Uzbekistan at a Crossroads: Ban Vapes or Regulate Vapes?

Should Uzbekistan ban all new nicotine products, or should it leverage innovation to reduce the immense harm caused by smoking? This was the central question at a recent high-level discussion in Tashkent, where doctors, researchers, and international experts gathered to explore how Uzbekistan can build a more effective policy regarding modern nicotine technologies. Organized by the “Tamakisoz” Association on November 4th, the event, titled “Science and Dialogue: Tobacco Harm Reduction,” highlighted the urgent need for a shift from prohibitive measures towards an evidence-based, regulated approach, drawing on the successful experiences of other countries.

Public Perception vs. Scientific Reality: A Widespread Confusion

The discussion began with a powerful illustration of the current public mindset in Uzbekistan: a video survey of citizens. Respondents revealed significant confusion and misinformation about the relative risks of different nicotine and tobacco products. Most believed that traditional cigarettes, naswar (a traditional local smokeless tobacco product), vapes, snus, and nicotine pouches were all equally dangerous to health. Some even asserted that modern nicotine products were more harmful than cigarettes, while others incorrectly assumed naswar was the safest option because no smoke is inhaled. This widespread confusion underscored a critical gap in public knowledge about the concept of tobacco harm reduction.

Professor Damin Asadov, head of the Department of Public Health and State Administration at the Tashkent Institute of Postgraduate Medical Education (TIPMO), set the tone for the discussion. “Harm reduction is not about promoting nicotine, but about promoting science in the name of saving lives. And it all starts with an open dialogue,” he stated. Professor Asadov highlighted the scale of the problem, citing local data estimating over 2.5 million smokers in Uzbekistan as of 2022, with WHO estimates placing the figure even higher at around 3.8 million. He reminded attendees that the harm from cigarettes, primarily due to carcinogenic tars from combustion, is undisputed.

He also pointed to the widespread use of naswar, a traditional, unregulated smokeless tobacco product consumed by an estimated 2.5 million Uzbeks. “Recent studies in the republic have already proven that it is a highly toxic and harmful product due to the lack of standardization and regulation in its production and circulation,” he added.

The Pitfalls of Prohibition: A Global Perspective

Professor Asadov noted a critical regulatory dilemma. In following the WHO Framework Convention on Tobacco Control (FCTC), Uzbekistan has adopted policies that effectively ban most innovative tobacco and nicotine products from the market, with the exception of heated tobacco. However, he warned of an unintended consequence seen in other countries with similar bans: “Due to the absence of certified innovative products on the market, the majority of smokers return to cigarettes.”

Federico Fernandez, founder and CEO of the organization We Are Innovation, provided the international context for tobacco harm reduction. He referenced a 2023 risk perception survey conducted in 28 countries, including Uzbekistan, which found that over 70% of current smokers in the republic believe vaping is as harmful as smoking, and over 30% believe it is even more harmful. With such a skewed perception of risk, he argued, “even if the state offers the population an alternative, no one will switch to a less harmful option.”

Fernandez presented the Swedish experience as a working model. Sweden, which once had high smoking rates, is now on the verge of becoming the first officially “smoke-free” country in Europe (defined as having less than 5% daily smoking prevalence). This achievement was largely driven by the adoption of innovative, less harmful nicotine products like snus and, more recently, nicotine pouches, guided by a methodology of the “3 A’s”:

Accessibility: Innovative nicotine products must be available through both offline and online channels, accompanied by relevant and accurate information.
Acceptability: A variety of nicotine levels and flavor profiles helps smokers successfully switch from cigarettes.
Affordability: Price is a powerful motivator. As Fernandez noted, “the most sensitive human organ, as we joke, is the wallet.” A significant price difference between cigarettes and less harmful alternatives encourages switching.

He emphasized that this approach is yielding results elsewhere. The Czech Republic achieved the EU’s largest reduction in smoking prevalence between 2020 and 2023. In Japan, a mass transition to heated tobacco products led to a 52% drop in cigarette sales. The UK and New Zealand are accelerating their smoking decline by actively using innovations, and Greece has seen a reduction in tobacco consumption after 15 years of stagnation by allowing alternatives onto the market.

Fernandez stressed that for any country serious about tackling the smoking problem, it is vital to create sensible regulations that allow adult smokers to switch to less harmful alternatives, ensure access to credible information, and actively combat misinformation. “It is very important to recognize the scientific gradations of harm and safety of products. Smoking and innovative nicotine products are not the same thing, so they cannot be treated the same way,” he concluded.

