Agreement: I AgreeBody: Dear Editor This article offers a welcome overview of the role of tobacco excise, which is widely regarded as the most important FCTC tobacco control measure. to reduce tobacco prevalence. I agree that excise is necessary (although unlikely to take hold in large countries with state-owned tobacco industries), but I suggest it is not sufficient. Where taxes are already high, additional progress depends on embedding harm reduction, equity safeguards, enforcement, and fiscal planning. Experience from New Zealand and Australia—two countries which have attained the "highest level of achievement" with tobacco excise—shows both its strengths and its limits. In New Zealand, tobacco taxation laid the foundation - annual 10% increases on top of inflation between 2010 and 2020 - but it was harm reduction that made the difference. Daily smoking fell from 16.4% in 2011/12 to 6.9% in 2023/24 (2). The sharp acceleration since 2019 coincided not with further excise increases, but with widespread uptake of vaping; by 2019, 5% of the adult population vaped daily, increasing to 11% by 2023/24. Australia’s daily smoking declined from 12.2% in 2016 to 8.3% in 2023 (3), slower than New Zealand despite steeper price increases. With some of the world’s highest cigarette prices and restricted access to legal supplies of reduced-risk nicotine products, illicit tobacco markets have expanded, with ministers citing organised crime involvement (4). As prevalence falls, the remaining smokers are disproportionately low-income and Indigenous. Further excise hikes risk becoming regressive, while yielding diminishing health gains. In New Zealand, Treasury and Ministry of Health analyses show excise revenue levelling off and expected to decline in line with prevalence—an anticipated consequence of success(5, 6). Tobacco excise is strengthened by additional policies including regulation and taxation across all nicotine products based on risk — combustibles taxed most, less harmful nicotine products substantially less; equity safeguards; anticipation and management of illicit trade, retail compliance and enforcement; and realistic planning for declining revenues as smoking falls. Taxation alone cannot deliver rapid or equitable progress. References 1. Paraje G, Muñoz MF, Wu D, Jha P. Tobacco kills: stronger excise taxes would save lives Jha. Tobacco kills: stronger excise taxes would save lives. https://www.bmj.com/content/bmj/390/bmj-2025-085608.full.pdf 2. Ministry of Health. Trends in smoking and vaping: New Zealand Health Survey, 2024 https://www.health.govt.nz/statistics-research/surveys/new-zealand-healt... 3. Mendelsohn CP, et al. Tobacco harm reduction: evidence from Australia and New Zealand. Addiction. 2025. doi:10.1111/add.70006 4. Australian Government. Illicit Tobacco Taskforce reports. Canberra: Home Affairs, 2025. https://www.cdpp.gov.au/crimes-we-prosecute/serious-drugs/illicit-tobacc... 5. New Zealand Treasury. Heated tobacco products, Smokefree Environments and Regulated Products Act 1990, and Customs and Excise Act 2018: OIA response. Wellington: The Treasury; 2024. https://www.treasury.govt.nz/sites/default/files/2024-10/oia-20240568.pdf 6. Ministry of Health, EY. Evaluation of the tobacco excise increases as a contributor to Smokefree 2025. Wellington: Ministry of Health; 2018. https://www.health.govt.nz/system/files/2024-05/evaluation-tobacco-excis... No competing Interests: YesThe following competing Interests: Electronic Publication Date: Sunday, September 21, 2025 - 09:25AI use: No, I have not used AIHighwire Comment Subject: Tobacco kills: stronger excise taxes would save livesWorkflow State: ReleasedFull Title: Re: Tobacco kills: stronger excise taxes would save lives Highwire Comment Response to: Tobacco kills: stronger excise taxes would save livesCheck this box if you would like your letter to appear anonymously:: Last Name: BonitaFirst name and middle initial: RuthEmail: r.bonita@auckland.ac.nzAddress: PB 92019, Auckland, 1142, New ZealandOccupation: Emeritus ProfessorAffiliation: University of Auckland, New ZealandBMJ: Additional Article Info: Rapid response