Introduction

Deadpool + Wolverine = millions of QALY's

I spend a lot of time in two very different corners of the internet. In one, people debate the most ethical ways to donate money and structure their careers to maximize global welfare. In the other, they argue about nicotine policy and share tips for helping smokers switch to safer alternatives. Writing an introduction to tobacco harm reduction for effective altruists feels a bit like hosting a crossover episode that nobody asked for.

Yet it’s been years now that I’ve had the feeling that these communities need to talk to each other. Every year, smoking kills more people than HIV/AIDS, tuberculosis, and malaria combined. While smoking rates have plummeted in wealthy nations, nearly 80% of smokers now live in low- and middle-income countries, where access to cessation resources is limited and tobacco companies market aggressively.

The tobacco harm reduction movement offers a pragmatic response to this crisis. As researcher Michael Russell put it way back in 1976 (in the ancient times before crossovers became commonplace): “people smoke for nicotine but they die from the tar.” By helping smokers switch to dramatically safer forms of nicotine when they can't or won't quit entirely, we could help millions of people live longer and happier lives.

This approach aligns remarkably well with effective altruist principles. The scale is enormous, with over a billion smokers worldwide. It's notably neglected – despite the death toll, tobacco harm reduction receives little attention from funders and policymakers. Most importantly, it's tractable – we already have proven harm reduction tools.

I wrote about all this back in 2022 as part of Open Philanthropy’s cause exploration prizes, and my lazy side hoped that the attention we got would galvanize the EA community enough that I could go back to surfing and earning to give while EA and THR formed a lifelong bond and lived happily ever after. Sadly, the problems have continued piling up, with vape bans multiplying, misinformation rampant, and millions of smokers continuing to die early deaths while unaware of or unable to access better options.

The continuing crisis, however, also presents an opportunity for EA’s to step in and contribute. I’ll do my best here to present some evidence for why it’s worth it, and listen to your counterarguments. And if you are convinced, we’ll look at some ideas for how to do so.