In a recent interview, EU Health Commissioner Olivér Várhelyi stated that alternative tobacco products are “as harmful as traditional cigarettes.” [1]The claim was made categorically, without any nuance or hesitation, and in the context of the Commission’s planned tobacco reform in 2026.
As always, the devil lies in the details. Nicotine pouches are sometimes excluded from the category of “alternative tobacco products,” while other non-combustible products such as vaping and heated tobacco are more commonly targeted in current policy discussions, including in the Commission’s work on cardiovascular health and in the OECD’s assessment of cardiovascular risk in the EU.
However, Commissioner Várhelyi has repeatedly endorsed the broader claim that alternative nicotine products contribute to serious disease, including cancer. Regardless of where individual products are placed within regulatory definitions, the underlying assertion remains the same—and it is wrong.
This matters. Not because policymakers are obliged to endorse harm reduction, but because this is a scientific claim. And scientific claims stand or fall on evidence.
For the statement to be true, either the European Commission or the WHO would have had to uncover new scientific evidence showing risks comparable to those caused by smoking: cancer, chronic pulmonary disease, and cardiovascular harm. No such evidence has been presented. On the contrary, the WHO itself has long been clear that: ”Nicotine is the addictive component, but it is the other toxic chemicals in tobacco smoke that cause the vast majority of smoking-related disease and death”[2].. A finding that non-combustible nicotine products are as harmful as cigarettes would therefore represent a profound break with the existing evidence base—and would require extraordinary proof.
Real world evidence is however increasingly pointing in the other direction: Where non-combustible nicotine products have achieved widespread adult uptake, smoking rates and tobacco related harm are historically low. Sweden is the clearest example but not the only one Daily smoking and smoking-related disease in Sweden are at levels unseen elsewhere in the EU: only about 5,3 % of adults smoke daily, the lowest prevalence in Europe, This is not a theoretical projection. It is an observed population-level outcome over decades. If alternative products were as harmful as cigarettes, or if they sustained smoking at population level, this pattern should not exist. Yet it does and Sweden continues a clear trajectory toward smoke free status in the near future without bans or disproportionate restrictions. Iceland, widely reported to have one of the highest per capita levels of nicotine pouch use, is emerging as another contender to reach smoke free status first.
When this empirical reality is raised, the response is rarely to revisit the original claim. Many of the same actors who once argued passionately for reducing smoking now resist outcomes that achieve exactly that when they arrive via substitution rather than abstinence. Alternative explanations are then offered. Sweden’s outcomes are attributed to “strong tobacco control,” despite broadly similar regulatory frameworks across the EU. When that explanation fails, the discussion shifts again, most often to the gateway hypothesis. Yet here too the data contradicts the claim. Since the expansion of nicotine pouches, smoking among Swedes aged 16–29 has fallen by roughly two thirds. If a gateway effect existed at population level, this is precisely where it should be visible.
At this point, the debate ceases to be about evidence and becomes about preserving a fixed conclusion. That may occur in ideological or religious contexts, where claims are not expected to be tested against reality, but the European Commission is expected to operate under a different standard.
When hypothetical risks to public health are suggested, regulatory responses are swift, as they should be. But when real-world evidence points to substantial harm reduction and the potential to reduce both disease burden and public expenditure on a massive scale, through substitution away from smoking, it is not even considered a possibility. The standard of proof appears to change depending on whether the evidence supports or challenges established narratives.
As Europe prepares to revise its tobacco legislation in 2026, this matters. The Commission’s forthcoming evaluation report will be the key test of whether public health and tobacco control are being assessed through the right lens. Presenting all nicotine products as equally harmful erases the most important distinction in tobacco control: the difference between combustion and non-combustion. In practice, such an approach does not eliminate nicotine use. It removes incentives for smokers to abandon the most dangerous form of consumption. Europe has around 80 million adult smokers. For many, abstinence-only approaches have already failed. According to Eurobarometer, smoking prevalence in France remains at 27% despite highly restrictive measures that were aimed at discouraging smoking. The real question is not whether nicotine use should exist, but whether regulation should acknowledge differences in risk and use them to accelerate the decline of smoking.
Europe’s 2026 test is not whether it can be tough on nicotine. It is whether it can truly support smokers in search of alternatives and distinguish between products that cause harm and products that help smokers leave those products behind.
Commissioner Várhelyi does not need to endorse harm reduction, but he does need to explain, with evidence, why observed reductions in smoking, disease, and cost should be ignored when shaping Europe’s tobacco policy.
[1] https://www.euractiv.com/news/varhelyi-wants-five-cents-more-for-chips-declares-new-eu-healthcare-era/
[2] https://www.who.int/news-room/fact-sheets/detail/tobacco