Envisioning a world free of tobacco use: progress, challenges, and opportunities for the tobacco endgame

The concept of a tobacco endgame – strategies designed to permanently eliminate or drastically reduce commercial tobacco use – has moved from theoretical debate to active policy implementation worldwide. This review synthesizes key global progress, identifies common policy approaches, and analyzes fundamental challenges and opportunities facing the tobacco control community as it pursues prevalence targets, typically set below 5%. Despite advances in moving towards a tobacco endgame, significant barriers threaten the equitable achievement of endgame goals. These include a persistent implementation gap for proven tobacco control measures, growing socioeconomic and ethnic health disparities in tobacco use, the increasing complexity of the market due to novel nicotine products, and continued tobacco industry interference. Opportunities for accelerating progress include broad public support for innovative measures and the potential for expanding the focus to low- and middle-income countries, many of which are already “Endgame Ready” based on low prevalence and strong Framework Convention on Tobacco Control (FCTC) implementation scores. Furthermore, the FCTC’s adoption of “forward-looking” measures offers an international platform to solidify these goals. Ultimately, the success of tobacco endgame measures will depend heavily on how they are implemented and supported. Thus, continued research and monitoring of tobacco endgame efforts, as well as continued support for comprehensive tobacco control programs, is essential to ensuring success.