INVESTIGATION: Who’s behind the anti-nicotine propaganda?

I’ve taken to trolling the Smoke Free Partnership - the flagship anti-nicotine NGO in Brussels - on LinkedIn recently. Mainly for fun, but one recent post of theirs got me thinking.

Their Director, Erin Roman, contributed to a piece calling for far tougher restrictions on safer nicotine products alongside the European Network on Smoking Prevention’s Charis Girvalki. Girvalki, you may remember, authored most of the scientific dossier supporting Palau’s extraordinary bid for a UN classification under the same UN convention that controls drugs like methamphetamine.

The piece is here, but I wouldn’t bother reading it. We do that so you don’t have to. In essence, it argues that Europe should regulate vaping "based on core principles rather than specific products": those principles being, apparently, that anything which competes with cigarettes must be presumed guilty until proven innocent across multiple decades of longitudinal data that nobody yet has, while millions keep smoking and dying.

It wasn’t the report that I found interesting at all: it reads like someone at the temperance movement was let loose with their own wild fantasies and a large language model.

But what was interesting was the small print alerting me to the fact that the report was commissioned and financially supported by pharmaceutical giant Sanofi and drug developer Regeneron. The broader Respiratory Health Initiative is also supported by the two companies. CIFS stresses that it independently conducted the research and retained full editorial independence.

Neither of these companies own nicotine replacement therapies, whose manufacturers have carped for years that vaping should be highly restricted despite selling crappy products that compete for many of the same smokers (I’m looking at you, Kenvue).

So why, then, are they so interested in safer nicotine products?

I don’t know the answer to that, but I can tell you about a few things I found on the internet.

Sanofi - a French pharmaceutical giant - turned over €10.5 billion in the first quarter of this year. Almost 40% of that turnover came from a drug called Dupixent, which was developed by Regeneron. Dupixent is to COPD what Ozempic is to diabetes: an expensive, indefinite injectable that manages a chronic condition rather than curing it.

I’m using Ozempic and it’s done absolute wonders for me, and if such a solution exists for sufferers of COPD that’s a wonderful thing. Imagine spending every moment of your life feeling like you're breathing through a wet blanket: that’s living with COPD. It is a progressive, irreversible lung disease that slowly suffocates you over years, turning the basic act of breathing into an exhausting, never-ending struggle.

Smoking, COPD and safer products.

In high-income countries, like the US and Europe, 70% of COPD cases are caused by smoking, according to WHO figures. Quitting smoking reduces harm: the US Surgeon General says it lowers COPD and cancer risk, while the CDC says it slows COPD progression and lung-function loss in people who already have the disease. After 10 to 15 years, excess lung-cancer risk is roughly half that of someone who continues smoking. But, as we all know, most quit attempts fail.

Although the precise benefit of switching from smoking to vaping remains uncertain, evidence indicates substantially lower risk. A 2022 British government review found that vaping exposes users to significantly lower levels of substances linked to cancer and respiratory disease and, in the short and medium term, poses only a “small fraction” of smoking’s risks. It cautioned that vaping is not risk-free and that its long-term residual risk remains unknown.

There is also some direct evidence in people who already have COPD. In a five-year study led by respiratory physician Riccardo Polosa, COPD patients who quit or substantially reduced smoking by switching to e-cigarettes saw their average annual exacerbations fall from 2.3 to 1.1, alongside improvements in lung function, exercise capacity and quality-of-life measures. The authors concluded that switching to e-cigarettes appeared capable of ameliorating — and potentially reversing some of — the harm caused by continued cigarette smoking: although the study was small, with complete five-year data available for just 39 patients.

Evidence on nicotine pouches points in the same direction. In June 2026, the US FDA authorised 20 ZYN products to claim that smokers who use them instead of cigarettes face lower risks of lung cancer, emphysema and chronic bronchitis, among other diseases. The agency also found that they contain substantially fewer harmful constituents than cigarettes. Nicotine is not harmless, but these findings challenge treating all nicotine products as equivalent to smoking.

Then there’s good old common sense. Because nicotine pouches do not involve inhalation or combustion, there is no obvious mechanistic pathway by which they would directly cause COPD.

If you think Ozempic’s expensive, wait till you hear what Dupixent costs.

