“If safer alternatives can save lives, what responsibility do we have to science, to fairness and to the people we serve?”
Suely Castro put that question to an audience at the United Kingdom’s Parliament in London. Hosted by the nonprofit she founded, Quit Like Sweden, the December 4 event examined the implications of Sweden’s approach to tobacco harm reduction: making safer nicotine products “acceptable, affordable and accessible.”
Swedes have ditched cigarettes in favor of oral snus and nicotine pouches on a large scale, and by 2025, this had brought Sweden’s smoking rate down to just 5.31 percent—the lowest in the world.
Compared to European Union averages, that has translated to 21 percent fewer smoking-related deaths, 31 percent fewer cancer deaths and 12 percent fewer cardiovascular deaths.
When such public health wins are attainable with readily available tools, Castro’s opening question becomes pointed and urgent.
Appropriately enough given the venue, the event presented a rigorous debate on tobacco harm reduction. For this purpose, British THR advocate Clive Bates played the part of a THR skeptic, voicing counter-arguments.
“Having Clive take the role of the opposing side ensured that arguments were properly tested, challenged and examined in a transparent way, reflecting how policy decisions should be made,” Castro told Filter.
“With so many lives on the line, public health needs to encourage a clash of ideas and a restless search for pragmatic, winning strategies.”
Bates made what he described as “the case for the prohibitionists and abstinence-only activists” with gusto, which led to some stimulating exchanges. But the need for THR advocates to provide their own opposition highlighted a stark mismatch in this field.
Events that portray vapes or pouches as public health threats—from World Health Organization policy meetings downwards—systematically exclude nicotine consumers and THR advocates. Meanwhile, THR-oriented events and conferences routinely issue invitations to researchers, regulators and policymakers who oppose their platform, seeking to foster constructive dialogue. But they don’t show up.
“It is a real shame that they won’t come and make their case in person,” Bates told Filter.
“If they really think the people who support harm reduction are so wrong and the companies making safer nicotine products are so terrible, surely they could come along and win an argument through persuasion rather than avoid the argument by staying away,” he continued. “With so many lives on the line, public health needs to encourage a clash of ideas and a restless search for pragmatic, winning strategies that save lives, not retreat into comforting bubbles.”
“How can you have a treaty that is dealing with people’s lives that will not allow consumers to have a say?”
Martin Cullip, a former chair of the New Nicotine Alliance consumer advocacy group, spoke at the event about the global stifling of both access to safer nicotine products and open debate about it—as demonstrated by the recent WHO COP11 conference, where countries were commended for imposing bans.
“How can you have a treaty that is dealing with people’s lives that will not allow consumers to have a say?” he asked.
Bates, in his debate role, countered that COP11 was democratic, and that “governments are allowed to meet to discuss the scourge of the tobacco industry.” Cullip argued in turn that the conference’s departure from scientific evidence undermined its democratic credentials.
“They’re going against their own treaty,” Cullip said, pointing to the preamble of the WHO’s Framework Convention on Tobacco Control, which identifies harm reduction as one of its pillars.
“It was entertaining to be challenged on the merits of harm reduction policies,” Cullip told Filter. “Harm reduction deniers like to pretend that there is increasing evidence against the benefits of such products, but in truth, the science hasn’t changed. Instead of confirming the merchants-of-doubt as correct, the arguments in favour of harm reduction just get stronger as time passes.”
Dr. Fredrik Nystrom, a professor of internal medicine and endocrinology at Linköping University in Sweden, spoke about the importance of pouches offering satisfying nicotine levels, to reduce the chance of people returning to cigarettes. His message was that one size does not fit all: The availability of a range of nicotine levels is necessary to meet consumers’ varying individual needs.
“Just because something is done regularly doesn’t make it addictive. Significant harm needs to be done.”
“If smokers didn’t get pleasure from vaping, then they probably wouldn’t vape,” Dr. Garrett McGovern, an addiction medicine specialist from Ireland, told the audience. He was making a case for accepting flavored vapes as key to smoking cessation.
“It’s as near harmless as you’re going to get,” he said. “There’s no tangible evidence that either flavors or vapor is harmful.” The WHO and others, he said, have turned something quite simple into something complicated.
Bates, playing devil’s advocate, retorted that McGovern’s stance was just “a strategy to extend the addiction menu—adding a starter, a main course and dessert, instead of just a bag of chips.”
“Just because something is done regularly doesn’t make it addictive,” McGovern replied. “Significant harm needs to be done.”
Youth “addiction,” particularly, is often used as a stick to beat safer nicotine products. Yet modern definitions of substance use disorders, including in the United States Diagnostic and Statistical Manual of Mental Disorders (DSM-5), focus less on frequency or quantity of use, and more on associated negative life impacts and harms. When the harms of vaping, say, are minimal, many experts see addiction as a misnomer.
Rational taxation can facilitate what would be one of the greatest transformations in public health history, Sweanor said.
To encourage people to switch to less harmful nicotine products, we also need “differential taxes for differential risks,” David Sweanor, an industry expert who chairs the advisory board of the University of Ottawa’s Centre for Health Law, Policy and Ethics, told the audience. Taxation levels, he argued, must ensure that safer alternatives cost less than deadly cigarettes. “People respond to prices, and the price that people are paying should reflect the difference in risk.”
Sweanor noted that this is something “Sweden got right.” He conducted research on snus 25 years ago, as the country’s mass migration from cigarettes was under way. The tax rate for cigarettes meant they were twice as expensive as a can of snus, and snus lasted twice as long. Rational taxation can facilitate what would be one of the greatest transformations in public health history, he concluded.
Bates responded with the idea that there should be a blanket tax on all nicotine products, in order to stamp out all consumption.
It depends on the desired outcome, Sweanor replied.
“If the goal is to reduce nicotine, then high tax and more law enforcement would be the way forward,” he said. “But, if the goal is to reduce death and disease, lower taxation on SNPs is essential in changing behavior [in a way] that would not encourage workarounds and a thriving black market.”
Photograph by the UK House of Commons via Flickr/Creative Commons 2.0
The Influence Foundation, which operates Filter, received an unrestricted grant from the the Sweanor Family Fund at the Ottawa Community Foundation in 2025. Filter’s Editorial Independence Policy applies.