Strategies for harm reduction in Latin America: the example of tobacco

Abstract

Tobacco consumption continues to impose a profound public health and economic burden across Latin America, disproportionately affecting men, adolescents, and low-income populations. Despite progress in some countries through implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), significant gaps remain due to weak regulatory frameworks, limited enforcement capacity, and persistent interference from the tobacco industry. Against this backdrop, tobacco harm reduction (THR), the substitution of combustible products with non-combustible or lower-exposure alternatives such as nicotine replacement therapies, electronic cigarettes, and heated tobacco products, offers a potentially valuable but underutilized strategy. Rather than a systematic review, this work offers a narrative, opinion-based synthesis of policy and evidence sources published between 2015 and 2024. While the WHO currently does not endorse electronic cigarettes or heated-tobacco products as cessation tools, the guiding principles of the WHO FCTC: proportional risk assessment, transparency, and surveillance, provide a conceptual basis for evaluating all nicotine-delivery systems under strict regulation. Latin-American governments should prioritize access to approved nicotine-replacement therapies and cessation services, while considering time-bounded, independent evaluation of non-combustible products within WHO FCTC guardrails where these are already present in the market. This perspective aims to inform balanced, evidence-based debate rather than advocate adoption of any specific product or policy.