On 3 February 2021, the long-awaited Eurobarometer report was published. Titled “Attitudes of Europeans towards tobacco and electronic cigarettes,” the survey examined European citizen's relationship with tobacco and related products. Fieldwork was conducted between August 2020 and September 2020 and involved interviews with 28,228 people from 27 EU member states and the UK. Data from the previous Eurobarometer report in 2017 is also made available for comparison. It is an extensive report, 334 pages long, with separate factsheets available for each member state plus the UK. A 54-page summary of the main points is also available. The importance of the Eurobarometer cannot be overstated as it will feed into the TPD review due latest 20 May. See our article “What do we know about the TPD application report” for more details.
Since Eurobarometer 2017 smoking prevalence has declined by 3%, from 26% to 23%. Countries with the lowest smoking prevalence are Sweden (7%), the UK and the Netherlands (12%). Smoking prevalence is highest in Greece (42%). Over half (54%) of current and former smokers began smoking before the age of 18.
It comes as no surprise that Sweden has almost reached smoke free status of <5% smoking prevalence; widespread substitution of cigarettes with snus has seen to that. The UK is a success story too, having experienced the sharpest decline in smoking rates since 2006. A large part of this success must be attributed to the UK having public health agencies which support and promote tobacco harm reduction (THR). The value of pointing smokers to safer nicotine product to help with cessation attempts cannot be underestimated.
Despite the well-known risks of smoking only slightly more than half of current smokers (53%) said they had attempted to quit at some point. The majority (76%) of those who did make a quit attempt did so unaided. For those who sought assistance, 13% used nicotine replacement therapy and other medications, 11% used vapour products. A meagre 6% of smokers sought assistance through medical support and smoking cessation services.
But does vaping really help with smoking cessation? According to the report the answer is yes. 31% of those who successfully quit smoking said they used vapour or similar products; a huge increase from 14% in the previous Eurobarometer report. A further 27% said they had reduced their use of combustible tobacco products. There is scope for further gains in this area as only 2% of respondents said they were current vapers.
The main reasons for people starting to vape won’t come as a shock either. Stopping or reducing tobacco consumption was cited as the main reason by 57% of respondents, 37% said it was because vaping was less harmful than smoking (congratulations to those well-informed individuals), and 23% cited lower cost as the reason.
Open systems were the preferred choice of 72% of vapers, the very type of device the WHO are recommending should be banned. See our January news update for details.
The report makes a strong case for the importance of flavours, something I’m sure many prohibitionists won’t be happy about. Fruit flavours were the most popular by a large margin (48%), followed by tobacco (36%), menthol or mint (30%), candy (20%), and alcohol (4%). These figures are very important in light of proposals to ban all but tobacco flavours in the recently published EU Beating Cancer Plan. A rethink is surely needed now that the EU’s own data supports the fact that removing flavours would deny huge number of people access to the products that are keeping them from smoking.
As if evidence of the importance of flavours wasn’t bad enough, the mythical gateway hypothesis also took a hit in the report. Participants with a smoking history, whether current or former, were asked which product they tried first. The response was overwhelmingly combustible tobacco at 87%. Only 2% said they used vapour products before smoking.
It’s evident that vaping is providing a substantial public health benefit but is being hampered by constant streams of misinformation, often propagated by the EU themselves. This is borne out by the fact that 70% of people with little or no experience of vaping believe it doesn’t help with quitting smoking, and only 20% believe it does help. However, this number was substantially higher in the UK where 51% believed that vaping can help with smoking cessation. Once again underlining the importance for governments to guide people to safer nicotine products.
This misinformation might be the reason why support for restrictive regulations alarmingly high. 70% support banning the use of vapour products where smoking is banned, 47% are in favour of flavour bans (35% against), and 47% are in favour of plain packaging (36% against). Even more worrying is that 71% of respondents with little or no experience of vaping thought vaping should be regulated as strictly as cigarettes, and 65% believed vaping was harmful to the health of the user.
