Exclusive 2Firsts Contribution | Dr. Ziauddin Islam: Smoke-Free Pakistan — Dream or Reality?

Sep.01.2025

This article, contributed by Dr. Ziauddin Islam, public health professional and former Focal Person of Pakistan to the WHO FCTC, reflects on Sweden’s achievement as the first “smoke free” nation. He argues Pakistan can learn from Sweden’s strict policies and harm reduction strategy, urging stronger enforcement, public awareness, and adoption of reduced-risk products to move toward a smoke free future.

Disclaimer:

This article is published on 2Firsts with the author’s permission. The views expressed are solely those of the author and do not necessarily reflect the position of 2Firsts.

Editor’s Note | 2Firsts

● Background: In 2024, Sweden became the world’s first officially “smoke-free” nation, drawing international attention.

● Key Insights: Through strict tobacco control and harm reduction strategies, Sweden cut daily smoking rates from 22% to 3.5%, halving tobacco-related deaths; meanwhile, Pakistan records over 166,000 tobacco-related deaths annually, with weak enforcement and little research on harm reduction products.

● Industry Takeaway: The author calls on Pakistan to adopt Sweden’s evidence-based policies, promote reduced-risk products, and strengthen enforcement in its journey toward a smoke-free future.

Original title: Smoke Free Pakistan: A Distant Dream or a Realistic Goal?

Author：Dr. Ziauddin Islam

Sweden is understandably proud of being the first nation in the world to implement a rigorous smoke-free policy. This accomplishment demonstrates Sweden's unwavering resolve to combat the harmful consequences of tobacco on its citizens. Sweden officially became “smoke-free” on Nov. 13, 2024. Two decades ago, the government of Sweden initiated a massive tobacco control drive, which marked the beginning of its progress.It also means modifying tobacco and smoking product taxes, making sure that all establishments implementsmoke-free regulations, and spreading the public health message about smoking.

The embracing of a harm reduction strategy was one key tactic that helped Sweden succeed. Promoting the use of alternate nicotine products, including snus, a popular smokeless tobacco product in Sweden, was a component of this. The government was able to lower the number of people smoking combustible cigarettes by giving them safer alternative options. The government's decision to make quitting smoking a clear priority was another important consideration. The Swedish government adopted a goal in 2015 to achieve a "smoke-free Sweden" by 2025,defined as a daily smoking prevalence of less than 5% among the population.

Sweden's tobacco control initiatives have had an overwhelming impact. The percentage of daily smokers in Sweden has drastically decreased over the last 20 years, according to data from the Swedish National Institute of Public Health. Just 3.5% of people smoked every day in 2020, down from 22% in 2000. Sweden's public health has been significantly impacted by this decline in smoking rates. Since 2000, the number of smoking-related
deaths has decreased by more than 50%, and smoking-related diseases like lung cancer and heart disease have significantly decreased nationwide. Other nations can use Sweden's achievement as a model.

The government's all-encompassing strategy for tobacco control and its dedication to harm reduction and explicit goal setting has been essential inlowering the tobacco burden on its inhabitants. But what truly distinguishesSweden is its willingness to question conventional knowledge and accept new solutions. For example, the country has been at the forefront of promoting snus, a type of smokeless tobacco that is far safer than traditional cigarettes. Sweden has reduced tobacco-related harm and promoted a harm-reduction culture by giving safer alternatives to smokers. Sweden's performance demonstrates the strength of evidence-based policymaking and the relevance of establishing defined goals in public health. As the world continues to battle with the killing impact of tobacco, Sweden's experience serves as a beacon of hope and a model for other countries to follow.

As I sat down to write about Sweden's extraordinary accomplishment in becoming the world's first smoke-free country, I couldn't help but reflect on the countless lives lost to tobacco-related ailments in Pakistan. The World Health Organization (WHO) reports that over 166,000 people die each year. It's a sobering reminder of tobacco's detrimental impact on our country's health and economy. I recall speaking with a friend who is an oncologist. He told me tragic stories about patients who lost their lives to tobacco-related malignancies.It is a brutal reality that we cannot afford to overlook.

So, what can Pakistan gain from Sweden's success story? For starters, Sweden's comprehensive tobacco control strategy is worth emulating. The country's tobacco control laws are ineffective due to many reasons. The enforcement of relevant laws is missing in most places and times.

Public awareness initiatives have helped to educate individuals about the consequences of tobacco usage. Pakistan can also benefit from designing
appropriate policies and legislation for advertising alternative nicotine products, such as nicotine replacement therapy (NRT) or e- cigarettes, as harm-reduction products for those who want to quit smoking. This strategy has demonstrated the potential to lower tobacco-related harm in many countries. As I look at Sweden's accomplishments, I am reminded of the need for determination and effective policymaking. It is a lesson that Pakistan can learn from, and I hope it will motivate us to take bold action against the tobacco menace.

As we celebrate Sweden's accomplishment, we must also consider Pakistan's journey toward tobacco control. Regrettably, Pakistan is one of the top ten countries in the world with the highest prevalence of tobacco-related ailments. According to the Pakistan Institute of Development Economics
(PIDE), tobacco usage is responsible for the expense of treating tobacco-related diseases, which is predicted to be 615 billion rupees (3.85 US$) in
2019. Pakistan has made several attempts to combat the tobacco pandemic, including enactingthe Prohibition of Smoking and Protection of Nonsmokers' Health Ordinancein 2002.The ordinance bans smoking in public areas, imposes health warnings on tobacco packages, and limitstobacco promotion. Despite these measures, tobacco use remains a major public health concern in new-generation products. There is less or almost no research on harm-reduction products and their efficacy because of the stigma and apprehension linked to these products.

The worldwide public health community must now unite behind Sweden's achievement and try to replicate it. This will necessitate ongoing investments in tobacco control efforts, as well as a commitment to innovation and damage reduction. Together, we can eradicate tobacco, enabling individuals to lead healthy, smoke-free lives.

Pakistan must adopt a comprehensive tobacco control strategy to obtain Sweden's smoke-free status. This includes strengthening tobacco control laws and enforcement, raising public awareness, embarrassing and promoting alternative nicotine products, and last but never least investing in tobacco control research. Pakistan may get closer to becoming smoke-free by tightening tobacco control regulations, engaging in public awareness programs, marketing alternative nicotine products, and committing to research.

Sweden's success demonstrates the strength of evidence-based policymaking and the relevance of establishing defined goals in public health. As we celebrate this accomplishment, we must reflect on the lessons learned and apply them to our own situations. The journey to asmoke-free Pakistan is challenging, but with determination and the righttechniques, it is a goal that can be achieved with an open mind and heart.