May 2023. ETHRA submitted to the European Commission's public consultation on the evaluation of the legislative framework for tobacco control. The consultation was in the form of a questionnaire with the option to attach a supporting document. Due to the inherent bias against tobacco harm reduction in the questionnaire, our supporting document was our main contribution to the consultation. 

Download our submission here

See the questionnaire here

Dear European Commission

Evaluation of the legislative framework for tobacco control – Open Public Consultation 

European Tobacco Harm Reduction Advocates (ETHRA) is the voice of 27 million EU consumers of safer nicotine products. The safer nicotine products we use include vapes, nicotine pouches, snus and heated tobacco products.  ETHRA is a consortium of 25 grassroots consumer associations in 17 European countries, supported by experts in tobacco control and nicotine research. We are a voluntary operation with no industry funding or conflicts of interest. Our transparency registration number is 354946837243-73.

Please find attached our response to the Evaluation of the legislative framework for tobacco control’s Open Public Consultation. We have focussed on how  the European Commission and other bodies evaluate the evidence, drawing on what we see as the failures in the SCHEER report. Our main points are that the value of evidence should depend on:

  • How the evidence is evaluated. For example, are the risks associated with vaping compared to those from smoking or to abstinence?
  • What questions are asked and not asked? For example, will the questionnaire ascertain how many Europeans no longer smoke because they are using  safer nicotine products instead?
  • What counterfactuals are considered?  For example, if policies are introduced which make safer nicotine products less accessible or appealing,  will people smoke instead?

We found that the questionnaire was constructed with inherent bias against harm reduction, to force answers in favour of measures making safer nicotine products less accessible or appealing for people to switch to. A question such as  “Considering the TPD, please rate each of the below product categories according to the level of threat they pose to the public health, particularly among young people” excludes the option of considering these products as providing opportunities  which can benefit  public health. The questionnaire also does not capture the effects of anti-vaping policies on youth and adult smoking or likely countermeasures by consumers and suppliers. Therefore, the questionnaire is not an adequate framework for evaluating the evidence. 

We highlight the importance of rigorous application of the EU’s core principles relating to the internal market, proportionality, and non-discrimination in policymaking. We believe rigorous application of these foundational ideas would change the current approach to safer nicotine products. These principles justify a risk-proportionate regulatory philosophy with a critical distinction drawn between combustible and non-combustible nicotine products, not between tobacco and non-tobacco or between novel and established products.

We provide a summary of evidence to support some basic insights that should inform tobacco control policy as it applies to safer nicotine products and tobacco harm reduction.

  • Smoke inhalation, not nicotine, is the primary cause of ill-health, and there are, beyond any reasonable doubt, significantly lower risks in using non-combustible forms of nicotine products. European Union policy should focus on reducing smoking, not nicotine use. 
  • Cigarettes and safer alternatives function as economic substitutes; therefore, tax, regulation or other interventions designed to address vaping will affect smoking behaviour. These substitution effects are the source of perverse consequences arising from poorly designed policies for safer nicotine products, and cause increased smoking.
  • Multiple lines of evidence triangulate to show that vaping products support adult smoking cessation at minimal risk – these products should be primarily treated as an opportunity rather than a threat.
  • A more sophisticated approach to youth uptake of safer nicotine products is necessary. There is no evidence for gateway effects, but there is accumulating evidence that safer nicotine products divert some young people from smoking and may be beneficial to young people who would be more likely to take up smoking.

We hope the views in the attached submission are helpful. We look forward to further engagement with the Commission during the targeted stakeholder phase on these important issues.

Yours sincerely

Damian Sweeney
On behalf of ETHRA and Partners