Despite decades of high-profile campaigns, far too many people still smoke.Smoking-related cancer rates remain stubbornly high and the millions spent on trying to convince smokers to “stub it out” have yet to deliver the desired outcome.
But there is one notable blueprint for tackling this issue. They call it “the Swedish model” and with good reason: this modest Nordic country has managed what, to others, seems impossible: it has virtually eliminated smoking.
In fact, it is not the only country well on track to secure this commendable achievement. New Zealand and Japan are also well ahead of the curve and set to do the same, while in Europe, the UK and even Greece, with its long-time tradition for having one of the world’s highest rates of cigarette use, are making real inroads into slashing smoking.
But it is in Sweden where the real lessons are to be found.
Sweden’s success
So, what is the secret of its success?
Well, for a clue to this it is necessary to step back in time a few decades. It was in the early 1990’s that Sweden managed to negotiate an opt-out from EU-wide efforts to ban an oral tobacco product, known as snus. Snus is a small, tea bag-like pouch, which is put between a consumer’s gum and upper lip where nicotine and flavours are released.
This exception was granted when Sweden joined the European Union in 1994, in recognition of snus’s cultural significance and public health benefits. It is widely believed that without the opt out, Sweden would never have joined.
Snus, actually used in Sweden for over 200 years, is just one of the alternatives to traditional cigarettes. Snus does contain tobacco, while nicotine pouches and e-cigarettes – other smokeless products now also widely used by Swedes – are tobacco-free. Nicotine pouches are used in a similar way to snus whereas e-cigarettes are battery powered devices that heat e-liquid to produce an inhalable aerosol known as vapour. There are an estimated 690,000 pouch users in Sweden and 2.2 million across Europe.
Fast forward to 2025 and the latest government figures show that only 5.3 percent of Sweden’s adult population smokes. The EU average comes in at a whopping 24 percent.
A large contribution to this can be found in the shift to oral nicotine products such as nicotine pouches and snus, with 18percent of adult Swedes using them on a daily basis.
Why such a yawning difference? Well, consider the scientific facts: nicotine pouches contain significantly less toxicants than cigarettes.
And while snus is only sold in Sweden, nicotine pouches can be found in several other member states.
The evidence seems perfectly clear: when people have viable and affordable alternatives to cigarettes, they take them.
The Swedish experience is delivering irrefutable public health benefits. While tobacco-related disease and deaths across Europe remain relatively steady, Sweden is now a glowing and welcome exception. According to the Global Burden of Disease Study, Sweden has the lowest rate of smoking-related heart disease, lung cancer and even oral cancer.
This, surely, has to be a good thing for both the health of individuals and the huge cost for EU member states in treating smoking-related ill-health.
Tobacco regulation
That is the logic but there is growing concern that some are not on the same wavelength.
One particular fear is that, should the public not be able to access or afford alternatives, they will be driven to purchase from the unregulated black market.
Belgium and The Netherlands offer a case in point, having decided to do the complete opposite of Sweden by banning nicotine pouches and scaling back the availability of e-cigarettes. In an attempt to try and deter smoking, it appears this heavy-handed approach has backfired, instead pushing such habits underground while levels of smoking remain stagnant.
Data from the Dutch product safety board NVWA paints an underwhelming picture of compliance. Over one-fifth of supermarkets, cafés, and bars do not follow new regulations prohibiting them from selling tobacco and nicotine products. At the same time, illegal sellers have shifted their activities online, with the NVWA documenting over 1,800 online breaches in 2025.
In August, Dutch public service broadcaster NPO Radio 1 reported on how illegal Chinese e-cigarettes containing excessive levels of nicotine have flooded the market and are increasingly popular among Dutch youth. These illegal products have even caused hospitalisations, with 14 teenagers being treated in hospitals last year.
EU developments
The EU has set itself an ambitious target of becoming tobacco-free by 2040, defined as a smoking rate of 5 percent or below. But based on current progress, the bloc is way off track with estimates that it will not meet the target until the year 2100 – 60 years late.
To speed things up and reach the target, the Commission is reviewing EU-wide tobacco control policies.
This is where the Swedish, Belgian and Dutch examples, come to the fore. Will the Commission follow the Swedish model of making smokeless products available to smokers? Or will it go about it in the same way as Belgium and the Netherlands and propose stringent measures such as bans?
Central to this is the Commission’s work on the expected update of the Tobacco Products Directive, which regulates tobacco and nicotine products across the EU. While the European Parliament endorsed the role of smokeless products in its reports on the Beating Cancer Plan in 2022 and Non-communicable Diseases in 2023, the Commission seems to be more inclined to follow the heavy-handed approach seen in Belgium and the Netherlands.
For example, the Commission pushed for a flat-out ban on nicotine pouches in EU negotiations leading up to a 2023 World Health Organisation conference dedicated to tobacco control, contrary to the position of most member states.
With renewed negotiations on the very same treaty looming in the autumn, Sweden will surely be more active in seeking to protect its public health success story.
The EU is also coming under fire again for considering higher taxes on tobacco and nicotine alternatives to part-fund its long-term budget or, in EU jargon, “own resources.”
No final decision has been made – and none is likely until 2026 – but the Commission has proposed huge tax hikes on pouches – amounting to a sevenfold increase on what Sweden levies today.
