From vision to action: a framework to assess readiness for the tobacco endgame

Tobacco endgame strategies aim to reduce smoking prevalence to minimal levels (<5%) through measures that expand traditional tobacco control approaches. Although some countries have set endgame targets, most still report prevalence rates >15%, and practical guidance on how to assess readiness for endgame implementation remains limited. This study aims to synthetise the key determinants of jurisdictions' readiness for tobacco endgame and proposes a self-assessment tool to evaluate it.

A narrative review of peer-reviewed and grey literature published between January 2010 and September 2025 was conducted. Publications were identified through targeted searches of academic databases and relevant organisational websites. A thematic synthesis of evidence on political, social and structural determinants of readiness was undertaken to identify recurring domains, which were later used to inform the development of a self-assessment tool.

Nine readiness domains were identified: relatively low smoking prevalence; advanced implementation of WHO Framework Convention on Tobacco Control measures; robust enforcement infrastructure; social denormalisation of smoking; broad public understanding and support for ending tobacco use; a positive political climate and strong political will and leadership; a cohesive tobacco control community and civil society; minimal tobacco industry interference with strong protective mechanisms; and sufficient resources to implement tobacco endgame action plan. These domains guided the development of an evidence-informed self-assessment tool to help jurisdictions evaluate readiness, identify gaps and prioritise strategic actions.

The Assessment of Readiness for Tobacco Endgame tool offers an evidence-informed framework to assess tobacco endgame readiness, helping jurisdictions assess capacities, identify gaps and guide strategic decision-making.