Identifying urgent THR policy and implementation priorities

The starting point for advancing THR in LMICs is identifying what matters most—and what can be achieved first. Governments often face limited resources, competing health priorities, and complex political environments, making it essential to focus on actions that are both impactful and feasible. Priority areas may include clarifying the legal status of safer nicotine products, establishing product quality and safety standards, reducing taxes on low-risk alternatives, or integrating THR into existing cessation and primary healthcare programmes.

What constitutes an “urgent” priority will vary by country, depending on regulatory capacity, political will, existing tobacco control structures, and the burden of smoking-related disease.

A structured and evidence-informed approach supports better decision-making. This begins with assessing the national burden of smoking and understanding which populations are most affected. Mapping current laws and policies provides clarity on gaps, inconsistencies, or outdated regulations that may hinder harm reduction efforts. Analysing barriers, such as misinformation, weak enforcement, import challenges, or affordability issues, helps identify where action is most needed [^1].

Priorities should also reflect what is achievable in the short term. Quick wins create momentum, demonstrate progress, and build political and public support. For some countries, immediate priorities might include developing communication campaigns to correct misconceptions about nicotine; for others, establishing basic import regulations, licensing requirements, or testing protocols for safer nicotine products will be more critical. In settings with higher regulatory readiness, piloting THR clinics, integrating safer nicotine products into existing cessation programmes, or creating differential tax structures may be realistic first steps.