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The Challenge of Traditional Products: Can Naswar Be Standardized?

Associate Professor Timur Aripov of TIPMO presented a block of facts on smokeless tobacco. He noted that while Swedes prefer regulated snus, smokeless tobacco use is more common in the Asian region. In Uzbekistan, this is primarily naswar, produced from Nicotiana rustica, which has a higher nicotine content than standard tobacco. Its production is artisanal, lacks standardization, and nearly 100% of producers operate without quality certification.

The statistics he presented were new to a wider audience: up to 29% of men aged 30-69 use naswar, with over half using it daily, up to 7.5 times a day, and initiation typically occurring between ages 21-31. Aripov compared the risks of regulated Swedish snus to Asian chewing tobacco, stating, “The negative effect of snus for oral cancer and ischemic heart disease is lower than that of traditional chewing tobacco, and lower than that of cigarettes. Of course, snus is not healthy, but it is less harmful.” He pointed to Sweden’s low lung cancer mortality rate (12% below the European average) amidst low cigarette smoking and high snus consumption.

The key question, according to Aripov, is whether a standardization roadmap is possible for naswar. A research program has already been submitted for an international grant. “To be objective, we decided to do the analyses on naswar in Rome with partners. If the project is approved, we will be able to fully answer questions about its composition, risks, and manageable parameters.” The research aims to inventory toxicants (including heavy metals), calculate permissible doses, assess real health risks, and test the hypothesis of whether a standardized naswar could serve as an intermediate harm reduction tool.

Finding the Middle Ground: Between Prohibitive Bans and “Smart” Control

The discussion coalesced around the need for a “smart” regulatory system. Federico Fernandez outlined a minimal framework: “You need a framework that allows products to exist but controls quality, traceability, and completely excludes access for minors. And, of course, you need to talk about comparative risk.” He emphasized that it is regulation, not outright prohibition, that effectively reduces youth consumption, noting that in New Zealand, after improving their rules, the proportion of underage vapers decreased by about 30%.

Timur Aripov spoke of the “prohibitive reflex” trap: “We are a classic country where everything unknown is banned just in case. Now, parliament is leaning towards a complete ban on e-cigarettes and nicotine delivery systems. It’s easy to ban, but the demand won’t disappear.” He drew an analogy with alcohol prohibition, which has never worked and only leads to a rise in dangerous surrogate production and poisonings.

Damin Asadov added a cultural layer, noting that even if certified Swedish snus were introduced, “naswar consumers simply won’t switch because the product is unfamiliar. That’s why comprehensive work that takes into account traditions and behaviors is needed.”

Conclusion: A Call for an Evidence-Based Path Forward

The discussion in Tashkent revealed a clear consensus among the experts: Uzbekistan is at a critical juncture and ignoring the successful harm reduction experiences of other countries means continuing to make the same mistakes. There is a high demand for accurate data, as a significant gap exists between public risk perception and scientific evidence. Without systemic research, regulation will continue to drift between ineffective prohibitions and a return to deadly cigarettes.

For a country that truly wants to reduce harm, rather than just push it into the shadows, a comprehensive approach is necessary. This includes correct communication about comparative risks from regulators and scientific communities, not from advertising, as well as working with consumer habits. When asked for a final message, Federico Fernandez urged policymakers to “follow the evidence”: “Include innovations in the solution. Traditional measures will not get you to the finish line if you don’t bring new technologies into play. Allow talk about comparative risk, ensure accessibility, acceptability, and affordability – and smoking will retreat.”

Professor Asadov concluded by emphasizing the stakes: with the right strategy and state support, new technologies could save nearly 500,000 lives in Uzbekistan by 2050. The question that remains is whether Uzbekistan will continue down the path of prohibition or choose a more flexible, scientifically grounded, and ultimately more effective, regulatory model.

Reference: Разрешить или запретить – вот в чем вопрос. Как Узбекистану выстроить политику в отношении никотина

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Matthew Ma

Marketing at Ecigator

With over a decade of experience in the e-cigarette industry, Matthew Ma is a seasoned expert in both the manufacturing and usage aspects of vaping products. His extensive background has provided him with a deep understanding of the intricacies and evolving dynamics of e-cigarettes.