Europe’s Beating Cancer Plan: A Missed Opportunity

    Photo: Paulgrecaud | Dreamstime.com

    The European Commission’s Beating Cancer Plan fails to recognize the potential of safer nicotine products.

    By Stefanie Rossel

    In February, the European Commission (EC) presented its Beating Cancer Plan (BCP), which named tobacco as the top avoidable risk factor. According to the EC, tobacco use is responsible for 15 percent to 20 percent of all European cancer cases, which corresponds to 525,000 to 700,000 new diagnoses each year. The BCP aims for less than 5 percent of the EU population to use tobacco by 2040, thus creating a “tobacco-free generation.”

    To achieve this, the EC wants to tighten tobacco regulations, increase minimum taxation rates on tobacco products and harmonize the taxation of novel products. “As well as dealing with traditional tobacco products, addressing the next generation of tobacco and related products will remain a priority as new products, such as heated-tobacco and others, continue to enter the market,” the EC states on its website. The EC will also review legislation on cross-border tobacco purchases and address tobacco advertising, promotion and sponsorships. Member states will receive support in their implementation of the World Health Organization Framework Convention on Tobacco Control (FCTC).

    Damian Sweeney

    The plan was met with criticism by consumer organizations and trade associations. “The Beating Cancer Plan doesn’t just fail to make a distinction between the relative risks of combustible and noncombustible products, it also fails to recognize that low-risk alternatives like e-cigarettes and smokeless tobacco products are substitutes for the extremely hazardous combustible products,” says Damian Sweeney, a partner in the European Tobacco Harm Reduction Advocates (ETHRA).

    “The plan proposes stricter rules on novel products, including a ban on nontobacco flavors, plain packaging, taxation and recommendations to member states to prohibit vaping in public spaces. Such severe restrictions on low-risk alternatives to smoking will serve to protect the cigarette trade and perpetuate smoking. It is an abject failure on the part of the EU to ignore the important role safer nicotine products can play in getting Europeans to quit smoking,” says Sweeney.

    Dustin Dahlmann, president of the Independent European Vape Alliance (IEVA), a group that includes national associations, companies, manufacturers and wholesalers, says the EU strategy ignores harm reduction as an important instrument for public health. “Public Health England (PHE) estimates that vaping is at least 95 percent less harmful than smoking,” he says. “According to studies reviewed by PHE, vapers have a 99.5 percent lower risk of getting cancer than smokers. Many other studies show the great harm reduction potential of vaping. Ignoring these facts means ignoring the scientific evidence.”

    According to Dahlmann, ignoring the scientific basis for harm reduction is tantamount to climate change denial. “The EU must understand that too,” he says. “It is about the effective reduction of the smoking rate in Europe. In Great Britain, the smoking rate has been massively reduced within a few years with the help of vaping. The U.K. ranks first on the tobacco control scale, which shows the success of their sensible tobacco control measures. The EU must take this policy as an example if it is serious about its plans to reduce cancer.”

    Dustin Dahlmann

    Difficult Road Ahead

    Sweeney predicts a gloomy future for tobacco harm reduction (THR) in the EU if legislation sticks to the BCP. THR, he points out, is already facing challenges in the EU, with excessive regulations planned in Denmark, Germany, Latvia, the Netherlands and Spain. “These include flavor bans, plain packaging, increased taxation, online sales bans and bans on vaping in public spaces. If EU legislation follows the proposals in the plan, it will be disastrous for THR and for the health of millions of EU citizens. According to the most recent Eurobarometer Report, 57 percent of vapers have completely quit or reduced their smoking, and an overwhelming majority use nontobacco flavors,” he says.

    “There is no doubt that the measures will affect millions of vapers, depriving them of the lifesaving products they use to remain smoke-free and forcing many back to smoking or to obtaining their products on the black market. Even worse is that current and future smokers will be deprived of the opportunity to improve their own health by switching to safer nicotine products. It is imperative that we consumers of safer nicotine products are listened to. We have an in-depth knowledge of the products and of the many difficulties people face when trying to quit smoking,” says Sweeney.

    Back in its Box

    Whether the EC’s “quit or die” approach will achieve the desired effect remains to be seen. By eliminating tobacco use, the BCP committee argues, nine out of every 10 lung cancer cases should be avoided. “However, if old and unsuccessful tobacco control strategies are retained, the plan cannot succeed,” Dahlmann predicts. “Public health policy decisions need to be evidence-based. Public Health England recently published the seventh report on e-cigarettes. The facts presented speak a clear language: E-cigarettes are effective means of quitting smoking and can help millions of people reduce the risks of tobacco use. ‘Quit or die’ is a cynical attitude and leaves the mass of smokers alone who cannot just quit.”

