Stories

Public health loses credibility when ideology takes priority over evidence, empathy and real-world outcomes. The closing remarks from GFN26 call for a return to harm reduction principles: meeting people where they are, protecting access to safer alternatives and recognising adult autonomy. In nicotine policy, the goal should be reducing smoking-related disease — not punishing people who use nicotine. Evidence-based regulation must defend both public health and the right to make informed choices.

Rural communities often face greater barriers to quitting smoking, from limited healthcare access to higher stress, stigma and fewer cessation support options. These challenges make it especially important that tobacco policy reflects real-world inequalities rather than assuming one approach works for everyone. Harm reduction can offer more practical pathways for smokers who may struggle to access or succeed with conventional quitting methods. Reducing smoking-related harm requires policies that meet people where they are, not only where public health systems expect them to be.

The European Commission aims for a "smoke-free generation" by 2040, focusing on reducing smoking-related diseases. The debate revolves around treating nicotine or combustion as the main issue, with evidence supporting combustion as the primary cause of smoking-related deaths. The Commission's consultation on the Tobacco Products Directive should consider successful quitting experiences with smoke-free alternatives and differentiate between tobacco products' risks appropriately. Sweden's success in reducing smoking rates through lower-risk alternatives serves as a model. A credible consultation should acknowledge this evidence, leading to more effective tobacco control policies in the EU.

Vaping scare stories often begin with selective framing rather than balanced evidence. When studies are reported without proper context on relative risk, exposure levels or comparisons with smoking, public understanding can quickly become distorted. This matters because exaggerated risk perception may discourage adult smokers from switching to lower-risk alternatives. Better health communication should inform the public accurately, not turn complex evidence into fear-driven headlines.

Costa Rica is considering banning oral nicotine products, leading to concerns about driving users to more harmful options like cigarettes or the black market, dominated by criminal organizations. Tobacco smoking accounts for health issues and deaths in the country, making oral nicotine products a safer alternative and aiding in quitting tobacco. The ban could limit choices for smokers and fuel illegal trade, as seen in Australia. Critics argue the ban may benefit criminal networks and hinder public health goals. Costa Rica's potential prohibition could set a precedent globally, impacting smokers and black market dynamics.

Sweden’s move to block the EU nicotine pouch tax hike puts harm reduction at the centre of Europe’s tobacco policy debate. With one of the lowest smoking rates in the EU, Sweden argues that smoke-free alternatives should not be taxed in the same way as cigarettes. Raising prices on lower-risk products risks weakening the incentive for smokers to switch away from combustible tobacco. Evidence-based regulation should protect Sweden’s progress, not make cigarettes more competitive.

South Australia’s crackdown on illicit tobacco is highlighting the scale and resilience of the illegal cigarette market. Reports of rising black-market prices suggest enforcement may be disrupting supply, but also show how strong consumer demand continues to sustain organised illegal trade. The situation raises wider questions about whether high tobacco taxes, restrictive nicotine policy and limited access to lower-risk alternatives are creating conditions in which illicit markets can thrive. Effective public health policy must reduce smoking-related harm while avoiding approaches that push consumers further into unregulated supply chains.

Insurance rules often treat vaping the same as smoking, even when the health risks are not equivalent. In India, insurers may classify anyone using nicotine, including e-cigarettes or e-hookah, as a smoker when assessing health or life cover. This approach raises important questions about whether financial systems are recognising relative risk — or simply grouping all nicotine use into one high-risk category. More accurate risk assessment should reflect the difference between combustible tobacco and lower-risk nicotine alternatives.

Prohibiting non-combustible nicotine products risks protecting cigarettes rather than public health. When lower-risk alternatives are restricted or banned, adult smokers may be left with fewer realistic options to move away from combustible tobacco. Effective nicotine policy should distinguish between use and harm, prioritising reduced exposure, accurate risk communication and proportionate regulation.

Estonia introduced its own regulations beyond EU requirements, including a national e-liquid tax, a tobacco-only flavor ban, and an online sales ban. These measures led to a significant rise in legal market excise revenue when menthol was re-permitted, indicating a shift away from the black market. Despite the policy changes, Estonia's smoking rate decline started prior to implementation. The data suggests that a flavor ban did not reduce smoking but may have fueled the black market. This case study cautions against overregulation, emphasizing the importance of evidence-based policymaking. Brussels is reminded to consider Estonia's experience as it revises the Tobacco Products Directive.