Nepal is the first country in the world to require 100% graphic warnings on cigarette packs. Photo credit: Gunjan Raj Giri, CC4.0.
On February 7, 2025, Nepal announced that beginning August 17, pictorial health warnings will cover 100% of the front and back of all cigarette, bidi, and chewing tobacco packaging. According to the new provision, the background color of the pack, warning message, and picture will be Pantone 448C (drab dark brown). Brand names will only appear on the underside of the packs and not on the front or back. This move will make Nepal the first country in the world to completely cover the front and back of tobacco product packaging with graphic health warnings.
Public health advocacy groups, such as Bloomberg Philanthropies-funded Vital Strategies, praised Nepal for achieving a “public health milestone,” calling graphic health warnings “a powerful tool to prevent smoking among youth and children, encourage tobacco users to quit, and raise public awareness about the dangers of tobacco use.”
Since 2014, Nepal has required 90% graphic health warnings on both sides of tobacco product packaging, placing it on par with Timor-Leste and Türkiye, which mandate 85% coverage on the front and 100% on the back.
Nepal has a high rate of tobacco use. As of April 2024, approximately 34.1% of Nepal’s population used tobacco products in various forms, according to a survey by the Nepal Development Research Institute (NDRI). This marks an increase from 31.8% in 2020, and the rising trend continues. Currently, 10.7% of the population smokes tobacco, most commonly in the form of bidis, while 18.9% use smokeless tobacco products, such as paan, betel nuts, gutkha, and e-cigarettes. The remaining 4.5% engage in other forms of tobacco use. 55.8 percent of men use some form of tobacco, making it predominantly a male habit.
Numerous studies have examined the effectiveness of large graphic health warnings on cigarette packs. Depending on the sponsor of the research, results sometimes contradict one another. However, there is general consensus that pictorial warnings are more effective than text-only warnings in increasing smokers’ understanding of the dangers associated with smoking. Comparative studies across countries with varying warning label regulations indicate that larger, more prominent graphic warnings lead to higher levels of awareness and stronger behavioral responses among smokers. However, there is no clear evidence that enlarged pictorial health warnings directly reduce smoking prevalence.
In communities with high illiteracy rates, however, larger graphic health warnings have been found to be more noticeable and more effective in educating smokers about the health risks of smoking compared to text-only warnings. They are also associated with greater motivation to quit. In Nepal, approximately 23% of the population is illiterate—a number that has declined significantly over the past few decades. With an estimated population of 30.6 million in 2025, this translates to about 6.9 million individuals who are unable to read or write.
A 2022 study on the perception of cigarette graphic health warnings and their impact on smoking behavior in Western Nepal found that 80.5% of respondents reported that graphic health warnings informed them about specific health consequences of smoking. Additionally, 40.2% felt motivated to quit smoking due to these warnings, and 50.9% said they had attempted to quit as a result.
Whether the additional 10% increase in graphic health warnings and the newly introduced plain packaging elements on tobacco products will make a significant difference and achieve the desired impact remains to be seen.