    Sweeney, too, is pessimistic about the BCP. “The proposed measures are unscientific and ignore the experience of millions of citizens who have quit smoking using safer nicotine products,” he says. “Reducing smoking prevalence requires a new approach, which takes into account the technological advances which allow citizens to consume nicotine without being exposed to the cancerous compounds generated from combustion. Doubling down on outdated ‘quit-or-die’ policies and applying them to safer nicotine products is more likely to increase the ‘die’ part of that equation than the ‘quit’ part. Countries where safer nicotine products have been permitted to flourish, such as Sweden and the U.K., have been rewarded by steep drops in smoking prevalence. Countries which rely on traditional tobacco control measures are performing a lot less well. The EU should take a lesson from this.”

    The Beating Cancer Plan’s stance on tobacco harm reduction is strikingly similar to the EU Scientific Committee on Health, Environmental and Emerging Risks’ (SCHEER) preliminary opinion on e-cigarettes, which was presented in September 2020. The draft report was heavily criticized by academics, scientific experts and consumer associations for failing to compare the risks of vaping with the risks of smoking (see “Proper Context,” Tobacco Reporter, February 2021). Although only a preliminary opinion at that point, the findings of the document, which Dahlmann calls “fundamentally flawed,” appear to have made their way into the wording of the BCP. “From comments made in the BCP press conference, it looks as though the SCHEER report will be used as the scientific basis for the plan’s proposals for safer nicotine products, which is a huge concern,” says Sweeney. “The BCP has also stated that the Tobacco Products Directive [TPD] and the Tobacco Taxation Directive will be used to apply the proposals. The commission has made their intentions for tobacco control clear in the plan: They intend to pursue traditional tobacco control measures and will use EU directives to try to put tobacco harm reduction back in its box. The commission fully intends to ignore the voices of millions of us consumers, who have improved our health by switching to safer nicotine products.”

    Following an open public consultation that received ample response, the SCHEER committee was expected to adopt its final opinion during its plenary meeting in March. “We hope and expect that, given the depth of comments the committee has received, that it will decide that it is the time to reevaluate its findings,” Dahlmann states. “Decision-makers in the European Union have to make policy decisions in the best interests of Europeans. Ignoring THR would be a fatal mistake.”

    Science Over Ideology

    Much will depend on the EU’s attitude toward THR this year. By May 20, the commission will have to submit a report assessing the TPD. This review report will clarify which parts of the TPD the commission deems necessary to amend. The commission thus finds itself in the unusual situation that its approach may point the way for the FCTC’s ninth Conference of the Parties (COP9), which had to be postponed to this November due to the coronavirus crisis. “This report will be important to the position that the EU will take at the COP meeting,” Sweeney comments. “On the other hand, the hostility of the WHO and the FCTC secretariat toward safer nicotine products is very clear, so even if the report is favorable toward safer nicotine products, it is still going to be an uphill battle for THR at COP.”

    Dahlmann calls on the WHO to recognize the harm reduction potential of e-cigarettes. “The evaluation of vaping must be based on scientific facts,” he says. “These clearly show the public health potential of harm reduction, and it is the responsibility of the WHO to make sure smokers know the facts. Many smokers do not know that e-cigarettes are much less harmful for them than smoking. By the end of 2021, a lot more people should be able to separate myths from facts when it comes to tobacco harm reduction.”

    While the road ahead is bumpy, the battle for public health’s recognition of THR is not yet lost. “Despite everything that is going on and the constant bombardment of negative press and misinformation, I am quietly confident that common sense will win the day,” Sweeney says. “The fact that those opposed to THR don’t engage on the science but rely on ad hominem attacks and extremely suspect research tells me that they know they can’t win the battle based on facts. We are talking about saving people’s lives; this type of policy should be fact-based. It should not be a puritanical crusade against nicotine consumers and pro-THR scientists.

    “Engaging with your elected MEPs is the best way to foster change; they were elected by the people, and their job is to represent the people. There are millions of us consumers of safer nicotine products in the EU, and we make up a substantial voting bloc. It’s more important than ever to make our voices heard and to let the politicians know that the unintended consequences of denying access to THR products will be dire.”

    “The scientific evidence for the potential of the e-cigarette continues to grow,” says Dahlmann. “Two Cochrane reviews have concluded that vaping is a good means of stopping tobacco, likewise Public Health England. There are many researchers around the world who have delivered convincing results on the subject of tobacco harm reduction. We expect many more publications in the next few months to expand the knowledge base about vaping. Decision-makers who are serious about tobacco control should recognize what the science is telling them.”