Athens: At the recently held 8th Summit on Tobacco Harm Reduction, experts discussed strategies to implement harm reduction as a public health strategy for smokers who cannot or will not quit.
A key message from the sessions was that while cessation of smoking remains the gold standard, alternatives such as e-cigarettes, heated tobacco, and oral nicotine products “represent a pragmatic and science-based option”, the official press release from the event stated.
At the summit, Karl Fagerstrom – a Swedish psychologist and researcher known for his work on nicotine dependence, smoking cessation, and tobacco harm reduction – spoke about the history and future of nicotine and learnings from the Swedish context.
He said Sweden has reduced smoking prevalence to just 5%, the lowest in the European Union (EU) – a success largely attributed to the widespread use of “snus”, a type of smokeless tobacco that is placed under the upper lip for extended periods.
It originated in Sweden and is particularly popular in Scandinavian countries.
“This achievement is clear proof that tobacco harm reduction works, supported by robust real-world data,” he said.
Dr Stelios Kympouropoulos, a psychiatrist and former member of the European Parliament, shared his thoughts concerning the importance of harm reduction tools for improving public health.
He stressed that quitting smoking benefits not only physical but also mental health, reducing anxiety and depression while improving concentration and quality of life.
“Harm reduction is a duty when safer, regulated alternatives exist, and can serve as a complementary strategy, as non-combustible alternative products, if strictly regulated, are less harmful than conventional cigarettes. At the same time, strong measures are needed to protect young people”, he said.
Kympouropoulos reiterated that Europe must invest in smart and practical regulation, grounded in science, aimed at reducing smoking and protecting youth, while also preventing the growth of illegal markets.
At another panel session on public health, the speakers addressed the challenge of rising public healthcare costs in Europe.
The panel agreed that most countries cannot continue increasing healthcare budgets. Professor Andrzej Fal, a board member of the International Association on Smoking Control & Harm Reduction (SCOHRE), emphasised that chronic diseases impose a significant economic burden, making harm reduction and rehabilitation essential prevention strategies with both medical and economic benefits.
Christina-Maria Kravvari, the secretary general of public health in the Greek Health Ministry, presented the main points of the new Greek legislation on “Minors’ protection from tobacco and alcohol products” approved in July.
She emphasised that, “since 2019, our tobacco control policy has been based on evidence and strict scientific evaluation of new nicotine products including their relative harmfulness,” adding that this approach led to Greece achieving the second-largest reduction in smoking prevalence in the EU between 2020 and 2023 according to EU statistics.
“It is an approach rooted in realism and in our duty to strengthen public health protection,” Kravvari said.
In its framework, Greece adopts zero tolerance for the exposure of minors to tobacco, nicotine and alcohol to provide youth an environment free of addiction and harm as a strategic choice for the future of Greek society, she added.
In a panel discussion around misconceptions among consumers and healthcare professionals on the harms of nicotine a panelist noted that many healthcare professionals mistakenly consider nicotine itself as highly harmful.
Professor Giovanni Li Volti, an Italian biomedical scientist said that this is a misconception reinforced by contradictory scientific literature.
Clive Bates, a leading policy expert in tobacco control, in his speech contrasted the original expectations of the Framework Convention on Tobacco Control (FCTC) with today’s reality, describing it as “a good idea gone wrong”.
The FCTC is the first global public health treaty negotiated under the auspices of the World Health Organisation.
It aims to protect present and future generations from the devastating health, social, environmental, and economic consequences of tobacco use and exposure to tobacco smoke.
Bates noted that the FCTC was created to address the global smoking crisis by reducing its health, social, economic, and environmental impacts, providing countries with a framework that included advertising bans, higher taxes, sales restrictions, and cessation support.
“But was this effective?” Bates asked.
He argued that the current emphasis on nicotine and addiction has diverted attention from the core objective of reducing smoking-related harm.
He highlighted some major diversions from the FCTC’s original goal, namely the misplaced risk comparisons between cigarettes and novel products; the excessive focus on nicotine and addiction; a preoccupation with the tobacco industry and the prohibition of lower-risk alternatives.
“We have to go back to the objective,” Bates stressed. “There is one and only one big idea: to transform nicotine use from high-risk to low-risk behaviour.”
David T Sweanor, a Canadian lawyer and public health advocate, chaired a panel discussion focused on the decline of public trust in health authorities, with an emphasis on nicotine and tobacco issues.
He stressed that global trust in government is at 52%, and even lower in Western liberal democracies.
On the other hand, a global study indicated overall trust in science remains high. Panellists agreed that while it takes time to build trust, it cannot be rebuilt overnight.
Sweanor closed the panel with an optimistic note: “Despite all the misinformation, the barriers, and even the prohibitions, the market keeps changing at a remarkable rate and people are moving ahead, regardless of the wrong messages and policies.”
The session on uniting perspectives for tobacco harm reduction, as a conclusion to the summit, highlighted the growing international debate on the role of harm reduction in tobacco control strategies and efforts to reach consensus.
Panelists noted that despite increasing scientific evidence that alternative nicotine products such as vapourisers, nicotine pouches, and heated tobacco products can benefit smokers who switch from traditional cigarettes, acceptance remains limited.
Only a few countries, such as Britain and New Zealand, have adopted such strategies.
Professor Ignatios Ikonomidis, president of SCOHRE reaffirmed the association’s commitment to reshaping tobacco control: “Harm reduction must become a recognised pillar of public health policy, alongside prevention and cessation.”
