OPENING KEYNOTE: What will success look like?

The  public health tobacco goal is to prevent early death and disease caused by burnt tobacco products, especially cigarettes. The WHO Framework Convention on Tobacco Control  (FCTC), which came into force 15 years ago, is central to this endeavour. A first step is for all countries to ensure the effective and equitable implementation of the FCTC, as summarised by the MPOWER interventions. However, this alone is insufficient. Even where these interventions have been fully applied such as in New Zealand and Australia, smoking rates are falling only slowly and most of the progress has occurred in privileged sections of society further marginalising the most vulnerable. The second step is for all countries to embrace tobacco harm reduction (THR) alongside traditional approaches. Innovations in the delivery of nicotine such as e-cigarettes and heat not burn products offer an opportunity to accelerate THR progress. Sweden, with the widespread use of snus and now the lowest rate of smoking in the world, provides proof of the value of THR. Regrettably, the widespread adoption of THR is facing many impediments, notably from WHO and well-funded advocacy groups guided by poor quality science. Success will involve: full implementation in all countries of all available interventions, including THR, with WHO providing evidence-based technical leadership and facilitating dialogue rather than encouraging prohibition of less harmful products. The short-term  measure of success will be for all countries to match the successes of the best performing countries and achieve a very low adult prevalence (<5%) of cigarette smoking by 2040.