Public health researchers and policy experts have called on European regulators to recognise the different risk profiles of conventional cigarettes and smoke-free nicotine alternatives, arguing that current EU policy overlooks evidence that could accelerate the decline of smoking.
At the ninth summit of the Society for Harm Reduction and Evidence (SCOHRE), participants focused on the revision of the EU Tobacco Products Directive (TPD) and criticised how scientific evidence on alternatives is being handled. A central point of discussion was a survey conducted as part of the European consultation process, in which 77 per cent of respondents said smoke-free alternatives had been decisive in helping them quit cigarettes. Experts lamented that this result appears relegated to the annexes of the consultation and, in their view, has not been given sufficient weight in the conclusions.
The summit also revisited a 2022 request by the European Parliament for independent scientific assessments comparing the risk levels of different categories of nicotine products. Participants argued that this request has still not translated into an independent evaluation with enough influence on the regulatory process.
Sweden featured prominently as a case study. According to data presented at the meeting, daily smoking prevalence in Sweden stands at 3.7 per cent, compared with a European Union average of 24 per cent and 27 per cent in Spain. The incidence of lung cancer in Sweden is also roughly 33 per cent lower than the European average. Experts attributed part of this evolution to a strategy that has allowed regulated availability of smoke-free nicotine products, such as nicotine pouches, and argued that public policy should differentiate between products based on their risk profile.
This approach contrasts with measures being debated in other European countries, including Spain. SCOHRE participants warned that overly restrictive regulation could reduce options for smokers who cannot completely abandon nicotine and make the transition away from conventional cigarettes more difficult.
Other European examples were analysed. In the Czech Republic, participants linked a reduction in smoking prevalence from 30 per cent to 23 per cent to a strategy that has incorporated different alternatives. Greece was cited for a model that has allowed more open communication about differences between products.
At the opposite end, the summit examined Turkey. The country adopted a broad package of tobacco control measures in 2013 inspired by the World Health Organization's MPOWER model, while smoke-free alternatives have been subject to significant restrictions. According to data presented, the proportion of smokers rose from 27.1 per cent to 32.1 per cent over the past decade, while sales of conventional cigarettes reached high levels. Experts used this evolution to question whether policies based exclusively on prohibition are sufficient to reduce tobacco consumption. Their argument is that when legal alternatives disappear from the market, smokers may continue using traditional cigarettes or turn to products from the illegal market.
The economic dimension of tobacco regulation was also addressed. Federico N. Fernández, CEO of the We Are Innovation network, estimated annual losses linked to the illegal tobacco trade in Europe at around 13 billion euros. Participants cited KPMG reports on various European markets: in France, the informal market represents about 41 per cent of consumption, while in Germany roughly one third of cigarettes fall outside the tax circuit. These figures were used to argue that control policies must also consider the effects that certain restrictions can have on the illicit market. The thesis defended by the experts is that regulation which excessively limits legal supply can push part of demand towards unregulated channels, although the magnitude of this effect depends on each market and on other factors such as prices and border controls.
Along the same lines, the SCORE index, published in Frontiers in Health Services, was presented. Its authors analyse the relationship between tobacco control policies, product differentiation and health and economic outcomes.
The summit's conclusions come as Spain advances in revising its regulation on tobacco and nicotine-related products. The debate pits two approaches against each other: one that favours strict restrictions on all nicotine products, and another that advocates differentiating between them according to risk in order to accelerate the decline in smoking.