The European Union has published a questionnaire, asking interested parties to participate in helping to shape tobacco and nicotine regulation, as the process of revising its critical Tobacco Products Directive (TPD) continues.
The EU-wide TPD determines what will or won’t be legally available, and how it can be sold. Tobacco harm reduction advocates fear the upcoming revisions may contain damaging restrictions on safer nicotine products, such as a bloc-wide ban on vape flavors, in the region with the world’s highest smoking rates.
In that context, those advocates describe the questionnaire as a sham, its questions skewed in order to favor an anti-nicotine ideology.
The questionnaire was released on May 22 by the European Commission, the EU’s executive arm, which will be collecting answers until August 14. The stated aim is to give “stakeholders”—including national health authorities, NGOs, businesses, academics and private citizens—“the opportunity to express their views on the current rules and suggest possible changes to them.”
“It looks like it is designed to bolster support for simplistic policies that restrict or ban nicotine products that are far safer than cigarettes.”
But consumer group European Tobacco Harm Reduction Advocates (ETHRA) swiftly issued a scathing response, stating that “the survey is impossible to answer for anyone with an understanding of the differences in risk between different tobacco and nicotine products and a rational public health interest in the role that low-risk alternatives to smoking could play in reducing the burden of … disease.”
Tobacco harm reduction advocate Clive Bates, of Counterfactual Consulting, similarly sees the questionnaire as unfit for purpose. It “looks like it is designed to bolster support for simplistic policies that restrict or ban nicotine products that are far safer than cigarettes,” he told Filter.
ETHRA’s detailed response identifies eight generic failings in the nature of the questions asked. These include inadequate breadth or subtlety of available multiple-choice answers; inappropriate aggregation of very different products; no recognition of likely unintended consequences of policies; ignoring the counterfactual likelihood that many youth who vape would be smoking if vapes weren’t available; no recognition of trade-offs in framing questions; asking for opinions on factual matters; ignoring respondent risk perceptions; and no options to deregulate, for example by ending the EU’s existing ban on snus.
The critique additionally gives individual commentary on all 23 questions in the survey. One question, for instance, asks: “How important is it to you that the EU tobacco control legislation supports the following objectives with regard to tobacco, nicotine and non-nicotine products?”
“The question is heavily loaded. It does not differentiate between different products that have very different levels of risk” and “misses major outcome objectives.”
The eight available answers include “Preventing the initiation of use,” “Supporting the cessation of use,” “Ensuring that these products do not have attractive features” and “Minimizing the administrative burden on Member States”—but nothing about reducing deaths.
“The question is heavily loaded,” ETHRA comments. “It does not differentiate between different tobacco and nicotine products that have very different levels of risk.” And it “misses major outcome objectives (reducing the burden of smoking-related disease) that can be attained by switching from high-risk to low-risk products.”
Though around 700,000 EU residents die of smoking-related diseases each year, the survey, ETHRA states, “betrays a lack of seriousness about the size of the population, the toll of disease and death, and the options available to address it.”
The stakes are extremely high, advocates note, when around 100 million EU adults currently use nicotine in different forms. The nature of the revised TPD will heavily influence whether they, and future consumers, use safer products or deadly cigarettes.
“The survey is a window on the Commission’s thinking, and we can already see that they will do more harm than good if they get their way.”
“The survey is a window on the Commission’s thinking, and we can already see that they will do more harm than good if they get their way,” Bates said. As well as negative public health impacts, he predicts a much bigger illicit market if this happens—when the Commission should view safer nicotine options as a public health opportunity.
ETHRA said the questionnaire illustrates “contemptuous attitudes towards the views of citizens who have an evidence-based, nuanced public-health case for tobacco harm reduction.” The intent, it said, is not a “genuine” consultation, but to “frame questions” to create a mere “illusion” of openness.
Despite this, Bates still intends to participate, believing that having some kind of a say is better than none. He plans to attach ETHRA’s critique as a file upload with his completed form.
“I urge everyone with an interest in sound regulation to do the same,” he said, “unless you have a more personal statement to upload.” He plans to assume that each question relates only to products useful to consumers for harm reduction, and answer accordingly.
“We need to square up for a new fight, but this time the opposition is better organized and financed.”
“Where there is an opportunity to oppose a measure that damages consumer interests, I will take it,” Bates said. “I will not allow any answers to be misconstrued as support for excessive measures against vapes, pouches, snus or heated tobacco.”
Bates also counsels against despondency, noting that previous EU battles have been won despite seemingly dire prospects.
There was a time in 2012, he recalled, during the formation of the TPD, when the European Commission was planning to regulate vapes as medicine—hugely restricting access for people who smoke—and had the backing of many influential bodies. But consumers pushed back hard, and the outcome was a TPD that was far less damaging than anticipated.
“We need to square up for a new fight,” Bates concluded, “but this time the opposition is better organized and financed. Everyone needs to get ready, join or form consumer groups, and start getting busy.”
Photograph (cropped) via RawPixel/Public Domain