A fierce debate over the future of European tobacco policy is intensifying after European Health Commissioner Olivér Várhelyi (pictured) suggested that alternative nicotine products such as vapes, heated tobacco devices and nicotine pouches may cause the “same level of damage” as traditional cigarettes.
The comments, delivered during a Health Policy Conference in Brussels and later echoed before the European Parliament’s SANT Committee, have sparked a growing backlash from scientists, healthcare professionals and harm reduction advocates who argue that the Commissioner’s position is inconsistent with current scientific evidence.
At the centre of the controversy is a fundamental public health question: should European policy focus on eliminating all nicotine use, or prioritise reducing smoking-related disease and death among adults who cannot or will not quit nicotine entirely?
Scientists challenge “conflation” of cigarettes and smoke-free products
One of the strongest responses has come from the Platform for Tobacco Harm Reduction (“Plataforma para la Reducción del Daño por Tabaquismo”), a Spanish initiative bringing together scientists and healthcare professionals advocating evidence-based tobacco policy.
More than 100 independent scientists and public health researchers sent a letter to the EC because they are “increasingly concerned that the European Commission’s emerging approach to tobacco and nicotine regulation risks being built on a scientifically false premise: that fundamentally different nicotine products can be treated as though they carry the same public health risks as combustible cigarettes.”
Dr. Fernando Fernández Bueno, spokesperson for the Platform, argues that equating combustible cigarettes with smoke-free nicotine alternatives ignores overwhelming toxicological and epidemiological evidence accumulated over recent years.
“Yes, and it is also deeply concerning from a public health perspective,” Bueno said when asked whether conflating cigarettes with smoke-free alternatives contradicts scientific evidence.
“The scientific evidence accumulated over recent years consistently shows that combustible tobacco products are by far the main cause of smoking-related disease and mortality due to combustion and the toxic substances it generates.”
Bueno stressed that while smoke-free alternatives are not risk-free, denying the difference between combustible and non-combustible products misrepresents current science.
“No one is claiming that these products are risk-free, but denying the differences between them contradicts the available toxicological and epidemiological data,” he said.
“European regulation cannot be built on political simplifications when there is a solid scientific basis demanding differentiation and proportionality.”
Europe accused of falling behind on harm reduction
The dispute reflects a wider international divide over tobacco harm reduction policy.
Countries such as Sweden, the United Kingdom and New Zealand have increasingly incorporated harm reduction strategies into anti-smoking policy frameworks. Advocates point to these countries as evidence that encouraging smokers to switch to less harmful alternatives can accelerate declines in smoking rates and smoking-related illnesses.
“Absolutely,” Bueno said when asked whether Europe risks lagging behind nations already integrating harm reduction into public health policy.
“While some countries are implementing pragmatic, evidence-based strategies to accelerate the decline of smoking, the European Union increasingly appears to be adopting ideological positions disconnected from scientific reality.”
Sweden has become a particular focal point in the debate. The country is now close to becoming Europe’s first officially “smoke-free” nation, largely due to declining cigarette use and the widespread uptake of alternatives such as snus and nicotine pouches.
By contrast, critics argue that Brussels risks discouraging smokers from switching away from combustible tobacco products.
“Brussels risks adopting policies that discourage less harmful alternatives and unintentionally prolong cigarette smoking,” Bueno warned. “That would be a paradox that is difficult to justify from a public health perspective.”
Harm reduction versus nicotine abstinence
The debate has also exposed growing tensions between two competing public health philosophies.
Some policymakers and anti-tobacco organisations advocate the complete elimination of nicotine use in all forms. Harm reduction supporters, however, argue that such an approach ignores the realities of addiction and risks undermining efforts to reduce smoking-related disease.
“The main objective of public health policy should be to reduce disease and save lives,” Bueno said.
“Confusing the fight against smoking with a crusade against nicotine is a conceptual mistake that may have negative consequences for millions of adult smokers.”
He acknowledged that complete abstinence remains the ideal outcome but argued that policymakers must recognise that many smokers struggle to quit nicotine altogether.
“Complete abstinence should remain the preferred and ideal option, but we must also recognise the reality that a significant proportion of smokers are unable to quit nicotine entirely,” he said.
“Responsible public policies should provide evidence-based alternatives to reduce the harm caused by cigarette smoking. Refusing to incorporate this perspective means rejecting a potentially valuable tool to accelerate progress in reducing smoking-related mortality.”
WHO influence under scrutiny
The controversy has also renewed criticism of the World Health Organization’s approach to alternative nicotine products.
Commissioner Várhelyi indicated that the WHO would continue playing a major role in shaping future EU tobacco legislation. However, harm reduction advocates argue that the organisation has failed to adequately distinguish between combustible tobacco and smoke-free alternatives.
Public health researchers supporting harm reduction warn that messaging suggesting all nicotine products carry identical risks may discourage smokers from moving away from cigarettes — still widely regarded as the most harmful form of nicotine consumption.
PMI rejects Commissioner’s interpretation
Philip Morris International (PMI), one of the largest investors in smoke-free nicotine alternatives, immediately pushed back against Várhelyi’s comments.
A senior PMI executive stated that while alternative nicotine products are not risk-free and remain addictive, removing combustion dramatically reduces exposure to many of the toxic substances responsible for smoking-related diseases.
The company argues that the overwhelming scientific consensus is that combustion — not nicotine itself — is the primary cause of cancer, cardiovascular disease and respiratory illness linked to smoking.
PMI says adult smokers who would otherwise continue smoking should have access to scientifically substantiated reduced-risk alternatives.
“Equating smoke free products with cigarettes continues to spread misinformation. It misleads adults who smoke and can discourage them from switching, ultimately keeping them on the most harmful option: cigarettes”, said Dr. Moira Gilchrist, Chief Global Communications Officer of PMI.
The exchange highlights the increasingly polarised debate inside Europe over harm reduction policies as the Commission prepares possible revisions to the Tobacco Products Directive.
EU tobacco legislation battle looming
The clash comes as Brussels prepares possible revisions to the Tobacco Products Directive (TPD), legislation that could reshape the regulatory future of vaping products, heated tobacco and nicotine pouches across Europe.
With divisions deepening between regulators, public health campaigners, scientists and industry stakeholders, the political and scientific battle over Europe’s nicotine policy appears set to intensify in the months ahead.
As policymakers weigh future regulation, the central question remains unresolved: should Europe pursue an absolute war on nicotine, or prioritise reducing the deadly consequences of smoking itself?
