BRUSSELS — It was on the last day of May, a little after 5:00 p.m., when 20 or so men and women filed into a small room inside the European Parliament for a private event and packed into neatly arranged rows of seats. To the side stood tables laden with drinks, ready to be opened for schmoozing after the talk.
After a short introduction from the organizers, three MEPs took to the stage. One of them, Tomislav Sokol of the European People’s Party (EPP) group, was Croatian. But the other two, Sara Skyttedal, also from the EPP, and Johan Nissinen from the European Conservatives and Reformists (ECR) group, were both Swedish.
It was for good reason. The meeting was titled “Recipe for a Smoke-Free Europe: Learnings from the Swedish Experience,” and much of the discussion centered on snus.
Snus is a porous pouch filled with a tobacco mixture that users stuff under their upper lip, where saliva releases the nicotine to be absorbed into the bloodstream through the thin skin of the gums. The hit is strong, immediate, and smoke-free. In 2019, the most recent data available, snus was used daily by 14 percent of adult Swedes.
Sweden is the only EU country where snus is legal. The EU outlawed all oral tobacco in 1992 because of worries that Big Tobacco was developing new products to target teenagers, but snus is so ingrained in Swedish culture that the country asked for a special exemption when it joined the bloc in 1995.
It has been a thorn in Brussels’ side. A decade ago, a commissioner resigned in a snus-related influence scandal, and last year Swedish tabloids sparked outrage with a report that incoming EU rules would result in a tax hike on the tobacco product.
Now snus is back, this time ostensibly as a shining example of the public health advantages of cigarette alternatives.
But its appearance is raising eyebrows in some quarters, coming as the Commission lays the groundwork for a possible re-write of the bloc’s basic tobacco rules. With the EU aiming for a “smoke-free Europe” by 2040, the industry is bracing for harsh new measures.
Clearing the smoke
Sweden isn’t just unique for being the only EU country to sell snus. It also has the lowest smoking rate in Europe.
That’s not a coincidence, argued the speakers at the European Parliament event: Swedes are less likely to smoke because they have an easily available alternative. Instead of cracking down on alternative tobacco products, European governments should embrace them.
Policymakers are divided over the use of cigarette alternatives to fight smoking. There are concerns over both the long-term effects and the risk of getting new users hooked on nicotine and eventually onto smoking. While snus and other alternatives such as vapes do carry health risks, they’re far less harmful than regular cigarettes.
“I think the goal, if we want to fight tobacco-related mortality, is to get people to stop smoking cigarettes, because cigarettes actually kill people,” said Skyttedal at the May event. “I can tell you how we are not achieving this … over-regulating products that have a serious potential to take market share away from cigarettes. Nicotine pouches, Swedish snus and e-cigarettes are examples of this.”
Data from Eurostat shows Sweden’s smoking rates hovering at a little over 6 percent of the population, putting it within touching distance of the EU’s 5 percent target, where a country can declare itself officially smoke-free. That compares to a bloc-wide average of 18 percent. But it’s not clear whether snus is responsible.
An analysis of 73 scientific papers carried out by the Swedish Agency for Health Technology Assessment and Assessment of Social Services found there wasn’t enough data to say whether snus helped people quit smoking or increased smoking rates. However it did find, based on a low level of evidence, some suggestion that snus use could lead to smoking later in life.
Anna Wetterqvist, a press officer for Sweden’s Public Health Agency, said the country’s smoking rate had been falling since the 1980s, while snus consumption remained steady. It’s a finding backed by the report from the Swedish Council for Information on Alcohol and Other Drugs, which found the proportion of snus users was largely stable from 2007 to 2019, compared with a marked decrease in the number smokers. Wetterqvist attributed smoking’s waning popularity to anti-tobacco measures such as indoor smoking bans, ending the sale of flavored cigarettes and bans on advertising.
That hasn’t stopped proponents of snus from pinning Sweden’s remarkable success to its snus-friendly tobacco policy.
