9th Summit Wrap-up: Science, proportionality & evidence-informed policy at the centre of the tobacco-control debate

Opening the Summit, Professor Ignatios Ikonomidis, President of SCOHRE and of the Organising Committee, stressed that prevention and smoking cessation remain fundamental public-health priorities, while harm reduction should be considered as an additional approach for people who continue to smoke and assessed on the basis of scientific evidence. His central message set the tone for the three days: harm reduction should neither be accepted uncritically nor rejected on ideological grounds; the objective should be to translate evidence into measurable public-health outcomes.

Protecting youth without losing sight of adult smokers

The challenge of youth uptake was at the centre of the Summit from its opening session. Professors Ray Niaura and Brad Rodu, together with David T. Sweanor, examined long-term US data on cigarette smoking, vaping and broader risk behaviours among young people at a panel discussion titled “Navigating Public Health Priorities: Youth Protection and Effective Regulation.“

The data presented showed historically low levels of youth cigarette smoking, while vaping rose and subsequently declined after its 2019 peak. The panel cautioned against interpreting individual nicotine-product trends in isolation and stressed the need to examine youth behaviour in a wider context, alongside alcohol and drug use, mental health, sleep, social-media use and other behavioural changes. At the same time, participants agreed that youth protection must remain a core objective, including age restrictions, product oversight, enforcement and better information.

The discussion repeatedly returned to a difficult public-health balance: how to prevent a new generation from initiating nicotine use without limiting potentially lower-risk options for adult smokers who would otherwise continue smoking combustible cigarettes.

This distinction was also central to the keynote speech by Professor Neal Benowitz, who examined the pharmacology, benefits and risks of nicotine. He emphasised that nicotine is addictive and that use by young people and during pregnancy raises particular concerns, while also describing a continuum of risk between combustible cigarettes and non-combustible nicotine products. His presentation reinforced one of the Summit’s recurring themes: products should not be described as harmless, but neither should products with different characteristics automatically be assumed to carry identical risks.

Regulation, prohibition and the unintended consequences of policy

Experiences from Asia showed how different countries are responding to the same public-health challenge. The session “Tobacco Control in Asia: Taking Lessons from Regulation to Prohibition” examined approaches ranging from regulated access in countries such as Malaysia and the Philippines to prohibition-based models. Speakers argued that international evidence needs to be interpreted alongside local behaviour, market conditions, enforcement capacity and access to cessation support. They also highlighted a recurrent risk: where consumer demand remains but legal access is removed, grey and illicit markets may emerge or expand.

That question became the focus of one of the Summit’s major policy discussions, “The Illicit Trade Challenge: New Evidence, Regulatory Pressures and Policy Implications.”

David Bird presented data indicating that, although overall cigarette consumption in Europe is declining, illicit cigarette consumption has increased, with illicit products accounting for around 11% of cigarettes consumed in Europe in 2025 and an estimated €22 billion in lost tax revenue. He also described increasingly sophisticated criminal supply chains using online sales and new technologies.

Professor Panagiotis Liargovas argued that taxation remains an important public-health tool but should be designed together with anti-illicit-trade policy. He proposed three principles —calibration, differentiation and enforcement— warning that large changes in the relative price of legal and illegal products may have unintended consequences. As he put it, “Tax policy and anti-illicit trade policy should not be designed in separate rooms.”

Comparisons between New Zealand and Australia further illustrated the potential interaction between restrictive regulation and illegal markets. Marewa Glover reported sharply different outcomes for vaping under the two systems, including very high illicit-market penetration in Australia, where legal access to vaping is highly restricted.

Europe faces a critical evidence-to-policy test

European policy developments provided an immediate backdrop to the Summit. As a brief reminder of the recent events:

• On 16 September, the European Parliament adopted its resolution on an EU cardiovascular diseases strategy by an overwhelming majority. The final debate around the cardiovascular strategy recognised that nicotine products differ in nicotine levels, delivery mechanisms and potentially in their risk profiles — an important development in the debate over whether regulatory responses should reflect such differences.
• Less than two weeks later, on 28 September, Parliament’s Committee on Public Health (SANT) held its vote on the implementation report on Europe’s Beating Cancer Plan, where stronger measures concerning tobacco and nicotine products formed part of the debate. Europe’s Beating Cancer Plan aims for a “tobacco-free generation” by 2040, defined as tobacco use below 5%.

