The WHO’s Harm-Reduction Blind Spot — And How Australia’s Vape Prohibition Propped Up the Cigarette

Alan Gor 17 August 2025

Australia has become a live case study of what happens when governments follow the World Health Organisation’s abstinence-first playbook on nicotine: you get headlines, raids and seizures, and you accidentally protect the cigarette.

WHO sets the tone: “not risk-free,” therefore restricts or bans

The WHO’s public line on vaping has stayed essentially precautionary: warn about youth uptake, stress that products are “not risk-free,” push flavour bans, and advise countries that already restrict sales to keep tightening the screws. None of this distinguishes clearly between the catastrophic risk of smoked tobacco and the much lower risk of smoke-free nicotine. 

At COP10 in 2024, Parties to the FCTC sidestepped substantive decisions on e-cigarettes and heated tobacco; the vacuum leaves countries free to interpret “precaution” as prohibition. 

Australia implements prohibition by another name

Leaning into that stance, Australia moved to a prescription-only model with pharmacy-only retail and sweeping import restrictions—effectively a ban outside the medical channel. From 1 July 2024, all vapes (nicotine or not) can be sold only in pharmacies for cessation or nicotine dependence; states and the TGA rolled out staged reforms through 2024–25.   

On paper, the goal was to starve youth access. In practice, demand didn’t disappear; it went underground.

What the numbers show (and why methods matter)

1) Overall trendlines vs. youth detail.

A Department of Health–commissioned analysis of Roy Morgan’s monthly data (2018–2024) found:

• For all Australians 14+, current vaping peaked in 2023 and dipped in 2024 (9.1% → 8.2%); current smoking trended down to 10.5% in 2024.

• For 14–24 year-olds (note the aggregation of teens with young adults), smoking was “stable” 2022→2024 while vaping peaked in 2023.

  That aggregation choice matters: it mixes 14–17s (very low smoking) with 18–24s (where movement is bigger), dampening any spike in young-adult smoking. 

2) Young adults (18–24) specifically.

Roy Morgan’s subsequent releases and update (to June 2025) broke out 18–24s and reported:

• A sharp rise in cigarette smoking among 18–24s after the mid-2024 sales ban, alongside high vaping, taking total use (smoke or vape) in this group to about 28%, the highest of any age band. Several outlets summarised a ~36% year-over-year jump in 18–24 smoking to “more than 1 in 10.”   

These perspectives aren’t actually contradictory; they reflect different lenses on the same dataset. If you combine 14–17 with 18–24, youth smoking looks flat. If you isolate 18–24s—the cohort most likely to buy from retail and be displaced by a ban—you see the post-ban spike.

3) Baseline context.

The AIHW’s 2022–23 household survey shows daily smoking at a historic low overall before the 2024 clampdown, with rapidly rising experimentation with e-cigs. That’s the counterfactual: the fall in smoking had already happened; the question was how to keep it falling among young adults without fuelling an illicit market. 

Prohibition’s side effects you can see from space

• A booming illicit market. With legal adult retail shuttered, organised crime filled the gap. Police and media have reported a string of fire-bombings, shootings and arson linked to “tobacco wars” and black-market control, from Melbourne to Perth and Adelaide. This isn’t theoretical risk; it’s happening in shopfronts.   

• Policy optics that protect the cigarette. Cigarettes remain easy to buy; regulated vape products are scarce or criminalised. For a 20-year-old trying to avoid relapse, the “safer” option becomes the harder one.

How WHO’s stance helped set up Australia’s failure

The WHO told countries to focus on youth and “not risk-free” messaging and, more recently, urged flavour bans across all nicotine products. That approach gave political cover for Australia’s pharmacy-only, enforcement-led model without a parallel harm-reduction pathway for adult smokers who won’t or can’t quit nicotine. The predictable result: adult demand gets displaced to cigarettes and the black market, while youth access shifts from convenience stores to illicit supply. 

A better path (that WHO should champion—and Australia could adopt)

1. Differentiate risk in plain language. Put combustion at the top of the risk pyramid; place regulated vaping and other smoke-free products well below. Communicate this to consumers, clinicians and pharmacists. (Today’s “not risk-free” line obscures life-saving differences.) 

2. Swap prohibition for product standards. Legal, adult-only access to compliant products; tight standards on emissions, ingredients, child-resistant packaging and nicotine limits; licensing and real penalties for selling to minors. (You already use this model for alcohol and many medicines.)

3. Price signals that match risk. Keep cigarettes the most expensive nicotine product; make smoke-free alternatives clearly cheaper.

4. Clinical “switching” support. Let quit services and GPs offer structured switching for people who won’t quit nicotine, including advice on device types and nicotine titration.

5. Crush youth supply chains, not adult access. Retail licensing, frequent compliance checks, proxy-purchase penalties, age-verification online—proven tools from other age-restricted categories.

Bottom line

Australia shows how the WHO’s abstinence-first framing, filtered through national politics, becomes prohibition and how prohibition protects the cigarette. When safer products are pushed underground while cigarettes stay legal and ubiquitous, young adults drift back to smoking, and crime networks take over the supply.

If the goal is fewer Australians inhaling smoke, harm reduction isn’t a side note; it’s the strategy.