Influence of international actors

International NGOs, philanthropic foundations, and global health networks strongly influence how tobacco harm reduction (THR) is interpreted and implemented in low- and middle-income countries (LMICs) [^1]. Much of the funding for tobacco control in these settings comes from major donors such as the Campaign for Tobacco-Free Kids (CTFK) and Bloomberg Philanthropies [^2]. These organisations have made important contributions to tobacco taxation, smoke-free laws, and public education. However, their positions on safer nicotine products (SNPs) are often sceptical or opposed to harm reduction, shaping how local governments and civil society view and regulate these products.

Because many LMICs depend on donor funding to sustain public health programmes, global policy preferences can easily become national priorities. In several countries, donor-supported messaging promotes the idea that all nicotine use is equally harmful and that abstinence is the only acceptable goal. This leaves little space for discussions about relative risk or the potential role of harm reduction. Policymakers who lack independent research resources may adopt these external views without assessing their relevance to local smoking patterns or the needs of people who struggle to quit.

This donor-driven environment affects more than messaging. When external agendas overshadow local evidence, countries risk losing autonomy over their tobacco control strategies. Researchers who question dominant narratives may face difficulties securing funding or publishing their work, which limits scientific diversity and slows innovation. As a result, the influence of a small group of powerful international actors can delay the uptake of harm reduction policies that might benefit people who smoke who are unable or unwilling to quit entirely.

A more balanced approach requires valuing local expertise and promoting policy pluralism. LMICs should be supported to generate their own evidence, engage in open scientific debate, and design regulations that reflect both global best practice and domestic realities. Strengthening local autonomy and scientific integrity is essential if harm reduction is to serve as a tool for empowerment rather than an externally imposed agenda.