A smoke-free future, built on innovation and advanced regulatory policies, was the focus of the annual TECHNOVATION conference, held in Neuchâtel, Switzerland.
Current tobacco control policies, designed decades ago to 'fight' the smoking phenomenon, are not fully addressing the reality of smoking today. Not only in Europe, but in all countries where a prohibitionist approach is followed. Technological developments have led to the creation of less harmful products such as smoke-free alternatives (SFP), heated tobacco products (HTP), electronic cigarettes and nicotine pouches, which can contribute to improving public health by offering a less harmful alternative for adults who choose not to quit smoking.
However, some governments and public health organizations, including the WHO, have adopted a restrictive stance, treating these new products in the same way as traditional cigarettes. On the other hand, countries that have opened up the door to alternative products and provided information to citizens have seen significant reductions in smoking rates.
Tobacco control policies
The success of tobacco control policies should be measured by their impact on reducing smoking. A comparative analysis of prevalence data from eight different regions shows that countries that ban SFPs and strictly implement WHO measures have struggled to achieve significant reductions in smoking rates. Meanwhile, countries where smokers have been able to switch to safer alternatives have experienced declines of almost 50% in the past decade.
Today, only four countries are recognized for fully implementing the WHO MPOWER measures:
Turkey, Brazil, Mauritius and the Netherlands. Of these, the first three categorically ban smokeless products, while the Netherlands does not. Notably, the Netherlands has seen the largest reduction in smoking prevalence over a similar timeframe, reaching a 26% decline.
Smoking and illicit trade
In Turkey, the prevalence of smoking in 2022 remained above 30%, unchanged since 2014. This is despite strict measures such as banning advertising, increasing excise taxes, plain packaging, banning flavors and smokeless products. These data show that, despite strong prohibition policies, smokers continue to consume harmful products and do not have access to safer alternatives.
Furthermore, Turkey faces a high level of illicit tobacco trade, which accounted for 27.9% of total consumption in 2022. The situation is similar in Mauritius (-6.2%), Brazil (-13.9%) and Thailand (-12.6%), where the ban on smokeless products has also led to the creation of illicit markets. In Brazil, for example, 7.3% of adults use these products even though they are prohibited by law. Being on the black market, there is no quality control, the age of purchase is not limited and the state does not benefit from taxes.
Cases of success
Japan represents a successful model, with a drastic reduction in smoking since the introduction of heated products in 2014. While from 2011 to 2015 cigarette sales fell by 1.8% per year, after the introduction of heated products this decline increased fivefold. By 2022, smoking prevalence had reached a record low of 10,6%.
Likewise, New Zealand, which has integrated tobacco harm reduction into its tobacco control policy by differentiating regulations for combustible and non-combustible products, encouraging smokers to switch to less harmful alternatives (heated products and electronic cigarettes), has achieved a similar reduction in prevalence (52,8% reduction between 2013-2014 and 2022-2023).
In Nordic countries such as Sweden and Iceland, the use of oral nicotine products such as snus and nicotine pouches has led to large reductions in smoking – 49.5% and 50% respectively. Sweden today has the lowest smoking prevalence and tobacco-related mortality among men in the EU, precisely because it is the only country that has not banned snus.
To have a tangible impact on public health, it is essential that traditional tobacco control policies are reinforced with modern, evidence-based approaches that not only ban cigarettes as the most harmful form of nicotine consumption, but also educate and promote the use of safer alternatives for those who choose not to quit. To accelerate the reduction in smoking prevalence, governments in Central Europe should also provide the necessary information and less harmful alternatives to adult smokers, while strengthening measures and controls on cigarettes, as the most harmful form of nicotine consumption.
MPOWER is a package of measures recommended by the World Health Organization (WHO) to help countries implement the Framework Convention on Tobacco Control (FCTC), with the aim of reducing tobacco consumption and protecting public health. This package includes: monitoring tobacco use and prevention policies, protecting people from exposure to tobacco smoke, providing help to quit smoking, warning about the risks of smoking, implementing bans on advertising, promotion and sponsorship of tobacco products, and increasing taxes on these products.
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