To summarise, vaping is providing a great public health benefit by reducing smoking prevalence, but disinformation is profoundly limiting the potential health benefits. Risk reduction is the main factor for those deciding to use vapour products, and non-tobacco flavours are of particular importance. Therefore, proposals to ban flavours are short-sighted, damaging and could very well prolong smoking. The gateway effect has still not materialised.
The UK has shown that the promotion of tobacco harm reduction is the way forward. The EU should take note before they get left behind and actually cause smoking to increase due to their hostile approach to tobacco harm reduction.
Tobacco harm reduction news from Europe.
The Commission published their dismal Europe’s Beating Cancer Plan early in February. News from Germany added to the gloom, when the German finance minister revealed plans for exorbitant taxes on e liquids and to equate heated tobacco products with cigarettes there. Happily, the month ended well with the publication of Public Health England’s annual update, which confirmed that vaping is best for quitting smoking and that UK youth are not interested in vaping. Read on for more on that and lots of other news.
Beating Cancer Plan launch
The EU Beating Cancer Plan was published on 3rd February. The plan makes it clear that the Commission intends to use the Tobacco Products Directive and Tobacco Excise Directive to impose restrictions and increase the expense of vaping and other safer nicotine products. DampfFreiheit echoed the thoughts of many in calling it “a plan for more cancer” - see their [EU] Europe’s Beating Cancer Plan – Plan für mehr Krebs article for links to some of the many articles reacting to the Plan.
ETHRA letter and BECA exchange of views on the Plan
4th February saw an exchange of views on the Plan, between the Special Committee on Beating Cancer (BECA) and Health Commissioner Stella Kyriakides. Ahead of the meeting ETHRA and partners wrote to every MEP on BECA to express our dismay at some of the Plan’s proposals. Read our letter here:
Europe's Beating Cancer plan fails smokers
ETHRA Partners IG-ED and Ex-Raucher also published the letter, here and here.
Our letter was covered by Planet of Vapes (Eng), E-cig Mag (Fr), Ashtray Blog (Eng), Sigmagazine (It), Tobacco Reporter (Eng)
Vapers Finland has also written separately to Finnish MEPs to ask them to take the harm reduction into account in the EU Cancer Plan:
Petition to Finnish MEPs to take the harm reduction model into account in the EU's cancer program (Google translate English)
During the BECA exchange of views Kyriakides reinforced the Commission’s intentions:
“There was a question on smoking and tobacco. I just want to say here that we should recognise that cigarettes and other forms of tobacco use are responsible for 15 to 20% of all European cancer cases and this is a top avoidable risk factor. So we will be looking exactly at also addressing the next generation of tobacco related products to be a priority. We will be reviewing the Tobacco Products Directive and the Tobacco Taxation Directive.
But because many of us have spoken of prevention we need to really build into our education system and with children from a very young age, prevention programmes promoting healthy lifestyles so that we are able to be really effective.”
4th February also saw the launch of the BECA consultation into the Impact of the COVID19-pandemic on cancer prevention, health services, cancer patients and research
The consultation was only available in English, replies had to be in English and it was restricted to organisations signed up to the EU transparency register. Despite these barriers, ETHRA and partners managed to respond to the consultation and described the impact that COVID-19 related shop closures have had on access to less harmful alternatives to smoking. The consultation was due to close on 25th February but has now been extended until 11 March.
Europe’s Beating Cancer Plan Webinars
Two webinars to discuss the Plan were held at the same time, on Friday 12 February.
Many THR consumer advocates attended the EU Health Policy webinar with Stella Kyriakides and used the chat function to make comments and ask questions. Perhaps the most alarming response came from Matthias Schuppe, cancer plan team leader, who stated that the Commission, and also SCHEER, agree with the WHO’s view that novel products are harmful to health.
During the webinar we learned that a stakeholder contact group will be established under the EU Health Policy Platform EU Health Policy Platform and that all interested stakeholders can register.
