Western Pacific tobacco endgame stalls as youth vaping rises and taxes wobble

The Western Pacific is home to the largest population of tobacco users of any WHO region, yet it is reducing tobacco use more slowly than every other region. That uncomfortable arithmetic framed tobacco control as a central theme at the World Cancer Congress in September 2026 in Hong Kong, China, where discussions centred on innovative cessation and control measures, new nicotine products, and industry interference. A new situation analysis released during the 77th session of the WHO Regional Committee for the Western Pacific in October 2026 now spells out why the region’s endgame is in trouble: despite falling smoking prevalence, most countries are off-track to meet the target of a 30% reduction in tobacco use from the 2015 baseline by 2030.

The policy picture behind that shortfall is one of stagnation. MPOWER scores, which grade implementation of the WHO demand-reduction package—Monitor, Protect, Offer, Warn, Enforce, and Raise—have remained essentially flat across the region over time, a signal that the key measures are not being rolled out further. Meanwhile, tobacco industry interference scores show a worsening trend, pointing to greater industry influence and weak government responses. Where data exist for both age groups, youth e-cigarette use exceeds adult prevalence, which analysts describe as a youth-targeting e-cigarette epidemic. The 2026 acceleration plan drawn up in response sets three priorities: raise tobacco taxes, close implementation gaps, and regulate new and emerging tobacco and nicotine products to prevent youth uptake.

Taxation is the first priority, and also the most politically fraught. Countries in the region face very different challenges. Where tobacco industries contribute substantially to national revenue or economic activity, governments feel a direct tension between public health objectives and economic considerations. The analysis is blunt on the principle: raising tobacco taxation is not easy but is the right thing to do, and population health should not be traded for short-term economic gains. Governments are urged to pair tax reform with measures that counter industry influence and support a transition away from dependence on tobacco revenue.

At the other end of the spectrum sit countries with the highest cigarette taxes in the world, including Australia, New Zealand, and Singapore, where the challenge is sustaining the impact of taxes already in place. Australia’s Coalition Government recently unveiled a plan to wind back tobacco taxes, with the stated aim of killing the illicit tobacco market. The warning attached to that move is stark: reducing cigarette prices could increase smoking and reverse decades of tobacco-control gains in the country. Sustaining taxation policy, the analysis argues, requires firm political commitment and public support, plus a willingness to confront misinformation that can weaken proven tobacco-control measures.

The second priority targets the gap between policy on paper and policy in practice. Proven high-impact measures—cessation support, smoke-free policies, warning labels, and advertising bans—exist across the region but are implemented unevenly. Innovative tools such as personalised text messages and chat-based interventions to deliver cessation support are promising, though their success depends heavily on individuals’ willingness and commitment to quit. One proposed way to strengthen that commitment is to make visible the harm tobacco imposes beyond the user: preventable health risks, caregiving burdens, and increased health-care costs borne by others, particularly loved ones.

Younger children, older parents, and family members with chronic respiratory or cardiovascular diseases are all vulnerable to secondhand or thirdhand smoke, yet their health interests remain insufficiently represented in tobacco-control policies and cessation discussions. The proposed remedies are concrete: add warning signs on products to emphasise externalised harm to families and communities, increase public knowledge of secondhand and thirdhand smoke, and encourage smoking bans in outdoor public spaces, homes, and vehicles. The aim is to increase the visibility of people affected by tobacco who are often overlooked, turning an individual habit into a shared public-health concern.

The third priority addresses the products reshaping the market. Emerging tobacco and nicotine products, including e-cigarettes, or vapes, and heated tobacco products, threaten the tobacco endgame in the region. Through narratives of harm reduction, the tobacco industry is creating what the analysis calls the illusion that a smoke-free world is a healthier one, and by promoting new smokeless products it might draw a new generation of youth into becoming smoke-free smokers. Emerging evidence shows smokeless products can expose users to higher risks of cancers, cardiovascular and respiratory diseases, and adverse pregnancy outcomes, and can affect brain development in children and adolescents.

Studies from Japan, New Zealand, and Australia have consistently shown that although new nicotine products are displacing conventional cigarette smoking in some populations—especially youth—they are not eliminating nicotine use and could create a new generation of nicotine addiction. The number of dual users of cigarettes and novel nicotine products, new tobacco users among never smokers, and individuals who transitioned from cigarettes to new products remains high. Few cessation initiatives or strategies exist for new nicotine products, and some are even used as substitutes within cigarette cessation programmes. The recommended response is to bring new nicotine and tobacco products within established tobacco-control frameworks and treat them identically to traditional cigarettes.

The overall message is a reframing of the goal itself. Accelerating the tobacco endgame in the Western Pacific, the analysis concludes, will require the region to move beyond a narrow focus on smoking cessation, because the aim is not merely a smoke-free world but a tobacco-free one. With MPOWER scores stalled, industry interference worsening, youth vaping outpacing adult use, and even high-tax countries weighing rollbacks, the 2030 target will be decided by whether the three acceleration priorities—taxes, implementation gaps, and product regulation—are turned from plan into policy.

Subject of Research: A 2026 regional tobacco-control situation analysis and acceleration plan for the WHO Western Pacific, prioritising tobacco taxes, closing implementation gaps, and regulating new nicotine products.

Article Title: Accelerating the Western Pacific tobacco endgame

Article References: The Lancet Regional Health – Western Pacific (2026). Accelerating the Western Pacific tobacco endgame. The Lancet Regional Health – Western Pacific, 75, Article 102018. https://doi.org/10.1016/j.lanwpc.2026.102018

Image Credits: AI Generated

DOI: 10.1016/j.lanwpc.2026.102018

Keywords: tobacco control, Western Pacific, WHO, tobacco taxation, e-cigarettes, nicotine, MPOWER, smoking cessation, youth vaping, tobacco industry interference, heated tobacco products, secondhand smoke