Sweden’s lesson: harm reduction over prohibition
Sweden is is set to become the EU’s first smoke-free nation. Just over five per cent of its citizens still smoke, and its lung-cancer mortality rate is the lowest in Europe. Across the rest of the Union, however, progress has been slow: nearly one in four adults continues to smoke, a figure that has barely shifted in four years. The EU’s pledge to become smoke-free by 2040 now looks increasingly uncertain.
This gap between ambition and reality was the focus of a recent Brussels discussion organised by We Are Innovation, a global network promoting evidencebased approaches to public health. Legislators, academics and health experts questioned whether current tobacco-control policies are delivering meaningful results. Many concluded that without embracing harm-reduction tools — including vaping, nicotine pouches and heated tobacco — the Union risks missing its goal by decades. “Europe has set a bold target,” Greek MEP Emmanouil Fragkos told the audience. “The question is not whether we support that goal, but how we get there. Do we follow the evidence and what works, or do we follow ideology and prohibition?”
Speakers returned repeatedly to the Swedish example. Tetiana Rak, Chief Operating Officer of We Are Innovation, outlined how Sweden has cut smoking by 65% since 2008, compared with minimal change at EU level. “Sweden stands on the brink of becoming Europe’s first smoke-free nation,” she said. “Smoking rates are now just 5.4%, and that success has come with 36% fewer lung-cancer deaths and 21% fewer smokingrelated deaths overall.”
We are in a battle between deadly combustion and safer alternatives
Rather than aggressive bans, Sweden’s progress has been driven by what Rak described as “pragmatic regulation” — making safer nicotine alternatives accessible, socially acceptable and affordable. “The Swedish model works because it’s human-centred,” she added. “It “We are in a battle between deadly combustion and safer alternatives.” combines traditional measures with innovation—making safer nicotine products accessible, acceptable and affordable. As oral nicotine use rose, smoking fell almost in mirror image.” Other countries are beginning to see similar results. In the Czech Republic, adjustments to taxation and the inclusion of innovative products in cessation guidelines helped drive a sharp fall in smoking.
In Greece, after years of stagnation under strict controls, a policy change in 2020 was followed by a significant drop in smoking prevalence within three years. Dr Anders Milton, a Swedish physician, argued that regulation and price alone cannot explain these trends. Cigarette prices in Sweden and Denmark are comparable, yet smoking rates differ dramatically. “That tells us taxation is not the answer,” he explained. “What matters is offering people a credible alternative.” He also criticised what he sees as resistance within EU institutions to new technologies: “EU health authorities seem to be against everything except cigarettes. They oppose snus, they oppose vaping, they oppose heated tobacco, all of which save lives.”
For Rak, the debate should not be framed as smoking versus health, but combustion versus safer alternatives. “We are not in a battle between smoking and health,” she said. “We are in a battle between deadly combustion and safer alternatives. These products are helping millions to walk away from cigarettes. The future will be smoke-free, not because we ban everything, but because we invent better things to choose.” Modelling presented by We Are Innovation suggests that, under current trends, the EU may not reach smoke-free status until well into the next century. Adopting a Swedishstyle approach, however, could bring that timeline forward by more than fifty years.
Rethinking the public health toolkit
A second We Are Innovation event in Brussels explored the same question from a different angle: whether innovation can outperform blanket bans as a public-health strategy. Opening the session, Rak and We Are Innovation COO Tetiana Rak and CEO Federico N. Fernandez presented findings from a new report on nicotine pouches. Fernández noted that, despite decades of restrictions and higher taxes, one in four European adults still smokes. “At the current pace of decline, Europe will not reach its ‘smoke-free by 2040’ goal for more than a century.” Fernández argued that this represents millions of avoidable deaths — and a failure to adapt to better tools.
Countries such as Sweden and Greece, he explained, are reducing smoking not by intensifying prohibition, but by introducing and regulating lower-risk alternatives. Nicotine pouches, in particular, provide pharmaceutical-grade nicotine without tobacco, combustion, vapour or second-hand exposure. Sweden’s near smoke-free status, Fernández suggested, reflects the country’s willingness to treat innovation as an asset rather than a threat. Czech MEP Ondřej Dostál, a member of the European Parliament’s Public Health Committee (SANT), backed a proportional approach, emphasising that regulation should support well-being without undermining autonomy.
He also pointed to the importance of subsidiarity, arguing that national and local authorities may be better placed than the EU to shape culturally appropriate measures. Dr Karl Fagerström, a Swedish clinical psychologist and founder of the Society for Research and Nicotine and Tobacco, addressed common misconceptions about nicotine. He highlighted that nicotine itself is not responsible for cancer or tobaccorelated disease, and noted its role in cessation therapies. “It’s the thousands of chemicals contained in tobacco and tobacco smoke that makes tobacco use so deadly… It’s this toxic mix of chemicals, not nicotine, that causes serious health effects.”
At the current pace of decline, Europe will not reach its ‘smoke-free by 2040’ goal for more than a century
To illustrate these dynamics in real life, Carissa Düring, Director of Considerate Pouchers, shared her experience growing up in Sweden. Early progress in reducing smoking had mainly been among men who adopted snus. Women were slower to switch, in part because traditional products were seen as unattractive. That began to change with the arrival of nicotine pouches, which are discreet and do not stain teeth. Female smoking rates fell sharply, as did youth smoking.
Among young adults aged 16–29, prevalence now stands at just 2.3%. Düring’s conclusion was clear: a single solution will not work for every group. “One smoking cessation tool will not work for all groups of society. They will not affect women and men equally.” In closing remarks, Fernández warned that countries which ban innovation altogether — citing Mexico’s constitutional prohibition of vaping — risk harming both public health and scientific progress. Fagerström challenged the claim that all nicotine products carry equal risk, arguing that such statements are driven more by history and mistrust than by data.
The overall message from the panel was consistent: the fastest routes to a smoke-free society are emerging not from stricter bans, but from regulated choice and harm-reduction strategies. As Düring put it, “Let’s not waste time trying to reinvent the wheel when the evidence and the voices of consumers already exist and are pointing the way,” Düring said.
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