On a warm spring day in 2012, Xi Jinping, then Chinese vice president, met with Bill Gates in Beijing. As the men filed out of the meeting room, the conversation turned to smoking in a country that consumes nearly half of the world’s cigarettes.
Mr. Xi, a former smoker, said he felt much better after quitting years earlier and described smoking as a serious problem for China, recalled Dr. Ray Yip, then director of the Gates Foundation in China. Mr. Xi, who becomes president next year, has promised to “do something about tobacco,” Dr. Yip said.
A few days later, Mr. Gates appeared at an anti-smoking event with Peng Liyuan, the Chinese leader’s wife and a famous singer. Both wore red shirts emblazoned with an anti-smoking slogan.
Yet in the 14 years since, as Mr. Xi has become China’s most dominant leader in decades, Beijing has made only slow progress in reducing tobacco consumption or adopting a nationwide ban on indoor smoking. While cigarette sales have fallen in much of the world, China has moved in the opposite direction.
Cigarette consumption in China increased by 39 percent between 2003 and 2023, even as it fell by 26 percent in the rest of the world. The 2.4 trillion cigarettes sold each year in China represent nearly half of the global total, according to a report by a nongovernmental organization founded by former officials of the Chinese Center for Disease Control and Prevention.
The percentage of smokers has declined over the past 13 years as fewer young people smoke, but cigarette sales have increased steadily. Cigarette prices are low: a pack costs on average about $3, about a third of the price in the United States.
The failure to slow cigarette sales is a measure of the influence wielded by China’s National Tobacco Monopoly Administration, which both regulates the industry and manages the country’s main cigarette maker, the China National Tobacco Corporation.
The company generated about $244 billion in profits and tax revenue in 2025, about 7% of national government revenue and almost what China says it spends on defense.
With economic growth slowing and a prolonged housing crisis eroding local governments’ property revenues, tobacco revenues have become even more essential. The agency has also channeled its profits to support several of Mr. Xi’s strategic priorities.
Last year, it injected more than $1 billion into one of China’s biggest banks to shore up the financial system. He was also a lead backer of a $100 billion national semiconductor investment fund.
Financial weight translated into political influence. The agency’s chief administrator holds a rank equivalent to that of a deputy government minister. Seven former senior officials have been arrested on corruption charges over the past seven years.
In 2022, the agency expanded its authority to cover vapes, imposing much stricter rules, including limits on where they can be sold and bans on flavored products. Unlike other countries, vaping has not eroded demand for cigarettes in China. Beijing ratified the World Health Organization’s anti-tobacco treaty in 2005, but has never implemented its stricter provisions.
The administration’s clearest victory came around 2017 when it blocked a years-long push for a national ban on indoor smoking, shifting the responsibility to local governments, where enforcement is often weak.
Today, many local smoking regulations are largely ineffective and offer little protection against second-hand smoke, especially in less developed parts of the country. While cigarette packages in the United States and other Western countries feature health warnings that are impossible to ignore, packages in China carry a single-line warning alongside images of national symbols like pandas and the Gate of Heavenly Peace.
A 2022 study published by the China CDC concluded that the country’s failure to control smoking was the result of state monopoly interference and the government’s “ambiguous attitudes” toward tobacco.
The influence of local branches of the National Tobacco Monopoly Administration grew after the Covid-19 pandemic, when many governments faced financial difficulties due to the cost of mass testing. Their lobby is particularly effective because cigarette production and consumption taxes play a determining role in local budgets.
A study by Zheng Rong, a professor at Beijing University of International Business and Economics, found that about half of the revenue from each cigarette sold by Chinese manufacturers went into government coffers.
Addiction is acute in China’s largest tobacco-producing regions. In Kunming, capital of southwest China’s Yunnan province, tobacco taxes accounted for more than half of the city’s budget in 2024. In Changde, a city in central China’s Hunan province, tobacco taxes accounted for 20% of its tax revenue in 2022.
Local tobacco shops struggle to water down even modest anti-smoking initiatives.
In Xinyu, a city in Jiangxi province, the local health commission has proposed designating some public spaces as “smoke-free,” according to official documents posted online.
The proposal already excluded restaurants and bars, which does not meet the World Health Organization’s recommendations that all indoor public spaces be smoke-free. But the local tobacco bureau suggested narrowing the definition of smoke-free schools to apply only to primary and secondary schools. After a public outcry, the office’s efforts were in vain.
With government efforts stalled, young people, especially women, have begun organizing their own campaigns.
Alva Zhang, a 23-year-old influencer, created a social media account and WeChat groups encouraging her followers to confront smokers in public places and file complaints with authorities.
“Because there are only a few regulations that provide almost no punishment, I and many others felt angry and helpless,” Ms. Zhang said.
Public support appears to be growing. A comedian gained national attention and praise from health agencies after performing a routine that mocked inconsiderate smokers. Hundreds of people have shared their proposals for stricter smoking rules in Chinese government surveys.
Early in his term, Mr. Xi seemed willing to challenge the tobacco industry.
After coming to power in 2013, the central government issued a directive banning civil servants from smoking during government activities or in public places. He called on those responsible to show “exemplary respect” for the rules.
Dr. Yip, a former Gates Foundation official, said the directive most likely came directly from Mr. Xi and helped accelerate Beijing’s adoption of restrictions on indoor smoking, making the capital one of the first major Chinese cities to adopt such rules.
Two years later, in 2015, China increased tobacco taxes, driving cigarette prices up more than 10%.
But the push for a national ban on indoor smoking petered out around the same time. It was also the last time Ms. Peng, China’s first lady, publicly championed anti-smoking efforts, appearing again with Mr. Gates in Seattle to review research aimed at helping people quit smoking.
Dr. Yip and other experts point to one reason China’s tobacco control dynamics have changed. Starting in 2015, China intensified its crackdown on foreign non-governmental organizations, a major source of funding for anti-tobacco campaigns.
Matthew Kohrman, a Stanford University professor who studies smoking in China, said the country’s economic slowdown had most likely caused more people to turn to nicotine as a “powerful mood modulator,” while weak enforcement of smoking restrictions had made cigarettes easier to consume in public.
Since the start of the pandemic, the National Health Commission has prioritized disease control over tobacco control. China still officially aims to reduce smoking rates to 20% by 2030, from 23% currently.
Wu Xiangtian, an official with the National Health Commission, acknowledged in 2024 how difficult that goal would be.
“To be honest,” he said, “the pressure is immense. »
