In 2012, then–Vice President Xi Jinping told Bill Gates during a meeting in Beijing that he had quit smoking years earlier and felt much better. He described tobacco use as a serious problem for China and expressed a desire to take action against it. Days later, Gates attended an anti-smoking event with Xi’s wife, singer Peng Liyuan, where both wore red shirts bearing anti-smoking slogans.

Fourteen years later, Xi has become China’s most powerful leader in decades, yet progress on tobacco control remains limited. Despite global declines in cigarette sales, China’s consumption rose 39 percent between 2003 and 2023, while the rest of the world saw a 26 percent drop. A private report by former officials of China’s Center for Disease Control and Prevention found that China sells about 2.4 trillion cigarettes annually, nearly half of global sales.

Experts attribute the lack of progress partly to the influence of the State Tobacco Administration, which both regulates and operates the industry through the China National Tobacco Corporation. The company earned about 244 billion dollars in 2025, roughly 7 percent of national revenue, comparable to China’s declared defense budget.