One of these is Delon Human, president of Health Diplomats. A controversial figure in the world of tobacco control, Human was secretary general of the World Medical Association between 1998 and 2004. Human is open about the fact that he has taken money from the tobacco industry and describes Health Diplomats as a for-profit organization with a social mission. But he insists that it’s only ever in the service of harm reduction, never to promote smoked tobacco.
He said the Swedes are role models for the rest of Europe. “The key lesson that the Swedes learned was the fundamental difference between combustible tobacco and non-combustible tobacco,” he said.
Snus hits Brussels
The WHO Framework Convention on Tobacco Control makes it difficult for tobacco companies to lobby Brussels directly. It stipulates that governments keep the industry at arms length when making tobacco policy. The Commission’s health department, for example, only meets with the industry when it absolutely has to, and lists all meetings online.
But it can be difficult to know when a group is working on behalf of a cigarette-maker. Tobacco Tactics, a website run by the University of Bath’s Tobacco Control Research Group, describes how the industry often works through intermediaries like think tanks, PR firms, or lobby groups. Lilia Olefir, director of NGO Smoke Free Partnership (SFP), agrees. “It’s a very common tactic to use front groups,” she said.
In May, SFP criticised the Parliament event for promoting the narrative of the tobacco industry and called for it not to go ahead. “Now that the review of major policy files is either ongoing or forthcoming (Tobacco Tax Directive, Tobacco Products Directive, Tobacco Advertising Directive, Council Recommendation on smoke-free environments), the tobacco industry’s attempts to gain access to and influence policymakers have intensified,” it said.
The event was organized by Brussels-based Parliament Magazine and sponsored by We Are Innovation, an organization that describes itself as a “global alliance” to promote innovation. At the meeting, Federico Fernández, CEO of We Are Innovation, said that while part of Sweden’s success was down to implementing public health measures, the secret ingredient was its embrace of alternative products.
“We believe that Sweden found the missing piece in order to fight tobacco consumption,” said Fernández. “Snus was a magnificent invention.”
Contacted by POLITICO, Fernández declined to say whether We Are Innovation accepted tobacco industry money. In an emailed reply, he said the event “was centered around broader aspects of public health innovation, not solely revolving around snus or its related discussions.”
Just one day later — on June 1 — snus was once again the center of a discussion at the European Parliament, this time in the public health subcommittee. The topic was endocrinology and Fredrik Nyström from Linköping University presented a study he ran on the effect of snus on insulin levels and blood sugar. But he didn’t stop there. Nyström also talked up its benefits as a smoking alternative; an intervention that clearly caught lawmakers by surprise. Afterwards, MEP Véronique Trillet-Lenoir said she was “shocked” by what she had heard, describing it as “clearly the promotion of a harmful product.”
Nyström — who had been invited to speak to the committee by the Swedish MEP Skyttedal, according to one of her assistants — told POLITICO he was surprised by the reaction. He was just presenting the science and had shared his slides the day before so they could be vetted. No one had influenced his choice of topic, he said.
In October last year, Nyström presented at an event in the European Parliament called Nicotine and Society: Ahead of the Tobacco Products Directive (TPD3). That meeting, organized by the Brussels Times newspaper and sponsored by Stockholm think tank Environment and Public Health Institute (EPHI), also featured Gavin O’Dowd, chief executive of Haypp Group, an online snus retailer. EPHI didn’t respond to emails from POLITICO asking if it accepted money from the tobacco industry.
For their part, Swedish MEPs have been quick to defend both snus and their contact with industry. When POLITICO wrote about Skyttedal and Nissinen’s meetings with various tobacco manufacturers and industry groups, Charlie Weimers, vice-chair of the ECR group, got in touch to say: “As elected representatives, we must listen to a variety of perspectives and [decide] policy based on evidence. That the Swedish alternative is an option worth exploring should be clear given that WHO soon will classify Sweden as Europe’s first smoke-free country.”
In an interview, Skyttedal told POLITICO she has no qualms about meeting with industry: if she is to create legislation to regulate the sector, she needs to know how it functions.
She also said that by dismissing products such as snus because of links with the tobacco industry, other lawmakers risked doing more harm than good. “We have a situation where legislators are more concerned about appearance than the outcomes and outputs,” she added.
Source: POLITICO
