Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 55 3 2026 10 04 42500 42500 Alireza Shoghli Health Services Management, School of Medicine, Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran Behzad Valizadeh MPH, PhD in Environmental Engeneering, Ministry of Health and Medical Education, Tehran, Iran Afshin Ostovar MD, MPH, PhD in Epidemiology, World Health Organization, Country Office for Iran, Tehran, Iran Sima Mohammadi Amid Abadi PhD in Economics, World Health Organization, Country Office for Iran, Tehran, Iran Mahbobeh Khaton Ghanbari PhD in Health Services Management, CDC, Iran Ministry of Health Morteza Amlashi Guilani MD, World Health Organization, Country Office for Iran, Tehran, Iran Sara Gholami MSc in Environmental Health Engineering, Ministry of Health and Medical Education, Tehran, Iran Nima Shoghli Financial Advisor, Razi Science Researchers Institute, Tehran, Iran Alireza Raeisi Professor of Endocrinology & Metabolism, School of Medicine, Tehran University of Medical Sciences Azam Maleki PhD in Reproductive health , Social Determinants of Health Research Center, Health and Metabolic Diseases Research Institute, Zanjan University of Medical Sciences, Zanjan, Iran Sabah Beigrezaee MSc in Environmental Health Engineering, Zanjan University of Medical Sciences, Zanjan, Iran 2026 04 30 2026 09 28 Introduction Illicit trade in tobacco products (ITT) undermines tobacco control, public health, and government revenues. In the Islamic Republic of Iran, illicit tobacco trade remains widespread despite accession to the World Health Organization (WHO) Protocol to Eliminate Illicit Trade in Tobacco Products (ITP), indicating persistent implementation gaps. Methods A mixed-methods policy and systems analysis was conducted, including a review of national legislation, policy documents, and WHO reports; two national technical consultative meetings; twelve semi-structured expert interviews; and a comparative review of international experiences in countries that have successfully reduced illicit tobacco trade. Qualitative data were analyzed thematically and mapped against WHO-ITP obligations. Results Illicit tobacco trade in Iran is large-scale and structurally embedded, accounting for an estimated 20–30% of cigarette consumption, more than 50% of flavored waterpipe tobacco, and nearly all emerging nicotine products. Key drivers include fragmented governance, absence of a fully government-controlled and industry-independent track-and-trace system, incomplete supply-chain licensing, weak deterrence against organized smuggling networks, and limited protection from tobacco industry interference. Evidence from other countries indicates that enforcement-only approaches are insufficient without integrated governance and supply-chain transparency. Conclusion Illicit tobacco trade in Iran reflects systemic governance and policy failures rather than border weaknesses. Comprehensive, WHO-ITP compliant reforms integrating governance restructuring, independent track-and-trace systems, and targeted enforcement are essential. The proposed policies offer a realistic pathway to reduce illicit tobacco trade while strengthening public health and fiscal integrity. https://ijph.tums.ac.ir/index.php/ijph/article/view/42500