South Africa’s leading health and community organisations, united as Protect Our Next, have welcomed the U.S. Food and Drug Administration’s (FDA) recently proposed policy to reduce nicotine to minimally addictive or non-addictive levels in cigarettes and other combusted tobacco products. This landmark initiative represents a decisive step toward reducing tobacco addiction and its devastating health consequences. 

The FDA estimates that implementing this proposal could have a profound public health impact. In the US alone, it could prevent 48 million youth and young adults from becoming smokers and save 4.3 million lives just by the end of this century. Within just five years, it is projected to prompt nearly 19.5 million current smokers in the US to quit. 

Expert Reaction

Speaking about the significance of the FDA’s policy, Dr. Catherine Egbe, from the South African Medical Research Council’s (SAMRC) Mental Health, Alcohol, Substance Use and Tobacco Research Unit (MASTRU), a partner in Protect Our Next, says: “Reducing nicotine to non-addictive levels in products is one of the tobacco endgame strategies – effective ways to create a tobacco-free society and save lives. Various endgame strategies are increasingly being adopted around the world, and this is just one way the US is adding on to other strategies like banning flavours that are being adopted in different parts of the US, although this may arguably be the biggest game changer. Nicotine is the addictive drug in cigarettes and electronic cigarettes. More than 80% of adults who currently smoke cigarettes started smoking as teenagers, before they could understand how addictive these products can be and the negative impacts these products can have on their lives. Protecting people from a lifetime of addiction should take priority over profits, always.”

Prof Lekan Ayo-Yusuf, Director, National Council Against Smoking, Head of the School of Health Systems and Public Health at the University of Pretoria, and Director: Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM), says:

The FDA’s proposed nicotine reduction rule has the potential to reshape global efforts in addressing tobacco addiction. Curtailing nicotine content in cigarettes will not only prevent young people from developing lifelong addiction but also enable millions of existing smokers to finally quit. This rule provides an evidence-based framework to prevent the initiation of smoking and reduce tobacco-related harm, particularly for vulnerable populations disproportionately affected by tobacco use. Reducing nicotine in cigarettes can help bridge health inequalities by encouraging cessation and preventing new addictions in these groups.Such actions are critical in reducing the burden of diseases like cancer and cardiovascular conditions caused by smoking.

Technologically, it is entirely feasible to manufacture cigarettes with significantly reduced nicotine levels, explains Ayo-Yusuf. “Research over the decades has shown how such approaches effectively reduce dependence without leading to compensatory smoking behaviors, where individuals try to consume more cigarettes or inhale more deeply.”

Research shows that very low nicotine content cigarettes reduce cravings, dependence, and overall smoking rates. Smokers who use cigarettes with only 0.4 mg of nicotine per gram of tobacco—95% less than standard cigarettes—report double the quit attempts compared to smokers using regular cigarettes. 

The proposed nicotine reduction standard is designed to cover all combusted tobacco products, including cigars, cigarillos, pipe tobacco, and roll-your-own tobacco. This is critical to prevent smokers from switching to other harmful alternatives and undermining the policy’s effectiveness

“Evidence suggests that the tobacco industry often exploits loopholes in tobacco control legislation,” says Dr Egbe. “Including all forms of combustible tobacco in the rule will help mitigate such tactics and prevent the promotion of other high-risk products as substitutes for cigarettes.” 

Dr Egbe did however expect that this should have been extended to electronic cigarettes. “Much still needs to be done to properly regulate electronic cigarettes. Hopefully, this will be done in the near future.”

A new era in Tobacco Control

As tobacco remains the leading cause of preventable death worldwide, this proposed rule by the FDA signals a turning point in how governments can take bold action to protect the health of their populations. Nicotine, known for its addictive properties, is the driving force behind tobacco dependency. Adolescents are particularly vulnerable to nicotine addiction, which harms brain development, impacting attention, learning, and impulse control. Research has shown that significantly reducing nicotine content can decrease dependence, reduce cravings, and increase successful quit attempts. 

The FDA’s proposal builds on over a decade of scientific research and global tobacco control practices, such as flavour bans, to address tobacco addiction. By setting an ambitious precedent, this move encourages countries around the globe, including South Africa, to consider bold regulatory actions to save lives and improve public health outcomes. 

Protect Our Next joins experts around the world in urging swift finalisation and implementation of this rule. Limiting the addictiveness of cigarettes is not just a step forward—it is a giant leap toward breaking the cycle of tobacco addiction and preventing millions of premature deaths. 

​www.protectournext.co.za