Sweden has almost done it. Just over five per cent of its citizens still smoke, and deaths from lung cancer are the lowest in Europe. Yet across the rest of the European Union, nearly one in four adults continues to smoke, a figure that has barely moved in four years. While some nations are making progress, the EU’s wider ambition of becoming smoke-free by 2040 appears to be drifting out of reach.
That persistent gap - between political aspiration and practical reality - was the focus of a recent discussion in Brussels organised by We Are Innovation, a global network promoting evidence-based approaches to public health.
Legislators, academics, and health experts gathered to examine whether Europe’s current tobacco-control strategy is delivering the results it promises. They concluded that without embracing harm-reduction technologies such as vapes, nicotine pouches, and heated tobacco, the EU may end up missing its smoke-free goal by more than half a century.
“Europe has set a bold target,” Greek MEP Emmanouil Fragkos told the event. “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?”
The scientific evidence, speakers argued, strongly suggests that pragmatism is the only effective route forward. Attendees heard how Sweden’s experience shows that making safer nicotine alternatives accessible, acceptable, and affordable can deliver rapid and sustained falls in smoking.
“Sweden stands on the brink of becoming Europe’s first smoke-free nation,” Tetiana Rak, Chief Operating Officer of We Are Innovation, told the event. “Since 2008, it has cut smoking by 65%, while the EU average has barely moved. Smoking rates are now just 5.4%, and that success has come with 36% fewer lung-cancer deaths and 21% fewer smoking-related deaths overall.”
The wider EU has much to learn from Sweden’s successful approach. But the Swedish story is not one of bans or heavy taxation. Instead, it has been achieved with what Rak described as “pragmatic regulation” - policies that make safer nicotine products both available and affordable, while giving adults clear information about relative risks.
“The Swedish model works because it’s human-centred,” she said. “It combines traditional measures with innovation - making safer nicotine products accessible, acceptable and affordable. As oral nicotine use rose, smoking fell almost in mirror image.”
That pattern has been repeated elsewhere. In the Czech Republic, smoking dropped seven percentage points in just three years, after taxation was adjusted according to product risk, and innovative products were included in national cessation guidelines. In Greece, one of Europe’s most entrenched smoking cultures, the picture was similar. After fifteen years of restrictive policies and stagnating rates, the government shifted its approach in 2020. Within three years, smoking prevalence fell by six points, freeing around six hundred thousand people from cigarettes.
These examples form the basis of what We Are Innovation calls the “3A framework” - accessibility, acceptability, and affordability. Make safer alternatives available in normal retail settings. Allow enough variety to make them realistic substitutes for cigarettes. Keep taxes low enough that switching is economically viable. “The countries that are succeeding all apply these three A’s,” Rak said. “That’s how you move smokers from combustion to safer choices.”
At present, however, few EU members follow that model. The Union’s health authorities remain cautious about new nicotine technologies, often treating them as threats rather than tools. The consequence, said Swedish physician Dr Anders Milton, is that the EU risks ignoring the one approach that has demonstrably reduced harm.
“Sweden has become the first country in the EU to reach smoke-free status and the government did very little to make it happen,” Milton said. “The real driver was people themselves, who accepted snus as an alternative and simply stopped smoking. It shows that consumer choice can achieve what prohibition cannot.”
Milton argued that taxation alone has limited effect. Cigarette prices are similar in Sweden and Denmark, yet smoking rates are far lower in Sweden. “That tells us taxation is not the answer,” he explained. “What matters is offering people a credible alternative.”
The debate also touched on what Milton called the “institutional inertia” of European health policy. “EU health authorities seem to be against everything except cigarettes,” he said. “They oppose snus, they oppose vaping, they oppose heated tobacco, all of which save lives. That is a mistake. We should be proud that Sweden has fewer deaths from lung cancer than any other European country. We should learn from success, not try to ban it.”
Rak went further, arguing that innovation and public health are not opposing forces but natural allies. “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.”
For Fragkos, the issue is now one of political will. “Public health should not be about punishing people for their past choices,” he said. “It should be about helping them make better ones.” The task for lawmakers, he added, is to design regulation that reflects how people actually behave, rather than how officials wish they would.
If adopted at European scale, that approach could have dramatic consequences. We Are Innovation’s modelling suggests that under current trends, the EU will not reach smoke-free status until the year 2116. Following the Swedish model could bring that date forward by more than fifty years.
For now, Europe faces a choice. It can continue down the path of bans and taxes, repeating policies that have barely moved the needle in two decades. Or it can follow the examples of Sweden, the Czech Republic, and Greece, and use innovation to accelerate change.
Read More: The EU Case for Innovative Nicotine Products Briefing Paper
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