The debate on smoke-free nicotine continues to create conflict in the EU. Now 26 doctors and health scientists are attacking EU Health Commissioner Olivier Várhelyi, who they say is spreading a scientifically incorrect image of nicotine pouches and e-cigarettes.
The controversy surrounding smokeless nicotine continues in the EU. Recently, a number of doctors and health scientists protested against statements by the EU Health Commissioner, who described nicotine pouches and e-cigarettes as ”as big a health hazard as cigarettes”.
- This is a scientifically incorrect statement. Cigarette smoking is unique in that it contains substances that directly increase the risk of various forms of cancer, cardiovascular and lung diseases, which in turn lead to death. It is not the nicotine that drives this, but the smoke, the doctors write in their letter to the Commission.
Calls for differentiated legislation
Doctors believe that the European Commission's approach risks leading to legislation that has the opposite effect.
- Today's discussion is almost exclusively about the absolute risks of nicotine use. And while smokeless nicotine is not risk-free, the focus must be on reducing smoking. We therefore need differentiated legislation, with the aim of keeping minors away from use, preventing the emergence of a black market and at the same time reducing the harm from smoking," the doctors write.
At the same time, several stakeholder organisations have argued that the European Commission is on the right track. The organisation Smoke Free Partnership, which has financial links to both various cancer organisations and the American Foundation Bloomberg Philanthropies, argues that high taxation reduces tobacco companies” profits and thus ”prevents the industry from attracting new customers".
”Could favour the cigarette market”
However, according to the 26 doctors, this is a misleading argument, even though several tobacco companies now sell smokeless nicotine products alongside cigarettes.
- Smoking remains by far the biggest source of revenue for tobacco companies in Europe. If smokeless nicotine products are taxed to bring their price level closer to cigarettes, such measures will ultimately favour the cigarette market, i.e. increase cigarette sales, the doctors write.
The 26 signatories include doctors, researchers and public health scientists from 15 European countries. Many of them have leading roles in neurology, psychiatry, addiction, cancer research and public health. They include heads of stroke units, professors of medicine and advisors to national authorities. They also include Vincent Amble-Naess, a Swedish physician and public health professional known for his work on harm reduction and evidence-based nicotine policy. Danish pulmonologist Philip Tønnesen has also signed. He specialises in pulmonary medicine and is internationally known for his work on smoking cessation and tobacco-related public health.
Sweden at the centre of the debate
Sweden has become one of the countries at the centre of the smoke-free nicotine debate. According to the latest statistics from CAN smoking in Sweden has reached record low levels, while the use of nicotine pouches and e-cigarettes has increased.
In contrast, overall nicotine consumption has remained at roughly the same level since the products entered the market in 2019. This suggests 'substitution' - that smokeless nicotine has replaced cigarettes in many groups.
This development has also prompted several Swedish MEPs to react to the European Commission's plans to severely restrict access to smoke-free products.
- "Snus and nicotine pouches are culturally important products for many Swedes and have become important tools in the work for a smoke-free society," says Jessica Polfjärd, who represents the Christian Democrats and the EPP in the European Parliament.
- We are keen to see the EU steer the market for smokeless nicotine products, but the legislation must be based on relevant science, take into account relative risks and not disrupt the successful development in Sweden.
Proposals to increase taxes
The European Commission's plans to regulate and tax smokeless nicotine at EU level have been on the negotiating table since summer 2025.
The latest proposal is to introduce minimum taxes on e-liquids - including nicotine-free ones - of around SEK 4 per millilitre. For nicotine pouches, taxes of around SEK 600 per kilo are under discussion. Currently, nicotine pouches in Sweden are taxed at around SEK 200 per kilo.
Criticised health commissioner
As the debate on nicotine pouches and vejpning continues, EU Health Commissioner Olivier Várhelyi is also being questioned.
He was originally appointed by former Hungarian Prime Minister Viktor Orbán and has close links to the Fidesz party. Mr Várhelyi was approved by the European Parliament after several compromises in 2019 and has also been accused of being close to the pharmaceutical industry.
He is also involved in an investigation into a suspected EU spy ring, something he has consistently denied any involvement in.
