European Societies call EU to Not Lose Momentum on Tobacco Policy

Tobacco consumption remains a leading cause of preventable illness and premature death, contributing towards many forms of cancer, and cardiovascular and respiratory diseases. This consequently accounts for nearly 700,000 deaths in the EU bringing a vast financial burden on national healthcare systems2.

The aforementioned organisations welcome the recent developments in this policy area, particularly the Commission's proposal on the Council Recommendation on Smoke Free Environments, an element of the Europe's Beating Cancer Plan. However, we note that while the recent uptake of novel products does not allow for a precise estimation of long-term health risk at this stage3, there is a growing body of evidence documenting their harmfulness for health4 (e.g., clear evidence has confirmed the correlation within the use of Heated Tobacco Products (HTP) and respiratory disease, and the harmful impact of vaping on endothelial functions has been documented5) and potential overall societal harms, we therefore urge Member States to ban the use of vapes and HTPs and in indoor and outdoor places, including public beaches. We call for this proposal to be approved by the Council as soon as possible and upon the Hungarian Presidency to ensure its approval by December 2024.

The update of the Council Recommendations is one element of the ‘Prevention Pillar’ of the Europe's Beating Cancer Plan, which unfortunately has seen a significant stalling in proposed initiatives in 2021. Therefore, we urge the European Commission and the Member States to:

• Review and update of the Tobacco Products Directive (TPD), the Tobacco Taxation Directive (TTD), the Tobacco Advertising Directive (TAD) and the legal framework on cross-border purchases of tobacco by private individuals;
• Enforcement of EU laws and full implementation of the WHO Framework Convention on Tobacco Control6, including transparency obligations - in particular we stress that the EU, as a Party to the Convention, must fulfil its obligation to protect public health policies from commercial and other vested interests of the tobacco industry are comprehensive and effective;

To correct this loss of momentum, the organisations are calling for the next European Commission 2024-29 to:

1. Introduce excise taxes on HTPs, e-cigarettes and nicotine pouches, increase the minimum tax rates on cigarettes and fine cut tobacco, and adopt a mechanism to account for inflation;
2. Ban flavours in HTPs and prohibiting flavour accessories and additives for all tobacco and related products;
3. Introducing mandatory plain standardised packaging for tobacco products;
4. Ban on disposable e-cigarettes and sale to people under 18;
5. Introduce an annual public monitoring mechanism for tobacco control policies to measure Member States' fulfilment of EU legislation and recommendations to ensure the achievement of a Tobacco Free Generation by 2040; and
6. Implement the COP10 commitments and ensure better alignment in tobacco policy across Europe with the objectives and political efforts promoted by the WHO.

Noting the theme of World No Tobacco Day 2024, the organisations also specifically call for the protection of children from tobacco industry interference. The tobacco industry targets young people as the base of their business as this population group represents the source of replacement tobacco users. The involvement of the industry with emerging products hasn’t changed this. A recent review of 189 studies on vaping and e-cigarettes concluded that non-smoking youths who use e-cigarettes have substantially higher likelihood of starting smoking7.

While the tobacco industry is adapting its tactics through continuous innovation and marketing, legislation to prevent the uptake of smoking and protect people from the industry is lagging behind. Therefore, the organisations welcome the Mission Letter which includes plans for revising the EU’s tobacco legislation, with a particular focus on addressing concerns about young people's access to novel tobacco and nicotine products and call on the European Commission to launch a revision of the Tobacco Products Directive, the Tobacco Taxation Directive and the Tobacco Advertising Directive in a timely manner.

QUOTES FROM ORGANISATIONS

Dr Csaba L. Dégi, President of the European Cancer Organisation: “There's simply no excuse for not taking more aggressive action against the tobacco industry. We've known for decades that tobacco kills, yet we move at a snail's pace to address this clear and present public health threat. The European Commission must say loud and clear: ‘Enough is enough.’"

ESMO’s Director of Public Policy, Prof Jean-Yves Blay, stated: “with evidence emerging that new products like e-cigarettes and heated tobacco products pose serious health risks, and of the rapid increase of vaping amongst adults who had previously never smoked, the EU must react to these societal changes by expediting its delayed revision of the EU’s tobacco legislation to ensure the achievement of the Europe's Beating Cancer Plan’s objective to create a 'Tobacco-Free Generation' by 2040, where less than 5% of the population uses tobacco.”

