Sweden - Tobacco Reporter

WHO Urged to Follow Sweden’s Example

The World Health Organization should look at Sweden for inspiration when deciding how to effectively reduce smoking-related deaths, according to the Institute for Tobacco Studies (ITS).

In a paper published on Qeios, ITS’ principal investigator, Lars M. Ramstroem, says Sweden provides a prime example of how products that don’t burn tobacco can benefit public health. Sweden has the lowest smoking prevalence among men in the European Union and consequently the lowest tobacco-related mortality.

The “WHO needs to apply all science-based strategies to reduce tobacco-related deaths,” Ramstroem said in a statement.

“The meeting of the world’s health leaders in Panama in November, the COP10, represents a unique opportunity to take a fresh look at the most recent evidence with an open mind. After all, if Sweden had followed WHO’s advice from 20 years ago and banned snus, tobacco-related deaths in Sweden would have been much higher, and the only unintended beneficiary profiting from such advice would be the cigarette industry,” Ramstroem and his colleagues write in the paper.

“[I]ncreasing number[s] of scientists and national governments believe that these new products represent an opportunity that can accelerate the demise of smoking. Because they don’t burn tobacco, they are estimated to be far less harmful than smoking. To the extent that they can act as a substitute and displace smoking, thereby improving public health.”

Ramstroem said most “tobacco-related” deaths are in fact “smoking-related” deaths caused by repeated inhalation of smoke emitted when tobacco is lit on fire.

“When burning is taken out of the equation, the harm can be dramatically reduced. We have known for decades that people smoke for nicotine but die from the tar,” the paper says.

If Sweden had followed WHO’s advice from 20 years ago and banned snus, tobacco-related deaths in Sweden would have been much higher.

Lars M. Ramstroem, principal investigator, ITS

In addition to citing the experience of Sweden, the paper urges policymakers to study the examples of Norway, Japan or New Zealand. “Norway is now following a similar trajectory as Sweden, with daily smoking being at record-low levels and virtually on the brink of extinction among some population groups, largely due to snus,” the paper’s authors wrote.

In Japan, a large number of smokers have switched to heated-tobacco products, contributing to a decline in smoking from around 20 percent in 2014 to 13 percent in 2019, while in New Zealand, vaping helped reduce daily smoking to 8 percent and contributed to rapid fall in smoking rates even among Pacific and Maori populations where traditional interventions have been failing.

The paper also calls on the delegates to the COP10 to look at the real-world scientific evidence in making decisions during the meeting.

“When it comes to smoking, the WHO doesn’t need to reinvent the wheel: Just follow the science (and Sweden) this time, for the sake of 1 billion smokers who aren’t lucky enough to live in Sweden,” the paper says.

October 23, 2023

Sweden to Slash Snus Tax

The Swedish government intends to reduce the tax on snus by 20 percent and increase the tax on combustible tobacco products by 9 percent.

In a note on its website, the government said the move would lower the price of a snus can by approximately SEK3 and reduce the price of a cigarette pack by about SEK4.

Parliament had previously decided to increase tobacco taxes in 2023 and 2024. However, recent inflation has been higher than the forecasts upon which the increases were based.

Sweden already taxes smokeless tobacco at lower rates than smoked tobacco because it believes combustible products present a greater health risk.

The changes are expected to take effect on Nov. 1, 2024.

Tobacco harm reduction advocates applauded the decision. “Sweden’s new taxation policy is an exemplary move in fast-tracking the country even further towards its smoke-free target,” said Michael Landl, director of the World Vapers’ Alliance, in a statement.

“By making less harmful alternatives like snus more accessible through tax reductions, Sweden is not just theorizing harm reduction; it’s effectively implementing it. It’s time for the EU to take a leaf out of Sweden’s book.”

September 7, 2023

Sweden Close to Smoke-Free Status

Sweden has almost reached smoke-free status, which is considered 5 percent of the population or less smoking, reports AP. In 2019, 6.4 percent of Swedes over the age of 15 were daily smokers. Last year, 5.6 percent of the population were smokers, according to the Public Health Agency of Sweden.

“We were early in restricting smoking in public spaces, first in school playgrounds and after school centers and later in restaurants, outdoor cafes and public places such as bus stations,” said Ulrika Arehed, secretary-general of the Swedish Cancer Society. “In parallel, taxes on cigarettes and strict restrictions on the marketing of these products have played an important role.

Members of European Parliament expressed concern with the European Union approach toward smoking cessation, noting a need for an approach following that of Sweden. Charlie Weimers and Johan Nissinen called for a more open approach toward harm reduction in the EU at a press conference in Brussels that was hosted by the World Vapers’ Alliance.