The proximity of the two parliamentary files highlighted a question repeatedly raised during the Summit: How can European health policy reconcile strong prevention and youth-protection objectives with emerging evidence that different nicotine products may have different risk profiles?

Participants in the illicit-trade session specifically discussed the apparent tension between the recent cardiovascular approach and proposals being considered in the cancer-policy debate, arguing that the same regulatory or fiscal treatment may not necessarily be appropriate across products with different risk profiles.

82,000 voices: what does public consultation tell Europe?

The question of evidence-informed regulation was examined directly by Federico Fernández, CEO at We Are Innovation, who presented an AI-assisted analysis of the European Commission’s recent call for evidence on tobacco legislation at his speech titled “Evidence-Informed Regulation: Integrating Science and Public Consultation into European Policy.”

According to Fernández, We Are Innovation analysed approximately 82,000 submissions from 138 countries, removing duplicates, sampling submissions by stakeholder group and reviewing academic submissions and attachments. He reported that 91% of the submissions analysed raised at least one strong objection to the direction under consideration, while also noting that some critical submissions —including from medical organisations— called for tighter rather than lighter regulation.

Fernández argued that evidence-informed regulation should draw on four elements: science, real-world data, public consultation and proportionality. His recommendations included regulating according to relative risk, assessing impacts on innovation, employment and economic activity, anticipating illicit-market effects and applying the EU’s own Better Regulation standards consistently.

What is the cost of ignoring evidence?

The final day widened the debate from individual products and regulations to the broader consequences of preventable harm. In the session “What Are We Losing? The Health and Economic Price of Ignoring Scientific Evidence,” Professor Andrzej Fal argued that the burden of non-communicable diseases must be understood not only in terms of mortality and morbidity, but also through healthcare expenditure, lost productivity and pressure on public finances. He cited estimates of around €500 billion in direct annual costs from major NCDs in the EU, with more than another €500 billion lost through reduced productivity, while stressing that a substantial part of this burden is preventable.

Using Poland as a case study, Prof. Fal challenged the assumption that revenues from tobacco taxation compensate for the health and economic burden created by smoking. He also argued that prevention must be treated as a long-term investment rather than short-term expenditure and called for prevention, youth education and adult harm reduction to form part of an integrated policy response.

Professor Witold Orłowski reinforced the economic argument, estimating the cost of smoking in Poland at around 2.5–3% of GDP, with indirect productivity losses accounting for the largest share. He stressed that these costs substantially exceed tobacco-tax revenues and ultimately translate into pressure on public finances and slower economic growth.

The discussion returned to recent developments in Brussels. Asked about the different approaches reflected in the European Parliament’s cardiovascular disease strategy and the Beating Cancer Plan debate, Prof. Fal argued that Europe still lacks a sufficiently coherent health-policy approach across policy areas. His conclusion was straightforward: act on what is known, and where uncertainty remains, fund the research needed to resolve it.

Evidence alone is not enough: rebuilding trust around risk

In a closing keynote, risk-communication expert Peter M. Sandman approached the tobacco harm-reduction debate from a different angle: why does evidence sometimes fail to change perceptions?

Sandman distinguished between hazard —the actual level of risk— and outrage — the emotional response to that risk. He argued that public perceptions of non-combustible nicotine products are influenced not only by scientific evidence but also by decades of distrust and moral anger toward the tobacco industry. Simply correcting risk estimates, he suggested, is unlikely to succeed unless legitimate reasons for distrust are addressed.

He proposed deliberately demanding recommendations: acknowledge past misconduct, openly recognise present concerns including addiction, youth uptake, dual use and remaining safety uncertainties, accept regulation and external scrutiny, preregister research, make data available and engage critics in jointly designed studies. His proposed principle was simple: “track us, don’t trust us.”