Most people will not have noticed, but an experiment has been ongoing for the past few decades. It has not been commissioned, has required no specific funding, and has not been administered by people in white lab coats. It was not created by anyone, but occurred naturally, and the results are now in. The experiment has concluded that a miracle has happened in Sweden.
This year, the World Health Organization and the European Network for Smoking and Tobacco Protection predict that Sweden will be the first EU member state to become officially smokefree, defined as a national smoking rate of less than 5%, simply for the fact that it is unique in the EU of allowing the sale of snus as an alternative to combustible tobacco.
In 1995, Sweden joined the EU on the proviso that the EU-wide ban on the sale of snus would not apply to Swedes. It was an ill-informed prohibition that the EU has been stubbornly resistant to correct. However, the EU conceded, and the experiment began.
To illustrate the wisdom of the Swedish government on insisting on the exemption, smoking prevalence in Sweden is currently 5.6% and on the cusp of achieving the EU's goal of a smokefree Europe by 2040. While the average proportion of smokers in other member states languishes at 25%, Sweden will achieve the smokefree target a full 17 years ahead of the deadline.
This is not just a miracle for public health and political policy, but is also miraculous, on a personal level, for consumers who have been the unknowing subjects of this naturally occurring experiment. Their lived experience will have been one of freeing themselves from combustible tobacco use, many after a succession of failed attempts. They will have benefited from the huge sense of achievement that comes with escaping a smoking habit for good, while still being able to enjoy the nicotine that drew them to smoking in the first place.
Yet this miracle has gone almost unnoticed in the rest of the world. Worse than that, the EU Commission is completely unmoved by the data and will, once again, double down on its unjustified and damaging ban on the use of snus across the EU as it moves towards the latest review of its Tobacco Products Directive.
The Swedish experience is one which proves that smoking cessation policies based solely on abstinence do not work as effectively as tobacco harm reduction, whereby people who smoke are offered far less harmful alternatives which, although still containing nicotine, seek to guide them away from the deadly consequences of long-term inhaling of burned tobacco.
Sweden is not the only example of how such a policy can work. In Japan, there has been a staggering 50 percent collapse in cigarette sales since heated tobacco – another alternative to combustible cigarettes - was introduced to the nicotine market in 2016. Demolition of the cigarette trade in Sweden and Japan has never been seen on such a scale before.
Just as in Sweden, we know that it was the alternative consumer product which drove the decline in Japan rather than traditional tobacco control taxation, bans and restrictions, with research concluding that heated tobacco products "likely reduced cigarette sales in Japan", and that "the accelerated decline in cigarette-only sales since 2016 corresponds to the introduction and growth in the sales of heated tobacco products."
Furthermore, there is solid evidence that the potential of reduced risk products has translated into real world effects. Sweden's stunning smoking rate success is matched by a tangible miracle in terms of physical health consequences.
In Sweden, tobacco related disease and deaths are the lowest in Europe by a considerable margin. Likewise, Swedish lung cancer rates are over a third lower than the EU average and cancer, generally, is significantly lower. Japanese population medical data are also showing a downward trend in hospitalizations attributable to COPD and ischaemic heart disease since the introduction of heated tobacco products.
It has been estimated that if Sweden's policy of permitting snus to be sold was replicated across the EU, over 3.5 million lives could be saved in just 10 years. It is a dereliction of duty on the part of policymakers in Brussels not to consider the half a century of scientific evidence which shows snus to be orders of magnitude less harmful than smoking and a powerful driver of smoking cessation which could benefit EU citizens in every member state.
Those who have successfully moved away from smoking using snus, vaping products and other safer alternatives are constantly frustrated and confused as to why the huge benefits that they have experienced are not being recognized by legislators.
Having been lectured for decades to quit smoking, they have done so but are still hounded and criticised for their choice of method. Worse, they are having to struggle to defend the products which have worked for them against political intransigence and all-out attacks from the tobacco control establishment.
Governments fall over themselves in a rush to emulate measures such as plain packaging, incremental increases to age of sale and very low nicotine cigarettes, despite none having any proven track record of success, and certainly nothing to match the dramatic declines seen with harm reduction. Yet despite the snus miracle in Sweden delivering incredible results, governments across Europe seem determined to look the other way.
In the UK, where vaping is endorsed by the government and where the National Health Service recommends the products to adults who cannot quit smoking, there is resistance to lifting the ban on snus despite no longer being bound to prohibition since leaving the EU.
Even Swedish authorities seem almost embarrassed at the snus miracle that they created. Sweden does not overly advertise its success to other countries, nor does it petition the EU to allow snus use to be sold in other member states. Dramatic declines in smoking and positive health trends are happening with many health bodies seeking to oppose reduced risk products rather than promote them. One can only wonder at how much greater beneficial public health outcomes could be achieved if public health organisations across Europe actively encouraged these products rather than attempting to obstruct them.
Harm reduction products offer a perfect alignment of business, economic, and public health goals without the state having to do anything but allow them to be sold to adults who would otherwise smoke. With so many products now offering huge reductions in harm from smoking and consumers making purchases themselves without cost to taxpayers, one must wonder why there is not a similar stampede by regulators to emulate what has been happening with smoking prevalence in Sweden.
Are politicians interested in reducing the harms of smoking effectively, or are they more attracted to announcing tough new measures which emphasise their power but do very little to make inroads into smoking rates which, invariably, are most prominent in poor neighbourhoods and amongst people who are at the bottom of the socio-economic scale?
We have overwhelming data now to show that harm reduction works. The Swedish experience has shown conclusively that abstinence only policies are vastly inferior to those which meet the consumer where they are instead of where governments wish them to be. There is no longer any meaningful justification for perpetuating prohibition of snus throughout the EU while combustible cigarettes are available everywhere.
Most shamefully, consumers are being ignored and forgotten in the debate. The public health community only countenances punitive or medicinal approaches to reducing smoking rates. There is no recognition by publicly funded tobacco control groups that people who smoke react better if offered alternatives to choose for themselves rather than being ordered into compliance. No understanding of consumer behaviour and that smokers do not consider themselves sick and in need of a cure. It should not be surprising that smokers react better to options which mean they can continue using nicotine in a way that is orders of magnitude less harmful than smoking.
It is beyond time that the citizens of other countries are permitted to share in the miracle that Sweden has enjoyed. Policymakers should be able to do so as well. Instead of adhering to antiquated tobacco control policies driven by stigma, elected representatives should recognise that people would welcome being guided rather than ordered, and will look kindly on politicians who can deliver results with the consent of those affected rather than in opposition to it.
Reduced risk products such assnus, nicotine pouches, vapingand heated tobacco have the potential to deliver the smoking "endgame" to which public health advocates aspire. The decision by Sweden to exempt itself from EU snus prohibition saved millions of lives and has given the world a guide to how it can reduce smoking in the same way. We could be seeing the end of smoking in favour of nicotine use which eliminates the well-known harms of combustible tobacco. All that is needed is to take heed of the Swedish experiment and allow the same miracle to happen everywhere.
Read more about how replicating Sweden's success could save lives HERE.