Sweden is usually referred to as the best example in Europe of a country that combined wide bans of places to smoke conventional cigarettes with an offer of 250-year alternative product snus, a functional and satisfactory product that the nicotine users understand is a dramatically less harmful alternative. In reality, Swedish regulatory authorities and influential groups of medical professionals are as negative to snus as to cigarettes as they cannot accept any other policy than the quit-or-die paradigm. The success of snus in the Scandinavian markets is a function of word of mouth, in that everyone has relatives that died of smoking-related diseases but nobody can recall a single relative or loved one ever getting ill from snus use.
Sweden is also the only country in the European Union where snus is allowed due to the traditional nature and the EU acquis having to accommodate to avoid a no in the Swedish Referendum on joining the EU, and many prevalence statistics and epidemiological data suggest how the use of snus has been a fundamental factor for the comparatively low numbers of smokers among the population. A recent European survey indicated that Sweden has the lowest prevalence of daily cigarette use in the EU, with a 5% compared to over 20% average on most of Europe.
However, while the Swedish prime minister declared the goal of a smoke-free country by 2025, ecigs are also submitted to strict rules and increasingly considered on the same level as conventional cigarettes. Furthermore, a new report commissioned by the Swedish government suggests stricter regulation of tobacco-alternative products, including a blanket ban on all flavoured e-cigarettes and further tightening on the rules on marketing and advertising.
Catania Conversation discusses the topic with Atakan Erik Befrits, international THR expert, Chairman of New Nicotine Alliance Sweden and member of global umbrella CSO-NGO INNCO.
Mr Befrits, what is the current situation for Tobacco Harm Reduction in Sweden?
“We are witnessing a worsening in Tobacco Harm Reduction policies where we should have seen improvements, particularly on electronic cigarettes. This is due to the close bonds between European Union tobacco control and Sweden’s counterparts piggybacking on each other for useful home arguments, and then the issue of rules applied in three EU countries by national governments can be harmonised with EU laws to cover the entire union, as happened to snus ca 1990. Misinformation too, as In 2018, a parliamentary vote approved a law that blanket-bans vaping even outside in all public settings without even consulting consumers, A massive media campaign with blatant misinformation during 48 hours secured the smoking outside ban being widened to cover vaping as well, despite there was no majority.”
What are the main reasons?
In Sweden, health authorities knew at least since 1975 that there is no question that snus is between 95%-99.9% safer than smoking, but the governments continue to follow this concept that Harm Reduction somehow is bad. In psychology, it is called anchoring; if you anchor something, then the brain is such a complex machine in certain parts, but simple in others that it behaves very predictably, stupidly right. In medicine when you have something that is up to 90% safer, it would be considered fantastic. But, in public health policy somehow Tobacco Harm Reduction is misperceived. I believe people consider vaping more dangerous than it is because is measured from the cigarette end-point. If, for instance, snus was since decades acknowledged as the consumer version of NRT with a similar risk profile to NRT, then it would be greater effect trying to convince of the effectiveness and relative safety also of e-cigarettes as Tobacco Harm Reduction.”
What is the role of the New Nicotine Alliance Sweden?
The NNA Sweden, which I represent as chairman, focus on collecting and disseminating centuries of Swedish knowledge on Tobacco Harm Reduction and making them available to the international community. At the same time, we act as a watchdog for Swedish consumers to alert them of the wrong, dangerous and or misleading messages sent by international regulatory bodies. Overall, in the West, health bodies continue to base the THR policies on a gross and deadly lie regarding how safe a tobacco/nicotine product can be, partly because we think we can afford it and partly for gain or prestige, use it as political ammunition. However, this has unacceptable and dire negative health consequences in Africa, Asia, and LMIC. According to the World Health Organisation, the number of premature deaths for smoking-related diseases is expected to be one billion total before 2100 unless something changes. The very same organisation is currently doing most of the total tobacco control work to ensure that nothing changes.” In effect protecting the very deadliest forms of tobacco use and not nudging nations to incentivise their tobacco sector to rapidly move from index 100 danger tobacco use to index <5 risk nicotine/tobacco use where the harms, though not zero, are also effectively impossible to differentiate from background noise, air pollution, alcohol, lack of exercise, poor diet.
