Table 1

Policies with potential to achieve a tobacco endgame

Policy categoryPolicy
Product focused
  1. Mandate very low nicotine content (VLNC) for smoked tobacco products to make them non-addictive or minimally addictive.

  2. Set product standards for nicotine products that make combustible tobacco products unappealing or removed from the market for exceeding toxicity thresholds.

  3. Move consumers from combustible tobacco products to non-smoked reduced risk nicotine products (eg, e-cigarettes, heated tobacco products, smokeless tobacco products).

User focused
  1. Require consumers to obtain a purchaser’s licence or medical prescription to purchase tobacco.

  2. Restrict tobacco sales by year born (tobacco-free generation).

Market/supply focused
  1. End commercial retail sale of combustible tobacco (abolition).

  2. Set a regularly reducing quota on the volume of tobacco products manufactured or imported into a country (’sinking lid’).

  3. Actions that reduce the commercial viability of tobacco companies, such as a ‘corporate death penalty’, or criminal charges (eg, ‘corporate manslaughter’), requiring compensation for full impacts of tobacco use, or limiting profitability.

  4. Increases in tobacco tax that make tobacco products generally unaffordable.

  5. Restrictions on tobacco retailer density/location/type/licensing that substantially reduce tobacco availability.

Institutional structure focused
  1. Transfer management of tobacco supply to an agency with a mandate to phase out tobacco sales, for example, regulated market model, non-profit agency.

  2. Performance-based regulation whereby tobacco companies are required to meet smoking prevalence targets or be fined; or manufacturers pay a levy based on sales volume similar to ‘polluter pays’ schemes.