“The Swedish case presents the third and final determining pillar in the pro-harm reduction argument,” said Michael Landl, director of the World Vapers’ Alliance. “The science, the experience of the consumers and now the Swedish example are proof that harm reduction works in achieving a smoke-free society. Now we have an undeniable case that the EU-wide regulation must be risk-based and evidence-supported.”

“Policy should be evidence-based,” said Weimers. “WHO [World Health Organization] will soon classify Sweden as Europe’s first smoke-free country because of harm reduction policies and widespread use of snus. Sweden has a wide range of harm reduction products: We have snus, nicotine pouches, vaping, etc. People are given a choice!”

Nissinen said, “It is clear that smoking kills, and we need to do everything we can to prevent those unnecessary deaths. Sweden is the best example of how this is achievable, namely with a pragmatic harm reduction approach. It is the only country in the EU where snus is legal and popular, with 18 percent of the population using it. Consuming snus instead of cigarettes saved many Swedish lives. It is time that the EU Commission expects this reality and starts acting accordingly.”

“Snus has been used since the 1800s, so we have more than 200 years of a case study that proved that tobacco harm reduction works. Snus is a great way to continue consuming nicotine without harmful chemicals you take from the traditional combustible cigarettes,” said Carissa During, the director of the Considerate Pouchers. “Many countries in Europe are trying to overregulate or ban alternative nicotine products. Policymakers believe that banning something will make them disappear. We know that it is not true.”

The WHO, however, attributes Sweden’s declining smoking rate to tobacco control measures, including information campaigns, advertising bans and “cessation support” for those wishing to quit. The agency stated that Sweden’s tobacco use is at more than 20 percent when including snus and similar products.

“Switching from one harmful product to another is not a solution,” the WHO said in an email, referring to snus. “Promoting a so-called ‘harm reduction approach’ to smoking is another way the tobacco industry is trying to mislead people about the inherently dangerous nature of these products.”

June 2, 2023

Stingfree Launched in Sweden

Sting Free modern oral nicotine pouches have been launched in Sweden.

The Stingfree technology reduces the burning sensation and irritation on the gums, which is typical of regular snus and oral nicotine products, according to a press release. Several e-commerce distributors and stores are now selling the first product in an upcoming series of tobacco-free nicotine pouches with different flavors and strengths.

Several studies have shown that many snus users suffer damage to and changes to the gums, especially where the pouches are in direct contact with the gums. The U.S./EU patented Stingfree technology aims to counteract this and the associated burning/irritating sensation by having an impermeable barrier on the gum side of the pouch. A high percentage of snus users dislike when nicotine pouches and snus stings/burns and irritates the gums. This has been established by Sting Free AB in a comprehensive survey in 2022, with responses from over 1,000 Swedish snus users (of which almost 40 percent were women). Of the respondents, 67 percent of the women considered that the burning/stinging sensation, regardless of when it stings, is unpleasant as did 53 percent of the men. Almost 50 percent of the respondents had had oral health problems pointed out by their dentists linked to their use of snus/nicotine pouches.

A recent survey of U.S. females investigated why the use of smokeless tobacco products like nicotine pouches and snus is so much lower among women compared to men. A main factor concluded from the responses was the burning sensation and oral irritation caused by these products, with comments such as “irritation,” “burn,” “hurts my gums,” etc. Other factors were “negative stereotypes about smokeless users,” “deadly misconceptions” that smokeless products are more dangerous than e-cigarettes and smoking and the unfamiliar mode of delivery.

Sting Free AB’s vision is that the Stingfree technology will become a new industry standard for nicotine pouches and traditional smokeless tobacco products like snus and that customers in the future will be asked the question, “Regular or sting-free?” when they buy such products. The company also hopes that the technology will contribute to more smokers opting out of smoking in favor of significantly less dangerous nicotine pouches.

April 14, 2023

Sweden Approaching ‘Smoke-Free’ Status

Smoking prevalence is poised to drop below 5 percent in the coming months in Sweden—a level that would make the country “smoke-free,” according to a commonly used definition.

No other country in the European Union is even close to replicating this achievement and none are currently on track to even achieve it by the EU’s target of 2040, in 17 years’ time.

Sweden’s groundbreaking strategy to minimize the harmful effects of tobacco smoking and save lives is detailed in a new report titled “The Swedish Experience: A roadmap for a smoke-free society,” presented March 14 at an international research seminar in Stockholm.

According to the report’s authors, Sweden’s approach, which combines tobacco control methods with harm minimization strategies, could save 3.5 million lives in the next decade if other EU countries adopt similar measures.

“Quitting smoking like Sweden saves lives,” said Anders Milton, one of the report’s authors, in a statement. “It has annually saved more than 3,400 lives in Sweden. If all other EU countries did as Sweden did, 3.5 million lives could be saved in the coming decade in the EU alone.”

