Decades of tobacco control policy, firmly supported by the ESC, have delivered concrete results. In 2002, almost 40% of adults in Europe used tobacco. By 2023, this had fallen to 24%. Such progress is attributed to a combination of higher prices, marketing restrictions, packaging regulations and workplace smoking bans. In short, a coherent policy can impact public health.
However, a new danger has emerged in the form of 'novel' products such as vaping and snus, a kind of chewable tobacco. Both are promoted as being less harmful than cigarettes, with manufacturers highlighting their potential as smoking cessation tools. This, says Prof. Paul Dendale of Hasselt University, is not the full story.
"We already have nicotine replacement therapies which have been used for decades and are clinically proven to work," he says. "I don’t have patients who stay on nicotine patches for twenty years. But when people switch from smoking to vaping, many continue to vape."
More than that, says Prof. Dendale, vapes are marketed to younger people who are at risk of developing life-long addictions. If in doubt, stand outside a secondary school and prepare for a waft of Blueberry, Sour Raspberry or Blue Razz Lemonade. The names alone suggest the target audience is not a long-term smoker in their fifties.
Money talks: taxation as a public health tool
"That's why the ESC needs to take action here," Prof. Dendale says. "The number of smokers in Europe is gradually declining, but there’s a second epidemic coming among the younger generation. We are seeking increased taxation and stronger advertising rules."
Teenagers are sensitive to price, as well as being vulnerable to marketing tactics such as colourful packaging and sweet smells. A comprehensive European policy would target all aspects of how nicotine products are sold – just as policymakers did to reduce the harm of cigarette smoking.
"Industry would like products to be taxed according to known harms, which would see cigarettes taxed at a higher rate than vapes," he explains. "But it took 30 years to establish that cigarettes cause atherosclerosis. We can already see that nicotine in novel products affects all the precursors for coronary artery disease. We cannot afford to wait decades for confirmation."
The battle to influence policymakers
In the US, despite industry lobbying, the Food & Drug Administration (FDA) banned the sale of vapes to people under the age of 21 in 2019. The number of young people using 'alternative' tobacco products fell sharply while the European market has grown.
"Policy makes a difference," Prof. Dendale says. "That’s why we’re working with the European Chronic Disease Alliance, the Smoke Free Partnership and colleagues in respiratory and oncology societies to present our case to parliamentarians."
However, politicians are also inundated with counterarguments from other stakeholders, some of whom have an interest in clouding the issue. The European Commission is currently running a public consultation on the revision of rules on tobacco products and tobacco advertising. There has been a 'flood of submissions' saying vaping has helped people quit smoking, while some Member States – notably Sweden – continue to push for softer rules on snus. Prof. Dendale is unconvinced.
"For me, there is a clear attempt to resist firm regulation by claiming there is a possible health benefit from vaping and snus, or by saying the harms are unknown," he says. "Allowing people to become addicted now before introducing restrictions in 20 years would be a terrible loss of time and health."
Have your say: respond to the European Commission’s public consultation on tobacco and tobacco products.