One approach that was emphasized as essential on March 26 at the 7th expert conference "Tobacco Harm Reduction – Promising Strategies for Smoking Cessation" at the Charité in Berlin was the so-called harm reduction in tobacco use. Internationally renowned addiction researchers specializing in harm reduction focused on Germany’s ambitious goal of reducing the smoking rate to only 5% by 2040. Although this goal still seems distant – according to the latest data from the German Smoking Behavior Survey (DEBRA) as of October 27, 2024, the current moving average is 28.2% – there is now a clear need for new public health strategies.* Could the approach of "quitting through switching" finally gain greater political interest?
*See: https://www.debra-study.info/
Significant economic damage caused by tobacco
Tobacco dependence in Germany requires targeted countermeasures and well-considered strategies to enable a tobacco control policy in which the harm reduction approach can also have a place, said organizer Prof. Dr. Heino Stöver at the start of the conference. In his exact words, he appealed to the new federal government:
"100 billion euros in economic damage, 127,000 deaths, 450,000 hospital admissions – all caused by tobacco. Yet the topic seems to play no role in the coalition negotiations. What we need is an effective tobacco control strategy that includes tobacco harm reduction – and we need it now."
Because a so-called harm reduction approach, when it comes to tobacco, is still not part of a national health strategy in Germany. And this despite the fact that, according to most of the scientists at the conference, sustainable success can be achieved with risk-reduced nicotine alternatives such as nicotine pouches and e-cigarettes.
E-cigarettes as the most effective tool for quitting smoking
Are e-cigarettes really considered one of the most effective tools for smoking cessation? – © Image: AdobeStock
Nicola Lindson from Oxford University certainly seemed to think so. Presenting the latest results from the Cochrane Review on e-cigarettes, she stated that based on current research, e-cigarettes are among the most effective smoking cessation tools. In her opinion, smokers should not be forced to "quit vaping," as this could strongly encourage a return to cigarettes.
Nicotine pouches and snus as key to reducing consumption risks
With a look at Sweden, Karl Fagerström—one of the most renowned tobacco researchers and inventor of the Fagerström Test—also spoke at the conference. According to the tobacco expert:
"Sweden has a similarly high nicotine use rate at 22% as Germany. However, there are hardly any smokers, and the lung cancer rate is therefore the lowest in the entire EU. Risk-reduced nicotine alternatives like nicotine pouches and snus are the key when it comes to reducing consumption-related risks."
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In the fight against smoking-related lung cancer, snus in particular seem to show potential—at least when looking at Sweden, where snus use is widespread, cigarette use is low, and lung cancer rates are significantly lower than in other EU member states. – © Image: AdobeStock |
The reference to Sweden continues to illustrate in current discourse that tobacco cigarettes have immense harm potential — something that could simply be avoided through alternative sources of nicotine. And the fact that Sweden has managed to reduce its smoking rate to nearly 5% in recent years seems largely due to less harmful alternatives such as snus and tobacco-free nicotine pouches.*
* See: https://www.ad-hoc-news.de/unterhaltung/boulevard/stockholm-schweden-hat-mit-5-3-percent-eine-historisch-niedrige/66100804
Vaping in New Zealand helps reduce smoking rates
Although stricter regulations on e-cigarettes have recently been discussed in New Zealand, vaping appears to be having an effect — at least when it comes to lowering the national smoking rate. In fact, the New Zealand government has reported some successes in fighting tobacco use with the help of e-cigarettes.
"Our Ministry of Health launched a comprehensive educational campaign on risk-reduced alternatives to encourage people to try vaping in order to quit smoking. In addition, smokers were offered free vape starter kits. Today, vaping plays a major role in reducing the smoking rate in New Zealand."
said Ben Youdan, Director of ASH (Actions for Smokefree New Zealand), on the topic.
"If you ban a product, it does not mean that it disappears"
Thousands of unnecessary deaths due to failed public health strategies and regulations are one issue — the other is a growing black market for products that pose a risk to young people. As Clive Bates, Director of the consulting firm Counterfactual, emphasized:
"If you ban a product, it does not mean that it disappears, it just means that it is sold by somebody else."
In this context, it would be logical to reconsider the current situation regarding snus in Germany. While this is not a de facto "black market," the term "grey market" might better capture the reality. The lack of national regulations on nicotine pouches, combined with district-specific local sales bans, seems to be fueling this grey market. The call for national regulation — ideally aligned with a unified EU directive — is growing louder.
>> Read more here: Tobacco Directive in the New EU Commission: The Future of Snus and Nicotine Pouches
Does the e-cigarette for smokers endanger our youth?
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E-cigarettes offer smokers an alternative and less harmful form of consumption, which appears to be effective when it comes to quitting smoking. – © Image: AdobeStock |
"When advising older patients who are heavy smokers and have already failed many attempts to quit to switch to e-cigarettes, one is not endangering the youth, as some critics claim. Such criticism simply cannot be substantiated by the available data."
said Prof. Dr. med. Knut Kröger, Head of Angiology at the Helios Clinic in Krefeld. He also criticized the often highly emotional nature of the debate on smoking cessation during the conference. A fact-based approach, which allows for a more nuanced view of the issue, could be more helpful in achieving Germany’s goal of a smoke-free generation by 2040.
Pilot project: free vape starter kits support smoking cessation
In a presentation on a pilot project aimed at educating people in assisted living facilities about how e-cigarettes can help them quit smoking, Stephan Wiedemann, Head of the “Care and Living” division at the Association for Integrative Social and Therapeutic Work, shared fascinating and practice-oriented insights. As part of the project, participants were not only educated on the topic but also provided with free vape starter kits, which significantly increased their chances of success. In a final evaluation, nearly all participants endorsed the offered method for quitting smoking and stated they would recommend it to others. During his talk, Wiedemann also encouraged other institutions to implement similar projects—even though current political support for such initiatives remains limited.
This last point implicitly expresses some criticism and concern. If such a practical example shows how smokers can be supported in quitting with relatively little effort, then funding similar projects could create incentives for facility providers—which in turn could have a positive impact on reducing smoking rates in Germany.
>> Read here how education on nicotine pouches as a cigarette alternative can also lead to practical success.
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According to event organizer Prof. Dr. Heino Stöver, the conference was a complete success and highlighted that Germany still has a lot of catching up to do in the fight against high smoking rates—and that internationally implemented, effective strategies should serve as examples. Specifically, there is a need for education and funding for risk-reduced alternatives, and a regulatory approach based on product harmfulness, said Stöver, who also emphasized:
"It is incomprehensible why I can get tobacco from 400,000 cigarette vending machines around the clock, while far less harmful alternatives like nicotine pouches are only available on the black market due to bans."
While the event was hailed as a "complete success", it was also announced at the end that the conference "Tobacco Harm Reduction – Promising Strategies for Smoking Cessation" will now be held annually in Berlin. Perhaps this will finally draw greater political interest to the "quitting through switching" approach. In any case, there seems to be no shortage of arguments for risk-reduced nicotine alternatives—and even practical successes support a harm reduction strategy for tobacco using nicotine pouches and e-cigarettes.
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