The Swedish model combines recommendations in the WHO Framework Convention for Tobacco Control, including reducing the supply and demand of tobacco, banning smoking in certain places, but it adds an important element: accepting smoke-free products as less harmful alternatives.

Sweden has a very successful tobacco strategy that should be exported.

Karl Fagerström, co-author, “The Swedish Experience: A roadmap for a smoke-free society”

“It’s about combining tobacco control with harm minimization,” explained Delon Human, another of the report’s authors. “There are no risk-free tobacco products, but e-cigarettes, for example, are 95 percent less harmful than cigarettes. It is far better for a smoker to switch from regular cigarettes to e-cigarettes or nicotine pouches than to continue smoking.”

The benefits of Sweden’s strategy are enormous, with the country having the lowest percentage of tobacco-related diseases in the EU and a 41 percent lower incidence of cancer than other European countries. The report also describes how the percentage of smokers in Sweden has dropped from 15 percent to 5.6 percent of the population in 15 years, putting it on track to achieve smoke-free status 17 years ahead of the EU’s 2040 target.

“Sweden has a very successful tobacco strategy that should be exported,” said Karl Fagerström, who also authored the report.

“It would be of enormous benefit to the world if more countries did as Sweden did with measures that reduce supply and demand while having differentiated tax rates that give smokers financial incentives to switch from cigarettes to less harmful alternatives,” Fagerström added.

The report was commissioned by Health Diplomats, an international organization working to improve access to healthcare, encourage innovation and the use of harm reduction to minimize the negative impact of alcohol, food, nicotine and drugs.

For countries looking to replicate the Swedish experience, the report offers the following recommendation:

Recognize smoke-free products as less harmful and that they pose significantly less risk than smoking. Encourage smokers to switch from cigarettes to less harmful alternatives.
Provide fact-based information. It is clear that there are no risk-free tobacco products. But, for example, e-cigarettes are 95 percent less harmful than cigarettes. Of course, it is better for a smoker to switch from regular cigarettes to e-cigarettes, although it is not without risk.
Implement policy decisions that make smoke-free alternatives more accessible than cigarettes; for example, differentiated taxes that give smokers financial incentives to switch from cigarettes to less harmful alternatives.

The full report is available here: smokefreesweden.com/report_en.

March 14, 2023

EU Lawmaker Urges Snus Legalization

Johan Nissinen, a Swedish member of the European Parliament, has urged the EU to legalize snus, according to Snusforumet.

“Swedish snus and nicotine pouches are better options than cigarettes,” Nissinen said. “We can get rid of cigarettes once and for all thanks to snus and nicotine pouches. We need to highlight countries such as Sweden, but also Great Britain, where both Public Health England and the NHS [National Health Service] have encouraged citizens to use e-cigarettes instead of traditional combustible tobacco products to advance public health. It’s a further step in an already multi-year government health initiative aiming to make the U.K. completely smoke-free by 2030.”

“Sweden is proof of the public health advantages that come from embracing snus and nicotine pouches instead of cigarettes,” he said. “We need to do more to highlight the public health benefits. Sweden should also push to ensure the internal market is open for legal, equivalent products. If beer can be sold within the EU, wine should be too. If the sale of Coca-Cola is permitted, so must Pepsi, and so on. The same principle should apply to snus. If deadly cigarettes are permitted throughout the internal market, then a lower risk equivalent like snus should be as well.”

February 21, 2023

Sweden Approaching ‘Smoke-Free’ Goal

Smoking in Sweden has fallen to 5.6 percent, making Sweden the only European nation close to reaching the smoke-free goal set by the EU ahead of the 2040 target, Swedish authorities confirmed, according to BusinessWire.

According to participants in an event organized by the Oral Nicotine Commission in Stockholm, Sweden is about to become the first country in the world to be defined as “smoke-free,” representing a share of less than 5 percent of the population smoking.

Sweden’s smoking rates have plunged since the 1980s from 35 percent to below 6 percent. The next lowest smoking rate in Europe is double that of Sweden’s, with the EU average sitting around 23 percent, four times higher than in Sweden.

“If all smokers in the world, some 1.1 billion people, would switch to one of [the] less harmful alternative smoke-free, nicotine-based products, it could prevent disease and save millions of lives worldwide. Sweden has found the fire escape for smokers. We need to work together to repeat the Swedish experience globally to save lives,” said Delon Human, president of Health Diplomats and organizer of the Oral Nicotine Commission event.

“The upcoming Swedish EU presidency is a great opportunity to share their 5 percent success story to other EU countries,” said Karl Fagerstrom, professor, at the event. “We hope that Sweden will be generous with sharing this know-how internationally.”

