessment – To evaluate long-term economic and health impacts
• Launching pilot programs in high-burden districts – To test localised THR solutions
• Developing a national communication strategy – To raise awareness, fight misinformation and promote quitting through safer alternatives

“By adopting WHO-aligned harm reduction measures, Sri Lanka could save an estimated 85,000 lives by 2060,” He further stated. 

Prof. Marewa Glover of New Zealand, a 32-year veteran in tobacco control research, highlighted the need for flexibility and compassion in policy.

“Ending smoking is a journey. Countries must offer multiple pathways—awareness, behavioural interventions and safer alternatives. The key is to provide people with options that actually work.”

Sweden Linköping University Faculty of Medicine and Health Sciences Prof. Fredrik Nyström echoed this sentiment, stressing the importance of empathy in public health.

“Smokers aren’t criminals. Stigmatising them only drives the behaviour underground. Working with smokers, not against them, is far more productive—most are keen to quit when given practical tools.”

Kairos Kinetic CEO Dr. Sree T. Sucharitha spoke about the underlying causes of tobacco addiction, framing it as a human rights issue. Drawing on over 15 years of experience, she discussed strategies to address this challenge, emphasising the need to focus on lower-middle-income families, who face a higher risk of tobacco-related diseases.

Paraclete Associates Founder Nancy Loucas highlighted the importance of education, innovation and inclusive policymaking in advancing tobacco harm reduction across South Asia. She stressed that empowering communities with accurate information, supporting research-driven innovation and involving all stakeholders including Governments, healthcare professionals and civil society are essential to accelerate regional progress toward a smoke-free future.

Smoking causes significantly more harm than alternative nicotine products such as vaping. Unlike cigarettes, which burn tobacco and produce thousands of toxic chemicals, vapes operate at lower temperatures and use regulated e-liquids—typically containing just four main ingredients (nicotine, propylene glycol, vegetable glycerine, and flavourings). When manufactured and used under proper guidelines, these alternatives greatly reduce exposure to harmful toxins and are considered less damaging to the body than traditional smoking, which also raises internal heat and inflammation levels.

To replicate Sweden’s success, experts at the roundtable proposed the following key actions:

• Expand access to safer alternatives: Ensure adults who smoke can access risk-reduced nicotine products (e.g., vaping devices, heated tobacco and oral pouches)
• Affordability and availability: Make alternatives affordable and widely available, especially in high-smoking communities
• Risk-Proportionate regulation: Adopt taxation and regulation based on relative harm, rewarding less harmful choices
• Training for health professionals: Equip healthcare workers with smoking cessation and harm reduction skills
• Counter misinformation: Launch official campaigns to dispel myths and communicate evidence-based information about reduced-risk products
• Support local research and innovation: Encourage Sri Lankan institutions to lead research and innovation in THR

As Professor Glover concluded, “Countries have a wide set of tools at their disposal. The challenge—and the opportunity—is to use them wisely.”

Countries that have embraced harm reduction, like Sweden and New Zealand, demonstrate how evidence-based alternatives can drive down smoking rates twice as fast as prohibitionist policies. The message from Colombo’s roundtable was clear: South Asia can no longer afford to ignore what works.