On December 5, the European Parliament in Brussels, Belgium, held an unprecedented event, titled “Harm Reduction: The Road to a Smoke Free Europe.”
Topics discussed included tobacco harm reduction’s efficacy in preventing smoking-related disease and deaths, and how better European Union policies could unlock this potential.
Advocates told Filter that the event was unique, as the first time tobacco harm reduction (THR) consumers have been formally represented at the European Parliament.
It was hosted by Swedish MEP Johan Nissinen, who opened proceedings. Guest speakers included British advocate Clive Bates, public health adviser to ETHRA (European THR Advocates); Julio Ruades Esteban of the Spanish Association of Personal Vaporiser Users (ANESVAP); Tom Gleeson of New Nicotine Alliance Ireland; and Philippe Poirson of SOVAPE, an independent French THR association.
“The European institutions often treat consumers as if they are irrelevant or, even worse, just extensions of the tobacco industry. Yet they are the most important stakeholders of all.”
The event included special focus on the lived experiences of people whose lives have been transformed by switching from cigarettes to safer nicotine options. Millions of EU citizens have done this—despite hostile or unhelpful policies, such as a bloc-wide ban on snus sales, and growing national restrictions, like flavor bans on vapes and other products.
“The European institutions often treat consumers as if they are irrelevant or, even worse, just extensions of the tobacco industry,” Bates told Filter. “Yet they are the most important stakeholders of all.”
“They bear nearly all the costs through health and productivity losses, and their health and welfare are most directly threatened or, in rare cases, improved by the regulation formed in the EU,” he continued. “They deserve a respectful hearing. Several MEPs recognize this, and one, Johan Nissinen, offered to create a forum for their views to be heard.”
As background to his fellow speakers’ testimonies, Bates provided data on smoking and THR, “concentrating on snus as a proof-of-concept twice over.”
“First, as the clearest case of tobacco harm reduction,” he explained, “and second as the most telling example of the EU getting its policy wrong and then never reversing, no matter what the evidence shows.”
Bates said he felt lucky to have participated, and to have witnessed “insightful testimonials” from consumers whose stories might influence politicians. “It’s one thing to have charts and research papers,” he said, “but far more powerful to summarize a life experience.”
Transcripts from the European Parliament event were recently made available. Below are three consumer advocates’ testimonies, which Filter has lightly edited for length and clarity.
“ANESVAP represents 600,000 Spanish vapers, and my goal today is that, for the first time, you will learn about the experiences of real people who, after having tried everything, quit smoking thanks to vaping, recovering their health and their lives.
The fight is for our right to make informed decisions about our own health and on our own responsibility. For we have single-handedly achieved our solution to smoking, and we do not believe that anyone should stop us from doing so.
“We, the people directly affected, are rarely listened to.”
After 10 years, we have seen that authorities have misconceptions about vaping and the huge potential it has to change people’s lives. This influences regulations that will affect our health and our lives. And we, the people directly affected, are rarely listened to.
That’s why we created this book: 1,500 testimonials where vapers freely recount their experience. An unprecedented tool that demonstrates the public health potential of vaping and how misguided regulation can destroy it.
It is said that flavors attract children in order to justify their prohibition, leaving available, at most, the taste of tobacco. But don’t we adults also like pleasant flavors? Put yourself a moment in our shoes, and imagine what it would mean if you were forced to stay smoke-free by using a flavor that disgusts you.
Some countries have unilaterally taken this wrong decision. If they had asked us, perhaps they would have understood the following: Vapers stay away from tobacco because, for the first time, quitting smoking becomes a pleasurable journey, precisely because of the flavors and nicotine. We don’t consider ourselves sick, that we are taking medicine to quit smoking, nor do we need anyone to tutor us.
The key is pleasure. Flavors are not a whim. They are the cornerstone of quitting smoking. If legislators destroy the pleasure of vaping, millions will continue to smoke cigarettes and a massive, unchecked black market will be created across Europe.
“You cannot regulate a product that saves lives in the same way as a product that kills people.”
We need to think carefully about youth. It is a mistake to assume that banning flavors will stop young people from vaping or smoking. Prohibition works as an attractor for youth and, in fact, banning flavors from vaping will cause many to turn to smoking.
From ANESVAP, with great hope, we cry out for the European authorities to understand that the regulations of these products, not only of vaping, but also of other tools with historical success, such as Swedish snus, require care and dedication, and not a vague ban or equating them with tobacco. You cannot regulate a product that saves lives in the same way as a product that kills people.
