Ethical and practical debates in LMICs

Introducing THR in LMICs raises several ethical and practical questions.

Governments must decide whether to promote safer nicotine products while continuing to discourage smoking, a balance that can be difficult to achieve. In many LMICs, these products are imported, expensive, and poorly understood by both the public and policymakers. This creates challenges around affordability and access, especially for low-income earners who smoke who might benefit most from switching to safer alternatives.

Ethical discussions often focus on how to balance individual autonomy with public health protection. Some policymakers worry that promoting safer nicotine products might appear to endorse nicotine use, while others argue that denying access to less harmful options is itself unethical, particularly when smoking remains widespread and cessation support is limited. Ensuring that adults can make informed choices based on accurate information rather than misinformation or fear is central to the ethical case for THR.

In practical terms, LMICs face several barriers to implementing THR. These include limited research capacity, weak regulatory frameworks, and the spread of misinformation about safer nicotine products. Such challenges often lead to delays in evidence-based policymaking or to overly restrictive measures like bans and excessive taxation.

At its core, the ethical responsibility is to reduce harm where it is greatest. By ensuring access to safer, regulated alternatives and promoting truthful, science-based communication, LMICs can strengthen both public health and social equity, offering people who smoke safer choices instead of leaving them with none. Scholars have even argued that access to harm reduction constitutes a human right, grounded in the principle of minimizing preventable suffering [^1].