Will the EU Choose Cigarettes or Innovation?

When Jonas Salk developed the polio vaccine in 1955, health authorities did not restrict its use over concerns it might “renormalize injection.” Similarly, regulators did not ban antiretroviral therapy for HIV out of concern that patients might neglect abstinence. Every major public health breakthrough, from vaccines to clean water to seatbelts, has relied on innovation and technology. Smoking should be approached with the same commitment to progress.

Media coverage of nicotine pouches focuses on market dynamics and investor returns. Buried in that narrative is a public health revolution happening in real time, one European regulators are trying to kill before it can save lives.

Sweden’s smoking rate dropped to 5.3% in 2024, the lowest in the EU. The EU average is 24%, barely changed since 2020. At current trends, Sweden will be smoke-free this year. The rest of Europe? Try 2100. What accounts for this gap? Stockholm is not blessed with superhuman willpower. Swedes have access to a wide range of innovative nicotine products, including nicotine pouches. These small, tobacco-free pouches deliver pharmaceutical-grade nicotine without combustion, tar, or the thousands of toxicants in cigarette smoke.

Czechia saw smoking rates plummet by 7 percentage points between 2020 and 2023 after coordinating harm-reduction policies across government ministries. Greece, stuck at 42% for fifteen years, cut smoking by six points after reversing its ban on these products. Japan’s cigarette sales fell 52% as heated tobacco gained acceptance. The UK dropped from 16.4% to 10.4% after incorporating vaping into cessation strategies. A clear pattern emerges: countries that treat nicotine products based on their actual risk profiles see smoking rates collapse. Countries clinging to the fiction that all nicotine delivery is equally harmful watch their citizens keep smoking and getting sick.

The U.S. Food and Drug Administration recognized this when it authorized the marketing of nicotine pouches last year. As doctors Riccardo Polosa, Karl Fagerstrom, and Brad Rodu note in a recent paper, the FDA made a key distinction: “Nicotine is what keeps people using tobacco products. However, it’s the thousands of chemicals contained in tobacco and tobacco smoke that make tobacco use so deadly.”

Yet Belgium, France, Germany, and the Netherlands have banned these products outright. The prohibition reflex reveals a failure of imagination about what public health can achieve. Traditional interventions like taxation, advertising bans, and smoking restrictions remain valuable. But they have hit their ceiling. Smokers in 2026 need better options than “quit or die.”

This matters beyond Europe’s borders. Low- and middle-income countries face an explosion in smoking-related disease with minimal cessation infrastructure. India’s oral cancer rates are among the world’s highest, driven by smokeless tobacco use. Nicotine pouches could provide a direct substitution with the same delivery method and a fraction of the risk. But international development aid continues funding abstinence-only programs that do not work at scale.

Skeptics invoke the precautionary principle. Yet precaution demands weighing all risks, including those of doing nothing. Belgium has chosen prohibition while Sweden has chosen smart regulation and now faces smoking rates a fifth of the EU average. Perhaps both approaches carry risks. But what is certain is that only one appears to be working at scale.

Defeating smoking requires more than willpower and taxation. Technology has consistently been the catalyst for public health breakthroughs, creating pathways that make healthier behaviors practical rather than heroic. Nicotine delivery without combustion offers that pathway now. Europe can still lead this revolution instead of banning it.

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