Regulations must be debated transparently in the parliament that represents us all. Child protection must be integrated without sacrificing the health and lives of millions of adult citizens. But above all, please listen to your citizens. We are living testimony that harm reduction [for] smoking can be an excellent contribution to public health regulations; but also, with time and dedication, it could be the key to the end of the biggest cause of preventable death in Europe and the world.”
“We represent nicotine consumers, specifically consumers of safer products such as e-cigarettes and nicotine pouches, but we also represent the right of consumers of combustible products to access lower-risk alternatives, as they are the ones with the most to gain from these products.
I was someone who smoked close to 30 cigarettes a day. I was resigned to smoking all my life as even the recommended ‘proven safe and effective products’ had failed me.
“The day after purchasing that first e-cigarette I stopped smoking, never to go back. That’s 131,490 cigarettes never smoked.”
In 2011 I first came across e-cigarettes, and like everyone else I was skeptical. Admittedly it was the novelty that most appealed to me, and out of curiosity I got a small cigarette-like device with a blue light at the end.
The day after purchasing that first e-cigarette I stopped smoking, never to go back. That’s 131,490 cigarettes never smoked.
So, what was different about e-cigs, which in essence were just another nicotine replacement? Why did they work for me when gum and patches failed?
It was replacing the ‘something to do with my hands’ as much as the nicotine. It was also the fact that when I tired of one flavor, I had the choice of others. All this combined to make vaping as satisfying as smoking used to be.
Evidence shows that a support network and counseling are crucial to a successful quit attempt. When I switched to vaping, I met other people who were on the same journey; we supported each other, and the shop I bought supplies in gave me encouragement and advice.
Most stop-smoking services are under-resourced. In Ireland, we have nine “we can quit” facilitators, supplemented by occasional clinics, a hotline and smart phone app. But we also have over 300 specialist vape shops—a resource that is being ignored, and the opportunity to reach and support many more smokers is being lost.
When I first switched, e-cigarettes were largely unregulated other than as a consumer product. This changed with the EU [Tobacco Products Directive] in 2016. Now e-cigs are regulated as a subcategory of tobacco products.
The TPD, thanks to the input of consumers, turned out to be helpful but far from perfect, regulating the components and the liquid used in them for the protection of consumers.
As smokers embraced these new products, we saw a dramatic fall in smoking prevalence. Healthy Ireland figures show the decline in smoking rates from 2015 to 2019, as e-cigarettes replaced smoking.
So, what happened in 2019? We had a flurry of misinformation driven by the ‘EVALI’ incidents in the United States. The CDC refused to correct this misinformation even though they knew this outbreak was caused by illicit THC products.
This misinformation impacted e-cig uptake and led to a stalling in declines in smoking prevalence. As vaping prevalence fell from 5-3 percent, smoking increased by 1 percent and has remained stagnant at 18 percent for the last three years.
“‘Those things are worse than cigarettes, I might as well stay smoking,’ is a phrase I have heard all too often, and a damning indictment of public health in Ireland.'”
Consumers are directly affected by regulation in the expected ways and also in unexpected ways, unintended but not unforeseeable. There is a real danger that measures intended to reduce e-cig use will have negative consequences and protect the cigarette trade. This is because the two products are interchangeable, and anything that reduces the market advantage of one will increase the market advantage of the other.
As much as we wish the tobacco industry would bear the brunt of any regulation, the fact is that burden is borne primarily by the consumers of the regulated product.
After the TPD we had to struggle with 10 ml bottles, generating a huge level of plastic waste. We had to accept a 20 mg nicotine limit which for heavy smokers was a barrier to them completely replacing combustible cigarettes.
Now we are seeing proposals to ban flavors and restrictions on device options. This will be an imposition on consumers who have exercised their right to choose a reduced-risk product, and will reduce the appeal of e-cigs.
That of course is the stated intention, but it risks the unintended but foreseeable consequence of smokers continuing to smoke, and some vapers going back to smoking, especially the ones who had not fully switched.
Will it stop non-smokers from using e-cigs? It’s doubtful, as most e-cig use among non-smokers is experimental and occasional. However, it is possible, even probable, that this type of restriction will increase the number of people who experiment with smoking.
While no one wants non-smokers talking up vaping, can we be certain that any portion of those people won’t end up smoking if we go too far in discouraging e-cig use?
When we talk about the health cost of tobacco use, what we are referring to is the health cost of smoking. If we forget that and instead get distracted by reducing nicotine use, we will do more harm than good, if that shift in focus delays the inevitable decline in smoking. Negative messages about e-cigs can end up being perceived as positive messages about smoking: ‘Those things are worse than cigarettes, I might as well stay smoking,’ is a phrase I have heard all too often, and a damning indictment of public health in Ireland.
