COP10: A missed opportunity?
By Dr Delon Human, leader of the Smoke Free Sweden movement.
As the global community gears up for the delayed 10th Conference of the Parties (COP10) to the WHO Framework Convention on Tobacco Control, it is important not to lose sight of the one real tobacco control success stories in recent years. The World Health Organization may be ramping up the negativity on alternative products in the run-up to the conference, but we ignore at our peril the key role they have played in bringing Sweden to the brink of smoke free status.
With a smoking rate of 5.6%, Sweden is near the widely held threshold for being considered “smoke free”, and may by now have even passed it – nearly 17 years ahead of the EU 2040 target. The country’s incredibly low smoking rate should play a leading role in shaping the agenda during COP10. Its unique approach to tobacco harm reduction, particularly through a culture of smokeless products like snus and an openness to all alternatives, has yielded remarkable results. They set an example for other nations grappling with the tobacco epidemic, something that Smoke Free Sweden has worked hard to share around the world.
Article 4 of the Framework encourages all signatories to share any knowledge and expertise they might gain on how to reduce smoking. Not to do so is in breach at least of the spirit of the Convention. This stipulation is not merely symbolic, it can help save lives. Studies have shown that millions around the world would be alive today or enjoying a higher quality of life if others adopted the same approach as Sweden. A study by the Swedish Institute for Tobacco Studies concluded that if other EU countries practised the same tobacco consumption patterns as Sweden – encouraging smokers to switch from cigarettes to snus, for example – no fewer than 355,000 lives per year could have been saved.
By adopting harm reduction measures, Sweden has maintained the lowest rate of tobacco-related deaths in the EU. Combining tobacco control with low excise rates on alternatives and a rejection of flavour bans has led to a 60% decrease in smoking rates between 2006 and 2020, by far the greatest drop in Europe. This in turn has substantially curbed the rate of smoking-related diseases, including a cancer incidence 41% lower than the European average. The emphasis on harm reduction has thereby not only saved lives and improved quality of life, but also contributed to a decline in the overall burden on the healthcare system. This underscores the importance of Sweden’s approach in particular for those countries that cannot afford the significant healthcare infrastructure and costs associated with tobacco smoking.
It is disheartening to note that the WHO has often overlooked or failed to recognise what actually lies behind the success story that Sweden embodies in the global fight against tobacco-related harm. Despite Smoke Free Sweden’s drive to highlight this incredible story, the WHO’s own statements regularly lump alternative products in with tobacco smoking, deliberately failing to distinguish between their relative harms.
While the WHO’s campaigns for a COP10 focus on traditional tobacco control measures, it is crucial to highlight the importance of embracing diverse strategies in the fight against tobacco-related harm. Sweden’s experience demonstrates that harm reduction can be a powerful tool in achieving public health goals and reducing the prevalence of smoking-related diseases. It should serve as an inspiration for a global community seeking innovative and effective ways to combat the tobacco epidemic.
COP10 presents a critical opportunity to celebrate and learn from successful tobacco control initiatives. Recognising and promoting the achievements of a nearly smoke-free Sweden can contribute to a more comprehensive and nuanced global approach to tobacco control, ensuring that harm reduction strategies are given the attention they deserve. If progress on public health really is the focus of COP10, the WHO and all participating countries must remove their ideological blinders and put lives first.