Supporting public health in the EU through harm reduction strategies

The European Commission is under pressure to revise the Tobacco Products Directive, the EU’s main regulatory instrument for tobacco and nicotine products. In light of measures to ban flavoured tobacco products and require more information on tobacco ingredients, Parliament organised a panel discussion in cooperation with the Tholos Foundation to explore new approaches to harm reduction and forecast priorities for the next European mandate.

Peter Beckett of Clearing the Air opened the discussion with a bold statement: “There is nothing innovative about harm reduction.” He highlighted that over the past two decades Europe has accumulated significant data on harm reduction, supported by extensive toxicological studies. However, despite this wealth of information, the harm reduction landscape has remained largely unchanged over the past decade. This has resulted in a significant level of stagnation. This stagnation suggests that while the data and research are robust, there has been little progress or innovation in practical applications or policy progress in this area. On this issue, Tim Andrews of the Tholos Foundation added that smokeless alternatives are around 90% (snus), 95% (vapes) or 99% (nicotine pouches) less harmful than smoking cigarettes and should be celebrated as a powerful contribution to harm reduction. But he criticised governments for imposing restrictions or bans on vape pens or nicotine pods, arguing that such approaches raise a fundamental moral issue, limiting access to a life-saving innovation and reprimanding those who want to make the switch. Proposed bans on specific flavours in vape pens also raised concerns for Andrews. Flavouring bans, according to Andrews, could lead to two main outcomes: people either turning to the black market to buy flavoured products or returning to smoking cigarettes. “If you take away flavours, you take away what makes vapes a viable alternative to cigarettes,” he concluded.

“The most popular products in Sweden are nicotine pouches and snus, which have helped reduce smoking and smoking-related diseases in the country. This shows that giving consumers the option to choose their preferred smoke-free alternative works.” – Tim Andrews, Tholos Foundation

A recent article published by Tholos discussed a number of alternative solutions to the flavour ban. First, it outlined how governments should work to improve enforcement of existing laws to restrict access by minors. These controls could be implemented in a number of ways, including online and physical age verification, licensing of retailers and distributors, regular, unpredictable compliance checks with higher penalties and sanctions for non-compliant individuals, and communication about product flavours. To reduce the risk immediately, the article discussed how governments should also consider restricting the sale of some flavours to adult-only stores to ensure access by those more aware of the perceived risks. To raise awareness of the potential problems caused by vaping, the article also called for comprehensive education on the risks of vaping by minors. Concluding the first panel, Peter Beckett presented a case study of the UK, which has adopted harm reduction strategies. As a result, the UK now has one of the lowest smoking rates in Europe. According to Beckett, “the key problem is not the nicotine itself, but the delivery mechanism – combustion is the main culprit.” Beckett said the goal of harm reduction is to deliver nicotine in a safer way by changing the delivery mechanism.

During the second part of the discussion, Micheal Landl of the World Vapers’ Alliance reminded the public that the European Commission’s position is under scrutiny, with concerns about its hostility to smokeless alternatives. The Commission’s cancer plan “proposed actions from 2021 to help create a ‘tobacco-free generation’ in which less than 5% of the population will use tobacco by 2040, compared with around 25% today”, but this was met with criticism from some MEPs and members of civil society. The European Parliament said it “believes that e-cigarettes could enable some smokers to gradually quit” in a report by the Special Committee on Cancer and in a report on non-communicable diseases.

“We need to have a broader conversation about smokeless alternatives. Quitting is not easy, which is why we should not ban snus and other smokeless alternatives in the EU. Cold withdrawal is not good for our health,” MEP Johan Nissinen (ECR, Sweden)

MEP Johan Nissinen (ECR, Sweden) cited his home country, Sweden, as an example of what the EU could achieve if snus were not banned. He further noted that the Swedish government has implemented policies such as lower taxes on snus and smokeless alternatives as part of its harm reduction approach, suggesting that the EU should learn from their example. Landl discussed another key issue in the political dynamic: politicians’ susceptibility to public opinion on smokeless products. Speaking from personal experience, he revealed his own switch from smoking traditional cigarettes to vaping. Landl testified to the empowering effect of giving people choice, stating that it empowers them to decide to quit.

Closing the second panel, moderator Sanne Savelsbergh asked the panelists what can be done to combat disinformation? Michael Landl suggested countering disinformation by sharing powerful, personal stories, especially from smokers who have successfully switched to vaping and other smokeless alternatives. MEP Johan Nissinen expressed optimism about the eventual lifting of the snus ban in the EU, indicating that it may take some time, possibly up to 20 years, but remains positive about this development. While discussions on harm reduction and innovation seem to be ongoing at the European level for some time, looking at successful actions by Member States can provide policymakers with a good source of inspiration.