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An influential European Union report has taken a cautious, generally pessimistic view on tobacco alternatives.
A couple of examples, according to the report “Beating Cancer Inequalities in the EU”, presented at the Europe’s Beating Cancer Plan: Joining Forces conference held 31st January 2024, are that increasing vaping is a concerning development among young people, and e-cigarettes contain a variety of compounds with inconclusively characterised health effects.
Further, the report states that not enough time has passed since market entry for clear evidence of the role played by tobacco alternatives, but signs point to them having a negative overall impact on public health.
The report reads: “An opinion statement published by the European Commission in 2021 concluded that strong evidence exists on the role of e-cigarettes as a gateway to smoking, particularly among young people, while the addictive potential of the products is high because many of them contain nicotine.”
The report did conclude that daily smoking rates continue to fall, but pointed to rising vaping rates, with 6.1% of those aged 15 to 24 reporting they had used e-cigarettes in 2021 on average across member countries in the Organisation for Economic Co-operation and Development (OECD). “This is almost double the overall average of 3.2% among all those aged 15 and over,” the report says.
Taxes found to be the best tobacco-control policy
Overall, the report found that tobacco control measures were increasing. It said that taxes were the most cost-effective tobacco-control policy and that they had a particular effect on younger groups as well as low-income bands. For example, a 31% 2003 price increase in France corresponded with a 5% decrease in smoking prevalence that year, while an 18% Dutch increase in 2004 saw cigarette sales drop almost 13% that year.
The report found that the countries with the most stringent tobacco tax policies scored the highest on the Tobacco Control Scale (TCS), a comparative measure examining the effectiveness of tobacco control actions in each country. This put Ireland in first place on the 2021 TCS with 82 out of 100 points, compared to 71 for France in second place. As well as taxation, Ireland also scored well for having “the maximum possible on comprehensive smoke-free bans and advertising bans”.
However, taxation policies are falling behind developments in tobacco alternatives and need to be updated. The Beating Cancer plan refers to the need to work in full transparency towards extending taxation to novel tobacco products, the report says.
Countries did see improvement between 2010 and 2021 in most TCS categories. For example, all countries improved product labelling requirements on the dangers of smoking, while 22 of the EU+2 countries had strengthened bans on advertising cigarettes across different media, and 21 had increased mandatory smoke-free environments.
Countries advised to spend on tobacco control and smoking cessation
“Beating Cancer Inequalities in the EU” noted that the EU+2 countries have started to apply some of these same measures to e-cigarettes and other electronic delivery systems (such as heated tobacco systems) – though these policies are often weaker than those used for tobacco. This includes minimum-age sales restrictions, vaping taxes, bans on use in indoor spaces, sales regulations and advertising restrictions.
“Disposable e-cigarettes, which are popular among younger people and are associated with substantial health and environmental impacts, are expected to be further restricted via national bans or EU-level legislation to ban single-use disposable batteries,” the report says.
Curiously, the report concludes that EU countries have to do more to fulfil another policy recommended by the World Health Organization (WHO) – to increase access to, and financial coverage of, smoking cessation aids – but did so without any reference to the role alternative tobacco products might play.
It says there needs to be full coverage of tobacco replacement medications (currently offered by only three countries: Cyprus, Ireland and Romania) as well as efforts to get healthcare professionals more involved in providing cessation advice and aid.
Overall, the report concludes that it is important to remember that spending on tobacco control and smoking cessation should be implemented as a comprehensive package and would generally result in cost savings back. Such an instance is expected in France, where the country’s 2016-20 tobacco control interventions are expected to prevent 4m cases of chronic disease, save €578m in healthcare expenses, and return €4 for each €1 invested over 2023 to 2050.
– Freddie Dawson ECigIntelligence staff
