Four out of five smokers in Pakistan want to quit. According to a Gallup Pakistan survey, 80 percent of smokers expressed a desire to stop smoking. Even more striking, 93 percent of those who want to quit have already tried to do so at least once. The intention is there. The attempts are there. What is missing is sustained success.
These figures challenge a common assumption in tobacco control debates. The issue is not that smokers are unaware or unwilling. A large majority recognise the risks and want to stop. Yet relapse remains common, and many smokers cycle through repeated quit attempts without long-term abstinence.
Pakistan’s tobacco policy, however, is structured almost entirely around a single expectation: quit completely. Prevention remains essential, and cessation should remain the gold standard. But when most smokers want to quit and most have already tried, the policy question shifts. If motivation is high but outcomes remain limited, are existing tools sufficient?
The scale of the burden
The public health stakes are considerable. According to the World Health Organization (WHO), tobacco use contributes to approximately 164,000 deaths annually in Pakistan and imposes an economic burden of around PKR 700 billion each year. The harms of smoking are not in dispute. Combustible tobacco remains one of the leading preventable causes of disease and death.
Over the past two decades, Pakistan has relied on taxation, graphic health warnings, advertising restrictions, and public awareness campaigns. These measures have reinforced an essential message: smoking is dangerous and quitting is best. Yet prevalence declines have been gradual rather than transformative.
The Gallup data suggests the gap may not be awareness, but addiction. When 93 percent of smokers who want to quit have already tried, repeated relapse becomes a behavioural reality that policy must acknowledge.
Understanding where the harm lies
Scientific research consistently shows that the primary driver of smoking-related disease is combustion. The burning of tobacco produces toxic chemicals linked to cancer, cardiovascular disease, and respiratory illness. Nicotine is addictive, which makes quitting difficult, but it is not the principal cause of smoking-related cancers or lung disease.
At the same time, global health authorities, including WHO, maintain that no tobacco or nicotine product is risk-free and that cessation remains the safest course. That position remains central to public health policy.
However, recognising that risk levels differ across products is not the same as promoting use. It is a question of regulatory calibration. If harm is primarily linked to combustion, should regulation reflect that distinction while continuing to prioritise youth protection and prevention?
Lessons from abroad
Some countries have experimented with differentiated regulatory models. Sweden now reports one of the lowest smoking rates in Europe, with daily smoking prevalence around five percent, according to the report Smoke Free Sweden 2023. Tobacco-related mortality is lower than the EU average. In Japan, cigarette sales have declined significantly over the past decade, as documented in Transformation of the tobacco product market in Japan, 2011–2023.
These outcomes occurred within regulated environments that did not rely solely on abstinence messaging. The policy architectures differ and remain debated, but they demonstrate that regulatory design can influence behavioural patterns among adult smokers.
The relevance for Pakistan is not to replicate another country’s model wholesale. Rather, it is to recognise that binary framing, quit or continue smoking, may not fully address the realities of addiction.
A policy gap worth examining
Pakistan’s current regulatory framework largely applies a single lens across tobacco products. Taxation structures, warning regimes, and communication strategies are built primarily around combustible cigarettes. This approach emphasises deterrence, but offers limited structured pathways for smokers who repeatedly fail to quit.
The Gallup data makes this tension visible. When 80 percent want to quit and most have already tried, the challenge is not simply messaging. It is how regulation responds to behaviour that persists despite awareness.
Prevention must remain non-negotiable. Youth uptake must be tightly controlled. Cessation should remain the public health ideal. But ignoring the segment of adult smokers who struggle to quit does not eliminate smoking. It leaves the most harmful form of tobacco use as the default.
The policy debate, therefore, is not about weakening tobacco control. It is about whether regulation can evolve to better align with evidence on addiction and risk, while preserving strong safeguards. In a country losing over 160,000 lives annually to tobacco-related disease, that is a question worth examining carefully.
