In 2015, the WHO TobReg issued an advisory note recommending a strategy for reducing nicotine in tobacco to substantially lower levels. The authors considered that regulation of nicotine levels would lead to a decrease of smoking prevalence. In their review, they assessed the feasibility and relevance of the strategy using a range of different research activities, from tobacco plant genetics to consumer sensorial perception. However, what is also readily apparent is a number of unintended consequences that arise from such a strategy. For example, reducing nicotine raises multiple issues from an agronomy perspective, which would threaten the livelihood of millions of farmers. Additionally, market disruption would foreseeably benefit and increase in illicit trade.

Although the use of simulation models to predict the impact of a new policy is recognised as extremely valuable, only a few publications have simulated the impact to a population. The use of simulations would allow regulators to evaluate options and make informed decisions that do not have unintended consequences that undermine the original policy aim.

The objective of our study was to develop a simulation model enabling the assessment of the impact of nicotine reduction policy on illicit trade. Both the baseline and counterfactual case were considered. The baseline corresponds to the status-quo and predicts population status in future if regulation does not change. The counterfactual case predicts the population status if the current conventional cigarette (CC) becomes illicit once replaced by the reduced nicotine cigarette (RNC).

Each individual of the population was classified in one of four groups: non-smoker, smoker of licit products (RNC), smoker of illicit products (CC) and former smoker. For the baseline, status transitions were derived from published data. For the counterfactual case, scenarios were tested considering the reported negative impact of RNC on smoker’s satisfaction and on the probability to switch to more satisfying illicit products. Trends were assessed under various scenarios and demonstrate in some conditions the risk associated with a nicotine reduction strategy.