Lung Cancer Europe - LuCE: “Europe faces long-term risks from multiple and heterogenous drivers of lung cancer, including social-determinants. At nearly 29% of its population, Europe has the highest prevalence of people who smoke among adults globally, who will remain at high-risk of developing lung cancer for up to 25 years even after they stop smoking. To ensure that EU’s Beating Cancer Plan works for all high-risk populations, humane and empathy-driven strategies are needed that recognise the addictive nature of nicotine, comprehensively mitigate risk factors, including those tied to tobacco use, and promote equitable access to lung cancer screening across EU member states.”

Prof Filippos Filippidis, Chair of the European Respiratory Society Tobacco Control Committee: "The tobacco initiatives under Europe’s Beating Cancer Plan present a significant opportunity for tobacco control and protecting the youth and general population from the harmful effects of tobacco and emerging products. The EU has a responsibility to update legislations that are now lagging behind the tobacco industry’s innovation."

Dimitris Kontopidis, Chair of the European Lung Foundation: "Smoke from tobacco and novel products greatly impact lung health and are particularly harmful for patients. The rise in use of novel products in the youth is extremely concerning which is why the revisions of the tobacco legislations are needed. We call on the European Commission to launch this imminently."

Lilia Olefir, Director of Smoke Free Partnership: “SFP welcomes the proposal’s provisions on banning use of cigarettes, e-cigarettes and heated tobacco products in indoor and outdoor public places, particularly given the absence of harmonised EU-level regulations. Young Europeans are the demographic group most exposed to second and third-hand smoke, according to the results of the 2023 Eurobarometer. Almost 80% of respondents aged 15-24 reported encountering people smoking all kinds of tobacco products on outdoor terraces. Additionally, almost 40% of respondents saw people smoking the last time they visited outdoor spaces intended for children or adolescents (such as playgrounds, and nursery and school courtyards). This figure rises to 49% for e-cigarettes and heated tobacco products.”

Cornel Radu Loghin – ENSP Secretary General: “The Framework Convention on Tobacco Control (FCTC), adopted by the World Health Organization (WHO) and in effect for 20 years, represents the first and only legally binding international treaty in the field of public health. Ratified by all EU member states and the European Commission, the FCTC is designed to curb the devastating effects of tobacco through a wide range of evidence-based measures. It addresses health, economic, and social issues, recognizing tobacco as a hindrance to societal progress and an obstacle to sustainable development. However, two decades later, many challenges persist, as tobacco control requires ongoing, cross-sectoral collaboration. Tobacco impacts far beyond public health alone—it burdens healthcare systems, economies, and social development. For a unified, impactful response to these multi-layered issues, ENSP is urging the European Commission to establish a European Tobacco Control Agency, a dedicated entity focused on aligning with WHO-FCTC principles and effectively coordinating tobacco control efforts across EU member states. This agency could streamline EU tobacco control policies, allocate targeted funding, and support the enforcement of stricter regulations, marking a clear EU policy shift to prioritize public health over tobacco interests.”

References:

1 European Commission Mission Letter to Commissioner Designate https://commission.europa.eu/document/b1817a1b-e62e-4949-bbb8-ebf29b54c8bd_en

2 Aapro M, Medeiros R, Rubio IT, Van Meerbeeck J, Couespel N (2021). Primary Prevention: United for Action. European Cancer Organisation; Brussels

3 Antoniewicz, L., Brynedal, A., Hedman, L., Lundbäck, M., & Bosson, J. A. (2019). Acute effects of electronic cigarette inhalation on the vasculature and the conducting airways. Cardiovascular Toxicology, 19(5), 441–450. https://doi.org/10.1007/s12012-019-09516-x

4 Lyytinen, G., Brynedal, A., Anesäter, E., Antoniewicz, L., Blomberg, A., Wallén, H., Bosson, J. A., Hedman, L., Mobarrez, F., Tehrani, S., & Lundbäck, M. (2023). Electronic Cigarette Vaping with Nicotine Causes Increased Thrombogenicity and Impaired Microvascular Function in Healthy Volunteers: A Randomised Clinical Trial. Cardiovascular Toxicology, 23(7–8), 255–264. https://doi.org/10.1007/s12012-023-09802-9

5 WHO study group on tobacco product regulation. Report on the scientific basis of tobacco product regulation: ninth report of a WHO study group. Geneva: World Health Organization; 2023 (WHO Technical Report Series, No. 1047). Licence: CC BY-NC-SA 3.0 IGO

6 WHO Framework Convention on Tobacco Control Guidelines for implementation of Article 5.3 (who.int)

7 Banks E, Yazidjoglou A, Joshy G. Electronic cigarettes and health outcomes: epidemiological and public health challenges. Int J Epidemiol. 2023;52(4):984-992