If that happens, the massive inroads made by Sweden in persuading smokers to transition away from cigarettes could be under serious threat. Unsurprisingly, the Swedish government has already voiced its opposition to the proposal.
With Brussels policymakers currently working on revising EU nicotine regulation, the industry and others are now stepping up efforts to shape the conversation around these nicotine alternatives and the science behind them.
The message to Brussels is clear: before creating new laws, don’t ignore the real-world experience of Sweden. Take an honest look at all the evidence and properly consider what consumers are likely to do if the cigarette alternatives they’ve become accustomed to are taken away.
Moving to a smoke-free society
Many of these issues came under the spotlight in the Swedish capital recently, when EU policymakers, industry experts and others gathered in Stockholm for a one-day conference, called “A Better Tomorrow, Today.”
The event, aptly subtitled “What if the key to ending smoking has already been found?”, was organised by BAT and sought to delve into the story behind Sweden’s successful reduction in smoking rates.
One of the keynote speakers, Dr James Murphy, BAT’s director of research and science, said his company’s overall aim is to reduce the health impact of its business by offering adult smokers, who would otherwise continue to smoke, lower-risk smokeless products. This is part of efforts to live the concept of tobacco harm reduction – a public health approach which recognises that if the smoke and toxicants generated from burning tobacco can be removed, adults may still be able to use nicotine, with a fraction of the risk.
Sweden, he said “provides the proof”, with Europe’s lowest rate of smoking and smoking-related disease. Dr Murphy, based in London, drew attention to Omni, a comprehensive ‘manifesto’ on tobacco harm reduction launched by BAT with over 370 pages of evidence, science and proof points about how to effectively reduce smoking.
What the evidence says
The launch of this manifesto was a timely opportunity, he noted, to remind those interested in this debate about the science behind smokeless alternatives.
Public Health England, for example, states that e-cigarettes are some 95percent less harmful to health than traditional cigarettes, while the UK-based Action on Smoking and Health (ASH) says that e-cigarettes are “clearly the safer choice.”
Dr Murphy said, “For me it is all about evidence and what is happening on the ground in somewhere like Sweden, which could be said to be the home of harm reduction. My message is: consider this and then let adults make an informed choice.”
With even the WHO agreeing that nicotine is not the main cause of smoking-related diseases, smokeless products remain the lowest risk products available, said Dr Murphy.
Smokers who switch completely to nicotine pouches are exposed to significantly lower levels of toxicants compared to smoking. Crucially, Murphy added, an estimated 3.5 million premature deaths could be prevented in Europe over the next decade if the Swedish model was successfully applied across the EU.
“This,” he emphasised, “shows the profound health impact these products could have.”
“There is a weight of compelling evidence and you don’t just need to take my word for it. Multiple regulatory authorities have come to the same conclusion”
“Sweden is at the vanguard of such efforts. It is an inspiration and a role model.”
But a range of measures are required to emulate what the Swedes have done, including the right regulation and taxation, public education and product innovation, which is acceptable to adult smokers looking to quit.
Elephant in the room
But both BAT and Dr Murphy are realistic and he admits, “We must also address the elephant in the room here: we have to earn our seat at the table because the biggest challenge to tobacco harm reduction is probably the tobacco industry itself.”
“There is still a big job to be done if we are to make sure smokeless products are available for all adult smokers and I stress here two things: these products are solely for adults and not young people, and we need responsibly manufactured products.”
Misconceptions still prevail and he sought to dispel these.
One myth, he said, is that the industry needs to keep selling cigarettes to maintain a viable business.
“This is not true.”
Another “myth” is that the industry deliberately targets youth with packaging, flavours and advertising.
He emphasised that for BAT, this issue was its “number one focus” and it was working with its trade partners, particularly retailers, to reduce this.
He concluded by saying Sweden had “cornered the market in meeting the objectives” to reduce smoking, and this is the model other countries need to follow.”
Word on the street
Stepping onto the bustling streets of Stockholm, one thing strikes you straight away: hardly anyone is smoking. I last visited the city in the early 1990’s and that was certainly not the case back then.
Another striking impression is the wide availability of pouches, snus, and suchlike in any number of corner shops, supermarkets and other venues. The owner of one, Aymen, whose outlet had some 900 different flavours of smoke-free products on sale, told me: “The market for these things has exploded in recent years in a way you could not imagine. Nowadays, there is hardly any demand for cigarettes.”
It is no coincidence that, while a vast range of smoke-free products are displayed up front and centre in his and many other shops, you have to look rather more closely to find any cigarettes.
Sweden still, of course, has various regulations and controls around smokeless products. The law says that marketing of such devices, for example, has to be “modest” and there is a strictly enforced (over 18 only) age limit on the purchase of smokeless items in shops.
More than 1 billion people still smoke
In the past, smokers did not have much choice. They were pretty much told to either quit smoking or face the prospect of a premature death.
But fast forward to 2025, and there are real and viable alternatives available.
You only need to look to one EU member state for direct evidence of that.
The message from Sweden is crystal clear: A smoke-free society is not just a theory…. it is possible and it is happening here.
Now it is up to others to seek to do the same.