Slide from Europe’s Beating Cancer Plan -The next steps in the consultation process webinar
John Ryan had stated that “the plan is built on a holistic and multi-stakeholder approach”, so we’ll see how that goes!
Sigmagazine’s article about the webinar:
Europe: "On the electronic cigarette we follow WHO recommendations" (Google translate)
The second webinar was a debate, “EU PLAN FOR BEATING CANCER: has it met the great expectations?”, with MEPs Tomislav Sokol, Sara Cerdas and Nicolae Stefanuta. During the webinar Sokol mentioned harm reduction and had this to say about the Plan and smoking:
“The Plan has a pretty negative view on e-cigarettes etc it is based on science definitely but I personally believe we should invest more research into this about more clear data on whether these kind of measures can help in some instances if there is no other better way. If somebody can’t stop smoking maybe it's better to reduce harm by this”
You can watch that webinar here.
Eurobarometer’s long awaited survey on Attitudes of Europeans towards tobacco and electronic cigarettes was released with the Cancer Plan. The data from this will feed into the Tobacco Products Directive review. Here are some early reactions to it:
The final Opinion will be adopted at the plenary meeting 3-4 March.
- From the minutes of the SCHEER Working Group on e-cigarettes meeting on 19 January:
- From the Draft Agenda for the SCHEER Plenary meeting 3-4 March:
No information seems to be available on when the final Opinion will be made public.
See “UK”, below, for criticism of the preliminary Opinion in Public Health England’s annual update.
The Dubrovnik Times has reported that excise duty on tobacco products (including vaping products) will increase. The largest increase in tax will be added to heated tobacco products, which will see an increase of as much as 75%.
There is outrage at the news that the Danish National Board of Health and the Minister of Health did not release key information before the tobacco action plan was voted in. The tobacco action plan includes harsh regulations for safer nicotine products, based on the notion that vaping is causing young people to smoke. However, as DADAFO reports, the data actually show the exact opposite:
"Adolescents who start vaping or using snus would probably have started smoking if there had not been a low-risk alternative available. And the figures show that the few young people who start vaping or using snus do not go on to smoking tobacco. On the contrary, the figures show that young people who are already smoking are actually trying to quit smoking by switching to vaping or snus."
Nyheder reports that the National Board of Health paid extra to get a bigger sample size for the Danish Smoking Habits 2019 survey, in a quest to find more smokers. Publication of that report was delayed by several months, meaning that politicians did not have access to the latest figures during the negotiations for the tobacco action plan.
Shockingly, the good news that vaping is not a gateway to smoking for Danish youngsters was buried - and legislation which will deny adult smokers access to life saving products was voted in.
DADAFO's Peter Stigaard told ETHRA:
“the existing legislation is adequate, and if the enforcers of the law would indeed enforce the law (no sales to minors) there would be no need for restrictions on products which satisfy adult consumers, and keep adults away from smoking tobacco cigarettes.”
The Ministry of Finance is planning a tax hike for e liquids, starting at €0.02 per mg of nicotine and rising to €0.04 in January 2024. This would make e-liquids much more expensive to buy than combusted cigarettes and would lead to a huge black market.
The draft law is here and ECigIntelligence reports that “The tax authorities also justify the decision by the “existing risk potential” of vaping products in comparison with traditional tobacco.” Research from the German Cancer Research Center (DKFZ) is being used to justify the measures.
Given Germany’s influence over the EU generally, this is a very worrying development which might distort the process of the revision of the Tobacco Taxation Directive.
Read more about that in these links:
Better German news from Koblenz, where the Higher Regional Court ruled that the advertising slogan “E-cigarettes save lives switch now” is not misleading, on the grounds that e-cigarettes are less harmful to health than combustible cigarettes.