The monthly list price for Dupixent is $4,193.03 - that’s over $50,000 per patient per year. That’s in the US, so perhaps in Europe it’ll be 20-30% less. For comparison, the list price for a month's supply of Ozempic in the US is $1,027.51. No wonder Dupixent is doing so well for Sanofi.

Regeneron also has a lung cancer treatment - Libtayo - which is on the market with a list price of $11,703.03 per dose. Dosed once every three weeks, that’s almost $200,000 per year per patient. In phase three trials, the drug gave lung cancer patients an average nine months more time with their families.

A close family member of mine died of the exact kind of cancer Libtayo treats. We’d all have really liked nine more months with her. But a decade before she died I’d been trying to get her onto vapes instead. She resisted, mainly because she thought they were just as bad as smoking, driven by the kind of anti-vape propaganda coming from organisations like SFP. If she’d switched, there’s a decent probability she would still be with us now, five years later.

And Dupexient is about to get a competitor

Another name you see a lot of in the list of businesses funding anti-vape NGOs is AstraZenica: they’ve put money into the European Society for Cardiology and the Dutch Lung Foundation, both of whom take the prohibitionist line on safer nicotine products. Again, AsrtraZenica doesn’t make the nicotine replacement therapies that have failed so miserably to compete with safer nicotine products.

Once again, I can’t tell you why they seem to focus their largesse on anti-nicotine (rather than anti-smoking) organisations. But I can tell you that they’re in the late stages of getting approval for a competitor to Dupexient. Tozorakimab, administered once every four weeks, “demonstrated a reduction in moderate and severe COPD exacerbations in the primary population of former smokers by 29%” according to a company press release from earlier this month.

According to CNBC, the company forecasts peak annual revenue of $5 billion from the new drug when it launches.

Is this a conflict of interest?

I am not here to debate the business model of pharmaceutical companies. Drugs are expensive to develop, test, and get approved by regulators. For companies to keep making them, they need a return on what they spent doing it.

But what does interest me is whether funding relationships of this kind deserve more scrutiny.

Pharmaceutical companies selling treatments for COPD and lung cancer can derive substantial revenues from treating diseases for which smoking is a major cause. Some of those companies also fund organisations or initiatives advocating highly restrictive regulation of alternative nicotine products.

That does not prove that commercial interests determine those organisations’ positions, nor that the companies funding them are attempting to influence those positions. In the case of the Respiratory Health Initiative, CIFS expressly states that it retained full editorial independence.

But where companies derive substantial revenues from treating smoking-related disease, transparency around their funding of organisations involved in debates over alternatives to smoking should surely be at least as rigorous as the scrutiny routinely applied to funding on the tobacco-harm-reduction side of the debate.

That, ultimately, is the point. Funding does not automatically invalidate an argument, and a commercial interest does not prove improper influence. But those principles ought to apply consistently.

People working in tobacco harm reduction are routinely asked who funds them, what commercial interests sit behind their research and advocacy, and whether those relationships could influence their conclusions. Those are legitimate questions.

They are equally legitimate when the money comes from companies selling expensive treatments for diseases caused in large part by smoking.

If safer nicotine products replace smoking, there will be less COPD and less lung cancer to treat.

And if there is less COPD and less lung cancer, then there will be less money to be made for companies with expensive blockbuster drugs designed to treat COPD and lung cancer. You don’t need an advanced degree in economics to be able to work that one out.

The tangled web they weave…

SFP claims to be “transparent regarding our financial income”. It claims that “income sources can be found in the final section of each of SFP's annual reports”.

Problem is, they can’t. The 2025 report has no funding section at all. The 2024 report is a little better, giving broad headlines for categories of income such as “operating grant” and “member contributions”. But there’s nothing on where the money actually originates.

SFP has eight “main partners”, which presumably provide it with its “member contributions” and the members of its board. Who’s funding them? This question led me down quite the rabbit hole.

Charities and foundations set up other charities and foundations and staff their boards ad infinitum until you finally get to the source of the funding. This one requires a diagram.

Bloomberg Philanthropies

ENSP

Smoke Free Partnership financed by either partners:

Respriratory health Institute

It turns out, many of them are financed once again by pharmaceutical companies with either nicotine replacement therapies or products that treat smoking related disease.