Disclaimer：
This article is published in full with permission from Derek Yach. The views expressed are solely those of the author.
Editor's note
Derek Yach, a global health expert and anti-smoking advocate with over 30 years of experience, brings us a timely and insightful overview of the 9th Annual E-Cigarette Summit, held on May 19 in Washington, D.C.
We are witnessing a historic moment: for the first time, the sales of next-generation tobacco products have surpassed those of combustible cigarettes in the United States—one of the world’s most significant tobacco markets. This signals a profound shift in the global tobacco landscape.
The Summit also addressed critical topics such as the inclusion of vulnerable populations and the urgent need for robust scientific research on the safety of diverse products like heated tobacco and nicotine pouches—areas still marked by challenges and knowledge gaps.
The industry’s progress urgently needs greater involvement from the scientific community. Likewise, the advancement of tobacco harm reduction (THR) science depends on meaningful engagement and dialogue with industry researchers. As Dr. Robin Mermelstein, Director of the Institute for Health Research and Policy at the University of Illinois at Chicago, aptly noted in her remarks, diverse perspectives are essential to driving innovation in tobacco control.
As a leading global media and consultancy platform in the next-generation product (NGP) sector, 2Firsts is committed to advancing THR science and its communication. We aim to serve as a bridge for dialogue, collaboration, and knowledge exchange between science, regulation, business, and society—empowering the shared development of global THR efforts.
We warmly welcome engagement and support from across the community.
—Alan Zhao, Co-Founder and CEO of 2Firsts
What Did We Learn from the 2025 E-Cigarette Summit?
By Derek Yach
The 2025 E-Cigarette Summit convened in Washington, D.C., at a time of considerable uncertainty for tobacco harm reduction (THR) research and policy in the United States. The closure of the Centers for Disease Control’s Office on Smoking and Health, the abrupt retirement of senior Food and Drug Administration Center for Tobacco Products officials, and significant cuts to National Institutes of Health grants have cast a shadow over the field. Yet, the summit was a testament to the resilience and dedication of researchers determined to end combustible tobacco use.
This year, as in 2024, I focused on six critical questions that shape the future of tobacco harm reduction. Here are the key takeaways:
1. What Are the Major Trends in Cigarette and Vape Use in the U.S.?
Bonnie Herzog (managing director, Goldman Sachs) recently reported a historic shift: for the first time, sales of vapes, nicotine pouches and heated tobacco products in the U.S. are projected to surpass those of combustible cigarettes. Kenneth E. Warner (Avedis Donabedian distinguished university professor emeritus, University of Michigan) highlighted this trend and presented compelling data on the meteoric rise of the ZYN nicotine pouch and the concurrent decline in Altria’s combustible cigarette sales—a pattern echoed across other tobacco and tobacco harm reduction products. These trends are most pronounced among young adults under 25, while tobacco use among those over 65 remains largely unchanged.
2. Are We Addressing the Needs of Adult Smokers and Vulnerable Populations?
A notable shift this year was the increased focus on adult smokers and what Sharon Cox (principal research fellow, University College London) terms “hidden populations”—including residents of long-term care facilities, incarcerated individuals and people experiencing homelessness. Scott Sherman (professor, NYU Grossman School of Medicine) emphasized the urgent needs of older and heavier smokers, reiterating his previous statement: “Patients with early-stage chronic diseases who quit between ages 40 and 55 can achieve major health benefits.”
A global literature review confirms that these populations are often neglected by tobacco, pharmaceutical and vape companies—as well as by public health leaders. Addressing their needs requires new approaches and a reorientation of research priorities. (See: Yach, D. "New-generation nicotine delivery products require new approaches to research." Internal and Emergency Medicine, 2024.)
3. What Is the Evidence for Nicotine Pouches, Snus and Heated Tobacco Products as Cessation Tools?
There remains a dearth of high-quality studies on these products as cessation aids. Jamie Hartmann-Boyce (assistant professor, University of Massachusetts Amherst; Cochrane Tobacco Addiction Group) showed that vapes achieve cessation rates at twice the rate of nicotine replacement therapies and reiterated the urgent need for randomized controlled trials evaluating nicotine pouches and heated tobacco products. She called on public, philanthropic and industry funders to support research in regions with high rates of smoking and toxic smokeless tobacco use. Such studies could help build physicians’ confidence in recommending these alternatives.
4. Are Biomarkers Used Effectively to Assess the Health Impacts of Switching?
While biomarkers were not a major topic discussed, the broader issues of improving study design was addressed. For example, Steven Cook delivered a powerful critique of common methodological errors in THR research, particularly the misuse of cross-sectional studies to infer causality. His recent joint publication with Gal Cohen on best practices in THR research is essential reading for the field. (See Cook & Cohen, 2025, Current Research in Toxicology.)
5. Is There Progress Toward Medical Licensing of THR Products?
Despite robust debate in journals such as The New England Journal of Medicine and the Journal of the American Medical Association, there has been little tangible progress in the medical licensing of vapes or nicotine pouches. The sole exception is BAT’s Zonnic, now medically licensed in Canada. Several medically adjusted vapes, including Ventus, are under review by the U.K.’s Medicines and Healthcare products Regulatory Agency, but U.S. regulatory momentum has stalled despite calls for this by past heads of the FDA. The hope is for meaningful progress by 2026. I remain convinced that once we have a portfolio of medically licensed vapes and nicotine pouches, the physician resistance to THR will erode and as importantly, their active support for their patients who smoke to try THR products will increase.
6. Can International THR Practices Inform U.S. Policy?
This topic was not substantively addressed at the summit. Those seeking to learn from global THR advances are encouraged to attend the 2025 New Approaches meeting in New York City this September.
Concluding Reflections
Robin Mermelstein (director, Institute for Health Research and Policy, University of Illinois at Chicago) closed the summit by emphasizing the necessity of diverse perspectives to drive innovation in tobacco control. She urged public health organizations and specifically the Society for Research on Nicotine and Tobacco, to welcome industry scientists into the research dialogue.
Lion Shahab (professor of Health Psychology, University College London) echoed the call for consensus on methodological standards for long-term cohort studies evaluating THR products. These recommendations align with those made at a private-public sector meeting I conducted at the Harvard Club of New York last year. While there is growing recognition of the need for collaboration, the challenge now is to translate agreement into pragmatic, actionable solutions.
About the Author
A global health expert and anti-smoking advocate for more than 30 years, Derek Yach is the owner of Global Health Strategies. Previously, Yach was the director of the Foundation for a Smoke-Free World and a World Health Organization cabinet director and executive director for noncommunicable diseases and mental health. He was deeply involved with the development of the Framework Convention on Tobacco Control.