Carmine Canino, president of ANPVU, participated in a conference held in Rome to discuss smoking and the potential for vaping to reduce smoking. Carmine told the conference that traditional tobacco control measures are failing Italy’s smokers and that there is a duty to promote and ensure access to less harmful products. Sigmagazine’s article is here.
Acvoda presented their petition opposing the proposed ban on e-liquid flavours to the Dutch parliament. The petition had attracted over 19,000 signatures.
A consultation has been launched on proposals to introduce excise duty on e-cigarettes and other nicotine products.
In January the Norwegian government reduced the tax for snus by 25%, in an attempt to reduce “trade leakage” to Sweden from cross border purchases:
Nå er det full priskrig på snus i dagligvarehyllene /
Now there is a full price war on snus on the grocery shelves
Public Health England has just published the annual update to their review into e-cigarettes: Vaping in England: evidence update February 2021
Here is the news story:
Vaping better than nicotine replacement therapy for stopping smoking, evidence suggests
This report covers "the latest evidence on prevalence and characteristics of vaping in young people and adults in England" and also includes an update of the evidence of the impact of vaping products on smoking cessation.
Main findings from the STS data, from PHE’s update
The update includes data from ASH UK’s factsheet Use of e-cigarettes among young people in Great Britain
Key findings from Use of e-cigarettes among young people in Great Britain
New Nicotine Alliance UK welcomed the confirmation that vaping is a popular and effective way to quit smoking and that the UK has no problem with youth vaping, but regretted that perceptions of harm are still going in the wrong direction, with an increasing number of people thinking that vaping is as harmful as smoking.
PHE’s report also covers some selected international developments (from page 35) and includes criticism of the SCHEER preliminary Opinion:
More from the UK:
This Consultation into tobacco and related products legislation will finish on 19 March:
Let’s help to keep the UK on the right path by responding to this with our experiences of tobacco harm reduction and of living with the TPD.
New Nicotine Alliance UK has produced this guide to help you:
Don't miss this opportunity to help shape vaping regulations
The cancer plan will be discussed in the health working group of the council.
The next meeting of the Employment, Social Policy, Health and Consumer Affairs Council is 15-16 March 2021: https://www.consilium.europa.eu/en/meetings/epsco/2021/03/15-16/
The agenda will be made public around one week before the meeting.
It is very likely that the Cancer Plan will be on the agenda.
The SCHEER final Opinion will be adopted at the SCHEER Plenary meeting 3-4 March.
Something to watch:
Slide 32 from Clive Bates’ Vaping and tobacco harm reduction
We have just written to the MEPs on the Special Committee on Beating Cancer (BECA) to express our dismay at some of the tobacco control measures proposed in the European Commission’s Beating Cancer plan.
We hope that our elected representatives can take our views into account at tomorrow's BECA meeting and exchange of views with Health Commissioner Stella Kyriakides.
Consumers and experts submitted in their thousands to the two public consultations last year, yet those views are ignored in the Plan.
The Plan spectacularly fails to make a distinction between harmful smoking products and smoke free alternatives and signals that the Commission intends to turn its back on innovation and science by cracking down on vaping, the popular and far less risky alternative to smoking.
Read our letter here.
Tobacco harm reduction news from Europe.
EUROPE’S BEATING CANCER PLAN REPORT
ETHRA NICOTINE USERS SURVEY FIRST DATA
FLAVOUR BANS AND OTHER ANTI-THR MEASURES
ACCESS TO THR PRODUCTS IN LOCKDOWNS
UK GOVERNMENT LAUNCHES CONSULTATION ON TOBACCO AND RELA
WHO STUDY GROUP ON TOBACCO REGULATION MEETING
ETHRA WATCHES THE BREATHE VISION LAUNCH
Europe’s Beating Cancer Plan is an ambitious EU project which aims to reduce the cancer burden and address cancer related inequalities. The European Commission’s report for the Plan is due to be published on 3rd February but the draft was leaked to the media last week. According to the leaked document, the Plan’s proposals for reducing smoking are very hostile to tobacco harm reduction.