European policymakers’ attention has understandably been monopolised by the coronavirus crisis. Brussels is nevertheless trying to keep its finger on the myriad other issues affecting the bloc. On March 24th, for example, ministers cheered the green light given to accession talks with Albania and North Macedonia as an encouraging sign that the European institutions are still able to move forward on important policy matters during the pandemic.

This holds true even in the public health sector. From February 19th to 22nd, the 8th European Conference on Tobacco and Health (ECToH) took place in Berlin. The event gathered European anti-tobacco associations, health professionals as well as representatives from the European Commission and pharmaceutical laboratories under the umbrella of the European Cancer League, led by famous anti-tobacco czar Luk Joossens.

This collection of allies in the fight against tobacco use—the most significant cause of premature death in the EU—used the occasion to launch a new Tobacco Control Scale which quantifies the tobacco control efforts of some 36 European countries.

The ranking system features the addition of a new criteria by which European tobacco control policies are judged: their efforts to tackle the illicit tobacco trade, which costs the EU some €10 billion a year and undermines its public health initiatives.

While many European countries scored points in this category thanks to their ratification of the WHO Protocol to Eliminate Illicit Trade in Tobacco Products, they fell short in other areas. For example, none received credit for having implemented a system to track and trace tobacco products which follows the guidelines set out in the WHO Protocol. The EU’s track-and-trace system is thus not considered compliant with international public health regulation, a situation which spurred MEPs to prepare a modification of the Tobacco Products Directive.

Abiding by public health priorities or industrial interests?

The principal flaw in the European bloc’s track-and-trace system is that it’s not adequately safeguarded against the tobacco industry’s perpetual attempts to influence public policy.

Europe has more broadly failed to shield its public health decision-making from Big Tobacco’s attempts to promote its own interests. ECToH host country Germany’s long history of tight ties to the tobacco industry partly explains its position at the very bottom of the European Tobacco Control scale.

Though the conference was held in Berlin, where the tobacco industry still looms large—one public health expert dubbed Germany a “developing country” when it comes to tobacco regulation—NGO representatives in attendance widely criticized the lag with which Germany is applying effective tobacco control policies. Some of Berlin’s missteps were singled out for particular criticism; stunningly, Germany is the only country in the EU which still allows tobacco advertising on billboards and in cinemas.

The consistent delays with which Germany has implemented tobacco control measures—it was also one of the last EU countries to adopt a smoking ban in restaurants—have made it clear that European Commission president Ursula Von der Leyen’s native country is far from spearheading action on Europe’s leading public health concerns.

Tobacco spies in disguise

The lengths to which the tobacco industry is willing to go to subvert Europe’s public health agenda were on full display at the recent gathering in Berlin. Indeed, the conference’s organiser interrupted presentations from NGO representatives to denounce the presence of envoys from the tobacco industry in the plenary room. These industry representatives had apparently managed to get inside the conference venue under the umbrella of the so-called Foundation for a Smoke Free World.

The name of this organisation is carefully crafted in order to make it sound like an anti-tobacco crusader. In reality, however, the Foundation for a Smoke Free World has been unmasked as a front group for tobacco industry giant Philip Morris. The foundation, which the WHO has warned governments not to partner with, seeks to influence regulation in the tobacco industry’s interest. It focuses on two main objectives: gathering intelligence on tobacco control efforts and building a market for new tobacco products, such as electronic cigarettes and heated tobacco devices.

The Foundation for a Smoke Free World contests the accusations.

The alignment of new tobacco products’ regulation to traditional ones

The global tobacco industry was counting on these next-generation products, such as Philip Morris’s IQOS or British American Tobacco’s Glo, to expand the pool of nicotine consumers as public health initiatives are finally bearing fruit in the form of falling smoking rates. European authorities had initially seemed receptive to the industry’s arguments. Public Health England even rolled out campaigns—newly revealed to have been produced in conjunction with a lobby group associated with Philip Morris—arguing that vaping was “95% less harmful than smoking”.

Following a spate of serious vaping-associated lung injuries, which began in the United States in summer 2019, however, the public health community has increasingly become convinced that these novel tobacco products require serious handling.

The WHO has warned that these products increase the risk of heart and lung conditions, and has recommended that they be regulated in the same way as traditional cigarettes. Doing so would bear important consequences in terms of how these products are taxed, what sort of health warnings they should display, and how they are tracked and traced throughout their supply chains. Whether the EU will follow through on ratcheting up oversight on e-cigarettes remains to be seen. The bloc’s stumbles on measures such as track-and-trace, in any event, suggest a bumpy road ahead.

The way forward after Berlin?

The recent ECToH conference closed its doors with the unanimous adoption of a declaration setting the stage for the future of European anti-tobacco policy. Delegates notably committed to align all new regulation of tobacco products (electronic cigarettes as well as heated tobacco) with regulations on traditional tobacco products, with explicit references to excise taxes, health warnings, and advertising restrictions.

Amidst the spread of the coronavirus pandemic and early data indicating that both tobacco smoke (from traditional or heated tobacco productions) and e-cigarettes makes people more likely to suffer severe complications from COVID-19, the urgency for such reinforced oversight couldn’t be clearer.