By Munyaradzi Blessing Doma
Sweden has become a global reference point for effective tobacco harm reduction, achieving some of the lowest smoking rates while many countries continue to struggle. Their success is largely attributed to a pragmatic approach that encourages smokers to switch from combustible cigarettes to significantly lower-risk alternatives such as snus and regulated nicotine products. Data shows that daily smoking rates have dropped sharply, resulting in notable improvements in public health.
This discussion took centre stage on Day 4 of the Good COP 2.0, held concurrently with the 11th Conference of the Parties (COP) to the World Health Organisation Framework Convention on Tobacco Control (WHO FCTC) in Geneva, Switzerland.
The session, titled ‘Where’s the parade? Why do anti-smoking groups oppose harm reduction?’, was chaired by Reem Ibrahim and featured Kurt Yeo from South Africa, Jeff Smith from the United States, and Bengt Wiberg from Sweden.
Ibrahim said that smoking rates have declined across all age groups, although young people still use nicotine, but through safer alternatives. Wiberg added that Sweden uses roughly the same amount of nicotine as the European Union average,yet has far lower smoking rates because most people use pouches, snus, or vaping products, all of which are legally allowed and intelligently regulated.
He said that Sweden enforces an 18-year age limit, restricts marketing to prevent youth access, uses an e-identification system for online purchases, and requires shopkeepers to request identification from anyone who appears under 25. These measures have contributed to a dramatic fall in daily smoking and improved health outcomes.
Sweden now has the lowest daily smoking prevalence in Europe, at 5.3 percent. Among Swedish-born citizens, it is 4.5 percent. We have already reached the WHO and EU goal of a smoke-free nation for 17 consecutive years,” Wiberg said.
Because fewer people smoke, Sweden records 40 to 45 percent fewer lung and oral cancers than the EU average.
He dismissed claims that using snus, nicotine pouches, or vapes leads to smoking later in life. Government statistics show that daily smoking among 16 to 29-year-olds has dropped by 72 percent over the last decade, while daily use of snus and nicotine pouches has risen by the same margin.
Ibrahim criticised discussions at COP11 for treating all nicotine products as equally harmful. He said that equating the risks of smoking with those of vaping or oral nicotine contradicts scientific evidence. He added that Sweden demonstrates how behaviour and cost influence choices; when safer products are available at similar prices, people naturally switch, resulting in clear health benefits.
Wiberg noted that in 2022, the Swedish Government formally adopted a tobacco harm reduction approach. Taxes on snus were reduced by 20 percent, while taxes on cigarettes
increased by about 11 percent, aligning taxation with relative risk. He said Sweden now has three smoke-free generations, with smoking prevalence among 16 to 44-year-olds well below 5 percent.
Smith said the United States introduced a Tobacco 21 legislation to limit youth access to nicotine products, and most of the progress in reducing youth smoking was due to responsible retailers complying with age restrictions. This has had a positive impact on youth health.
Yeo said South Africa’s last global adult tobacco survey was in 2021, which showed a sharp rise in smoking among people aged 15 to 24, although he questioned some of the data. He said the country has a high smoking prevalence and lacks cessation support. He stressed that discussions should focus on the real crisis, which is the number of people dying from smoking-related diseases, rather than the small percentage of youth using vaping products.
He added that only 11 of the 43 FCTC signatories have conducted a global adult tobacco survey in the last 20 years, yet countries continue to cite figures without clear sources.