Speakers at the conference emphasized the need for sound evidence-based policy interventions in tobacco control.

December 7, 2022

Snus Lovers up in Arms After EU Tax Proposal

Swedish snus lovers are up in arms after the publication of a leaked document suggesting the EU wants to force Sweden to raise the tax on snus by 200 percent.

The document, which was seen by the Swedish daily Aftonbladet, contains proposals for a new excise tax on tobacco.

If the plan becomes reality, the price of a can of portioned snus could increase by approximately SEK34 ($3.26). The price of a can of loose snus would increase by approximately SEK62 compared to today. A can of General loose snus would cost over SEK120 under the proposal.

Patrik Hildingsson, head of communications at Swedish Match, said that while Swedes are accustomed to high tax rates, the leaked EU proposal goes too far. He urged the Swedish government to make it clear to Brussels that Sweden alone regulates snus.

“Imagine if the EU decided to raise the tax on Italian Parma ham or German beer. This is basically the same thing,” Hildingsson was quoted as saying by Aftonbladet. “In the snus issue, the EU has chosen to disregard the principle of member state self-determination.”

“To dramatically increase the tax on snus will be a deadly blow to tobacco harm reduction and can make users go back to smoking.”

Bengt Wiberg, founder, EUforsnus

Meanwhile, snus advocates pointed to the health impact of snus, which is considerably less risky than other tobacco products.

“The Swedish Experience of snus has made Sweden almost smoke-free,” said Bengt Wiberg, founder of the EUforsnus international consumer group. “Daily smoking is now only 5 percent in Sweden as per the EU’s own Eurobarometer and thus Sweden has the lowest rate of all tobacco-caused cancers in Europe.

“To dramatically increase the tax on snus will be a deadly blow to tobacco harm reduction and can make users go back to smoking. I am sure the Swedish liberal/conservative government will even consider using its veto right within EU to stop this proposal.”

Finance Minister Elisabeth Svantesson indicated she would oppose the proposed tax hikes.

While snus is banned in the EU, Sweden obtained an exemption on cultural grounds when it joined the union in 1995. In the following years, however, the EU has made several attempts to restrict snus sales in Sweden, according to Aftonbladet.

The recent leaked proposal is scheduled to be published in early December. It must then be discussed and decided by the EU member states.

November 27, 2022

Sweden: Lawmakers Reject Vape Flavor Ban

Sweden’s Parliament, the Riksdag, rejected a ban on sales of flavored vaping products, with 177 lawmakers voting against the proposal and 126 lawmakers voting in favor, reports Vaping360.

Introduced by the government’s Ministry of Social Affairs in late February, the new rules would have taken effect next January, and would have prohibited flavors other than tobacco in all e-liquid, including zero-nicotine vape juice.

In rejecting the proposal, lawmakers heeded the advice of the Riksdag’s social affairs committee, which had recommended adopting proposed regulations for nicotine pouches and synthetic nicotine but eliminating the flavor ban.

Seven other European countries have banned non-tobacco vape flavors. In Denmark, Estonia, Finland, Hungary and Ukraine, flavored vape restrictions are currently in place. Lithuania’s flavor ban will take effect July 1. In the Netherlands, the flavor prohibition scheduled to begin in July has been postponed until January 2023.

No European country has banned vaping products outright.

June 22, 2022

Vapers Petition Lawmakers to Stop Swedish Flavor Ban

The global vaping advocacy group World Vapers Alliance (WVA) on May 24 delivered an open letter to the Swedish parliament urging policymakers to stop a pending ban on flavors

A day later, the WVA marched in front of the Parliament with the slogan “Flavours help smokers quit” and urged lawmakers to vote against the ban.

Earlier this year, the Swedish government introduced a bill that would prohibit all non-tobacco vape flavors in nicotine and non-nicotine products. If approved, the bill is set to enter into force on Jan. 1, 2023.

“I benefited firsthand from vaping and managed to stay smokefree for the last few years,” said Michael Landl, director of the WVA, in a statement. “Like most other smokers, I tried to find a way out of cigarettes—but nothing worked for me—the patches, the gums, the inhalers. Vaping—and especially combined with flavors—was my savior. And like me there are millions around the world who are healthier and lead a better life because of vaping.”

According to Landl, the ban on vape flavors will have disastrous consequences on public health:

“According to Yale School of Public Health, vaping flavored e-cigarettes are associated with a 230 percent increase in the odds of adult smoking cessation,” he said. “If vape flavors were banned, more than 150.000 swedes could be pushed back to smoking, which goes against any public health authority.”

May 27, 2022

Tag: Sweden