Open letter to Director General of DG Sante on behalf of Smoke Free Sweden
Sweden’s success must inform Europe’s next tobacco policy
TO: Sandra Gallina, Director-General for the European Commission’s Directorate-General for Health and Food Safety (DG SANTE)
Dear Director-General,
I write in response to the European Commission’s recent evaluation of the EU tobacco control framework, which was published in the same week that two profoundly important developments took place.
One – and surely a cause for celebration – was new data from the Swedish Council for Information on Alcohol and Other Drugs (CAN), which showed that Sweden has reduced daily smoking to just 3.7%, placing it firmly below the global smoke-free threshold.
The other – a source of grave concern – was France enacting a sweeping ban on nicotine pouches, which removes a proven safer alternative from the hands of adult smokers. Second,
These events encapsulate a growing contradiction at the heart of European tobacco policy.
Sweden’s success is the result of a deliberate, evidence-based approach that makes safer nicotine alternatives – such as snus, nicotine pouches and vaping products – acceptable, accessible and affordable.
As smoking has declined, the use of these alternatives has risen, displacing cigarettes at a population level and delivering the lowest rates of tobacco-related disease in Europe.
Yet the Commission’s evaluation fails to meaningfully engage with this real-world success. Sweden is referenced only in passing, and not as a model to be studied or emulated, but as a cautionary example in relation to nicotine pouches.
This omission is particularly striking given the Commission’s own public consultation.
In 2023, citizens across Europe were invited to share their views on EU tobacco rules. In response, an overwhelming majority of the 24,000 respondents to the European Commission’s public consultation agreed that smokeless alternatives – such as e-cigarettes, nicotine pouches and heated tobacco products – help people move away from cigarettes.
The evaluation report shows no meaningful reflection of this significant consensus.
At the same time, the report signals concern about so-called “novel nicotine products”, despite mounting evidence that these products are accelerating declines in smoking where they are allowed to compete with cigarettes.
Nicotine does not cause cancer – combustion does. Policies that fail to recognise this fundamental distinction risk misleading the public and undermining efforts to reduce smoking-related disease.
If Europe restricts access to safer alternatives, it will not eliminate nicotine use. It will simply entrench cigarette consumption – the very outcome public health policy is meant to prevent.
By contrast, Sweden is on the verge of eliminating smoking altogether. The latest CAN findings are hugely encouraging, and we look forward to the Public Health Agency of Sweden confirming them when it publishes its official data later this year. If validated, Sweden will stand as the clearest real-world demonstration that tobacco harm reduction works and works rapidly.
European policymakers now face a simple choice: either acknowledge this success and apply its relevant lessons, or ignore it.
As the Commission shapes the next Tobacco Products Directive, the Smoke Free Sweden movement urges DG SANTE to ensure that future regulation is grounded in evidence, responsive to public consultation and proportionate to risk.
Sweden’s experience should be the foundation of Europe’s next chapter in tobacco control, not an inconvenient outlier.
Yours sincerely,
Dr Delon Human
Leader, Smoke Free Sweden