A tightly controlled webinar that excluded many consumer voices has mounted a sharp attack on Sweden’s world-leading record on smoking reduction – dismissing the role of safer nicotine products and questioning the science behind harm reduction.
The closed-door forum, Sweden: Setting it Straight, brought together tobacco control campaigners from across Europe and beyond. But multiple consumers say their registration requests were declined, leaving the discussion dominated by critics of non-combustible nicotine.
Those admitted heard repeated claims that Sweden’s dramatic fall in smoking “has nothing to do” with snus, nicotine pouches or vaping.
‘This narrative lacks evidence’
Opening the session, Swedish public health advocate Lisa Lennartsdotter Ermann rejected what she called the “harm reduction narrative”.
“This narrative lacks evidence,” she said, arguing that Sweden’s low smoking rates were driven instead by taxation, advertising bans, smoke-free laws and cessation services.
She pointed to decades of regulation, from workplace smoking bans in the 1990s to smoke-free restaurants in 2005 and outdoor areas in 2019, as the main explanation for falling cigarette use.
But harm reduction advocates argue that this account ignores what makes Sweden unique in Europe – the widespread use of safer oral nicotine products as alternatives to smoking.
Today, daily smoking in Sweden stands at around five per cent – the lowest in the EU – while snus and nicotine pouches are widely used by former smokers.
‘Lack of evidence’ claim questioned
Ermann also claimed there was “a lack of evidence” that snus and vapes help people quit smoking long term, citing Swedish reviews and surveys of 15-year-olds.
She told the audience that users of snus and vapes were “more common to start smoking over time”, and said youth data undermined claims that safer nicotine products reduce smoking.
Harm reduction advocates say this conflates teenage experimentation with adult smoking cessation, and overlooks a substantial international evidence base.
Multiple reviews by public health bodies in the UK, New Zealand and elsewhere have concluded that smoke-free nicotine products are far less harmful than cigarettes and can help smokers quit, particularly when other methods have failed.
Randomised trials have found vaping to be more effective than traditional nicotine replacement therapies, while long-term population data from Sweden shows sustained declines in smoking alongside high uptake of snus.
Critics also note that youth surveys are observational and cannot prove causation.
Industry links take centre stage
Much of the webinar focused on tobacco industry involvement in harm reduction. Karen Evans-Reeves of the University of Bath’s Tobacco Control Research Group warned that major tobacco firms promote the “Swedish experience” simply to protect profits.
“The big four still make most of their huge profits from the sale of cigarettes,” she said, while highlighting their growing investments in nicotine pouches.
She also detailed links between industry-funded groups and campaigns promoting Sweden as a model.
However, harm reduction supporters argue that focusing almost entirely on funding sources avoids engaging with the health impact of smokers switching away from cigarettes.
‘Trojan horse’ and bans praised
During the panel session, opposition to harm reduction became more explicit.
Norwegian adviser Maxime Compaore described the Swedish model as a “Trojan horse”, warning governments not to “open the market for new nicotine products”.
In France, campaigner Amélie Eschenbrenner outlined how her organisation helped secure a ban on nicotine pouches, after laboratory tests reportedly found heavy metals and high nicotine levels in some brands.
Speakers from the Netherlands and Denmark praised tighter regulation, flavour limits and nicotine caps, while Kenyan advocate Celine Awuor said harm reduction arguments were used to resist higher taxes.
Across the panel, restrictions and bans were presented as the preferred policy response.
‘Nicotine epidemic’ among youth
Swedish youth advocate Helen Stjerna said new products had fuelled what she called a “nicotine epidemic” among teenagers. “The sad truth is that nicotine pouches and e-cigarettes have created a nicotine epidemic among Swedish youth,” she said, citing surveys showing high experimentation rates.
She argued that all nicotine products should be regulated and taxed like cigarettes.
Consumer groups say youth protection and adult harm reduction are often treated as the same issue, despite requiring different policy approaches.
Missing voices
One striking feature of the webinar was who was not there.
No former smokers who quit using snus, vapes or nicotine pouches were invited to speak. No independent harm reduction researchers presented evidence on switching and disease reduction.
Instead, participants largely agreed that Sweden’s smoking decline was driven by regulation alone and that safer nicotine products were, at best, irrelevant and, at worst, harmful.
A disputed public health story
For supporters of harm reduction, Sweden remains one of the clearest real-world examples of what happens when smokers are given credible alternatives to cigarettes.
Countries that have embraced similar approaches, including the UK and New Zealand, have also seen rapid declines in smoking. Others relying mainly on bans and taxation have often seen progress stall.
One observer noted after the webinar: “They talked a lot about studies and statistics, but barely mentioned the biggest scientific fact of all: smoking kills, and smoke-free products don’t.”
