A small group of health experts has issued a bold call for the end of cigarette sales worldwide just as the world’s largest annual conference on tobacco control kicks off in Abu Dhabi, United Arab Emirates. They say that stronger reforms could mean that fewer than 5 percent of adults use the substance by 2040, and lay out their case for a prohibition-like approach in an article published in the Lancet, a leading medical journal, on Friday.  

The focus of anti-smoking advocates has largely turned to developing nations, where more than 80 percent of people who may die from smoking in the coming century currently live. Lately, tobacco companies that have faced dismal adoption rates and waning public approval in the world’s wealthiest countries have turned their attention to poorer nations where rates of smoking are on the rise. Due in part to the growing popularity of smoking in these nations, researchers say the world could suffer 1.1 billion deaths from smoking worldwide by 2100, according to one in a series of papers on tobacco control published by the journal.

The World Health Organization aims to reduce smoking by 30 percent by 2025, but only about a third of countries are on track to achieve the targets that would bring that goal within reach. The gap was particularly wide in Africa and the eastern Mediterranean, where health experts warn of “a rapidly growing epidemic of tobacco smoking in this region and a major additional burden of noncommunicable disease,” according to an analysis led by Dr. Kenji Shibuya at the University of Tokyo. 

Tobacco is still a lucrative business. Annual revenues from sales amounted to roughly $50 billion last year, said Prabhat Jha of the University of Toronto in an editorial. Most of the world’s anti-smoking policies have focused too narrowly on reducing demand through consumer education and awareness, and countries should pass measures that hinder the ability of the tobacco industry to operate -- such as banning tobacco products altogether, representatives from academia and public health institutions suggested in another article

One of the most effective ways to curb smoking is to instate a tax that makes cigarettes more expensive, according to the WHO's Framework Convention on Tobacco Control. Currently, though, fewer than 10 percent of people worldwide are taxed for cigarettes at the rates suggested by policy and health leaders.

Another solution may be to raise the minimum age for purchasing cigarettes -- a report by the U.S. Institute of Medicine published on Thursday said that increasing the smoking age from 18 to 21 would result in 223,000 fewer premature deaths due to smoking and 12 percent fewer smokers overall by 2100. The authors point out that most lifelong smokers take up the habit before they turn 26.  

Reducing rates of smoking in China will be particularly challenging. A state-owned agency called the Chinese National Tobacco Co. profits from tobacco production and is also in charge of regulating the industry. This arrangement means that the government indirectly benefits from the country's estimated 300 million smokers, who account for 1 in 3 smokers worldwide.

Overall, rates of smoking dropped in about three-fourths of countries between 2000 and 2010. Norway is on track to achieve a 45 percent reduction in smoking by 2025 and Sweden expects to attain a 37 percent cut in rates by then.