February 2021. ETHRA submitted to the BECA consultation on the Impact of the COVID19-pandemic on cancer prevention, health services, cancer patients and research. Submissions would only be accepted in English and from organisations on the EU Transparency Register. 


  1. Impact on lifestyle-related behaviours

  • What is the impact of the COVID19-induced lockdowns and quarantines on dietary habits, physical activity, alcohol consumption, smoking and stress and anxiety levels among the European population?
  • What measures could the EU take to prevent and to mitigate the negative consequences of lifestyle-related behavioural changes due to the COVID19-pandemic?
  • Please support your answer with data, evidence and/or concrete examples where available.

Lockdowns during COVID led to the widespread closure of vape shops across Europe, severely limiting access to safer nicotine products like vapour products, snus and nicotine pouches. This was in stark contrast to combustible tobacco products which remained widely available. Safer nicotine products are a substitute for combustible tobacco and carry a fraction of the risk of smoking, with a cancer potency of 0.4% compared to smoking according to Stephens (2018). Modifiable lifestyle risk factors are an important element of the cancer prevention strategy; restricting the availability and accessibility of low-risk products that people use to abstain from smoking runs the very real risk of causing harm by prolonging smoking. This was the case in Belgium, vape shops were closed and a ban on online sales was in place. A survey by Adriaens et al (1) found that a significant number of exclusive vapers switched to smoking or combined vaping and smoking due to the unavailability of vapour products. The same survey showed that smoking prevalence increased from 19.8% in 2018 to 21.9% during lockdown.

Sweden is an example of the public health benefits of switching to safer nicotine products. Sweden has almost reached smoke-free status due to the use of snus and as a result has the lowest cases of tobacco related cancers in Europe. Snus use is also common in Norway, smoking rates among young women are now at 1%, suggesting a smoke free generation is within Norway’s grasp.

To mitigate against the harms caused by the closure of vape shops during lockdown the examples of France and Italy should be followed. They recognised the public health benefit of keeping vape shops open, classing the shops as essential services.


  1. Adriaens (2020) available at:


You can download our submission here (PDF)