Smoking (4) The tobacco endgame: New Zealand is paving the way

15 December, 2022

Dear coordinators.

Please, consider this article.

Kind regards,


*The tobacco endgame: New Zealand is paving the way. *

Tobacco products are the world’s single largest cause of preventable death and disease, causing more than 8 million deaths each year.1

To address the globalization of the tobacco epidemic, WHO promoted the Framework Convention on Tobacco Control (FCTC), an international legally binding treaty that currently covers 90% of the world´s population. This treaty lays out evidence-based demand and supply reduction strategies that resulted in measurable progress: global cigarette sales have been declining since 2012 despite overall population growth.

But progress is being slower than expected, due to the uneven application of FCTC provisions between countries and regions. Largely due to the great influence of the tobacco industry on decision-makers.

Based on the FCTC Article 2.1 that explicitly encourages countries to go beyond the measures outlined. Many tobacco control advocates, but also key opinion leaders, began to question why not evolve from a proposal of progressive reduction of tobacco consumption to another of ending the tobacco trade by a certain date. These proposals were called Tobacco Endgame strategies and policies.

A proposed definition of tobacco endgame is: “Initiatives designed to permanently change the structural, political, and social dynamics that sustain the commercial tobacco epidemic in order to end it within a specific time.” This recognizes the need to shift from treating smoking as an individual behavior to a broader focus, including decreasing the availability of tobacco products, and establishing a Tobacco Free Generation (TFG) strategy, where sales of tobacco products are restricted to people born before a set year. Another one is: to eliminate tobacco product sales.

The concept of a tobacco endgame has some parallels with the eradication and elimination of communicable diseases.(6) Smallpox, a disease that killed 35% of those infected, has been eradicated thanks to coordinated global efforts.

Unlike infectious diseases, the tobacco epidemic is industrially-produced; the disease vector exists entirely for profit. The vector is observable and traceable, and its harms have been known for decades, but tobacco has remained widely available.

Although there is no history of the eradication of a non-infectious disease worldwide, there are examples of phasing out the sale of products that cause disease or environmental pollution, such as asbestos, lead, and naphtha. For example, 75 countries have declared ‘war’ on asbestos, a mineral that has multiple industrial uses.

Should global society not aspire to accomplish the same for an epidemic of a highly addictive product that kills more than half of its consumers?

Some jurisdictions have started to pass policy innovations aimed to endgame policies, making the tobacco endgame moves from aspirational and theoretical to a concrete and achievable goal.

Such is the case of New Zealand. In December 13, 2022, this country passed the Smoke-free Environments and Regulated Products (Smoked Tobacco) Amendment Bill, which will create an entire smoke-free generation. The three main dispositions included in the law : reducing the amount of nicotine in smoked tobacco products (to non-addictive levels) , decreasing the number of tobacco retailers (to a tenth) and the prohibition of selling tobacco to anyone born on or after 1 January 2009. This is really a huge step, from a nation, to put an end to the tobacco epidemic.

But New Zealand is not the only one. Last few years there are many other examples: In 2020, the Netherlands announced a policy plan to phase tobacco sales out of supermarkets. In January 2021 the U.S. state of California announced its endgame initiative(10) to reduce smoking prevalence to below 1.9% by 2035. Also, in January 2021, Beverly Hills and Manhattan Beach city councils go beyond the California resolution and implemented a complete tobacco sales bans, including e-cigarettes


§ Bostic C, Bianco E, Hefler M. Progress, challenges and the need to set concrete goals in the global tobacco endgame. Rev Panam Salud Publica. 2022;46:e118.

§ Cohen JE, Grilo G, Czaplicki L*, et al.* Low-income and middle-income countries leading the way with tobacco control policies *BMJ Innovations *2022;*8:*4-8

§ The official website of the New Zealand Government.

*Dr. Eduardo Bianco*

Director, International Policy Education


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*Chair, WHF Tobacco Expert


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HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Master’s in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Bianco’s research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. He is a member of the HIFA project on Mental health: meeting information needs for substance use disorders. Email: ebianco AT