Vaccines against nicotine: how effective are they likely to be in preventing smoking?

Cigarette smoking is the most preventable cause of death in industrialised countries. 30% of all deaths in smokers in the 35 to 69 years age range are attributed to chronic cigarette smoking; smokers dying in this age cohort lose an average of 23 years of life. Public health campaigns have attempted to reduce initiation of smoking in adolescents and to foster quitting in dependent smokers. The prevalence of smoking has declined in the US to 25% of the population, but this figure has held constant for the last decade. Vaccines against nicotine are a novel concept in the field of smoking cessation research and have not yet reached the stage of clinical testing. Vaccines could reduce smoking behaviour in 3 groups of smokers: (i) current smokers attempting to quit; (ii) former smokers wanting to avoid the possibility of relapse; and (iii) adolescent smokers before they become confirmed smokers. The rationale behind the approach is that nicotine is the pharmacological agent controlling the rate of cigarette smoking, and reducing its rate and extent of uptake into the brain may have therapeutic benefits.