Health inequalities will be reduced through measures that have a greater effect on smokers in higher-prevalence groups. That focus must be targeted on reducing smoking, which is the most significant cause of premature death, nearly 700,000 deaths every year in the EU. This is what will bring the greatest benefits to public health.”
“Major health problems have motivated me to try to quit smoking, after approximately 28 years of heavy smoking. This desire to quit smoking is shared by more than two-thirds of smokers. This is what we found in our European survey of nicotine users conducted by ETHRA in 2020, with over 37,000 respondents from the EU.
The persistence of smoking is not due to a lack of willpower on the part of smokers. The problem lies in their ability to achieve this desire.
In my case, I tried multiple methods: patches, gum, medications, hypnosis, and more. When smokers attempt to quit without assistance, over 96 percent fail. These failures are psychologically difficult to bear. They are experienced as personal failures, and in my case, they added to the burden of my health problems.
“According to the ETHRA survey, among the 31,000 vape users, 84 percent have quit smoking.”
Then, in 2014, I tried vaping. I haven’t smoked since. I am not alone in this experience. According to the ETHRA survey, among the 31,000 vape users, 84 percent have quit smoking. Among the 1,000 snus users, 74 percent no longer smoke. This rate rises to 85 percent among Swedish respondents, for known reasons.
To achieve such success, harm reduction tools must address essential aspects for consumers and have an environment that allows them to try and adopt these tools.
One fundamental aspect is nicotine intake. However, there is a major concern among smokers when they want to quit smoking: They tend to underdose themselves with nicotine. Fear of nicotine, which has been fueled by regulatory signals and confused discourse. It was by overcoming the fear of nicotine, to stay away from smoking, that I won the battle in the long run to solidify my smoking cessation.
However, relapse is something really difficult to experience. There is a feeling of personal failure. The guilt-inducing discourse on smoking, portraying it as a moral fault and lack of willpower, fosters a vicious cycle of seeking atonement: Not only should you quit smoking, but you should also do it without pleasure.
This mindset is entirely counterproductive. On the contrary, it is through the pursuit of pleasure that smokers have the greatest chance of success. It took me a while to understand this during my attempts.
Vaping has several advantages in creating this virtuous dynamic of pleasure as a driving force for smoking cessation. The diversity of flavors is crucial in this regard. It should be noted that nearly nine out of 10 vapers do not use tobacco flavors. As for me, I use a wide variety, with a preference for indulgent and confectionery flavors.
Diversity of devices is also important to cater to different types of users, or even to respond to different moments or situations for the same person.
At the time I quit smoking, I was in a financially tight situation, mainly due to my health problems. In countries without excessive taxation on vaping, vaping is cheaper than smoking. For me, this was a motivational boost to give it a try. In our 2020 survey, 65 percent of EU residents highlighted the importance of the lower cost of vaping compared to smoking in adopting it.
The point is quite obvious: For smokers to transition to reduced-risk products, they need to be able to afford them. A high cost is obviously a barrier to quitting smoking, especially for the less fortunate.
During my attempts to quit smoking, I had the extremely intense feeling of being torn between two personas: One wanted to quit smoking, the other wanted to have another cigarette. This extreme ambivalence provides fertile ground for doubt. When I finally succeeded in not smoking long-term with vaping, every new piece of information talking about alleged risks of vaping put me on alert.
“When I take a deep breath, there are no longer the crackling sounds that used to be present in my bronchial tubes.”
In the support group for smoking cessation using vaping that we facilitate with SOVAPE, we see thousands of smokers who are quitting smoking but relapse due to fake news about vaping.
This is a serious problem of public health that smokers are deprived of the ability to make an informed choice on the subject. In the United Kingdom, ASH (Action on Smoking and Health) has published a guide against vaping misinformation. In New Zealand, the Ministry of Health has created a website. In EU countries, I haven’t found anything similar.
However, if we resist these doubts and fears in the long run, we personally experience the health improvements of switching to vaping. In the last years when I was smoking, I would have brownish phlegm every morning. That disappeared after a few months of exclusive vaping. When I take a deep breath, there are no longer the crackling sounds that used to be present in my bronchial tubes. And I could give you other examples of improvements to my health.
Quitting smoking is not just an increase in life expectancy, which remains abstract. It is a very tangible improvement in health, noticeable in people’s daily lives. This is not just my personal testimony. In our 2020 survey, 97 percent of vapers emphasized the importance of health improvement and risk reduction in their adoption and continuation of vaping.”
Photograph of entrance of European Parliament building in Brussels by European Parliament via Flickr/Creative Commons 2.0