Paris’ plans to ban nicotine pouches do not add value to public health

Banning nicotine pouches in France looks like another counterproductive measure that mainly encourages the illegal trade of cigarettes and other smokeless tobacco products. For fresh ideas, we should look to the Swedish harm-reduction model, which has a real added value for public health, and the country is on the brink of achieving its smoke-free target.

France plans to ban nicotine pouches that have gained popularity among consumers and are considered an alternative for those wishing to stop smoking. “They are dangerous products because they contain high doses of nicotine,” Health Minister Geneviève Darrieussecq told Le Parisien, adding that the ban will be announced later this year.

However, France has a long-term problem with cigarette consumption. 15 million people smoke in the country, one of the highest prevalences in Europe. About 30% of the adult population smokes.

Despite strong regulations such as multiplication of no-smoking areas, plain packs, dedicated monopoly with the tobacconists and high prices fuelled by strong excise tax (about 83% of the price), smoking remains a daily habit for 12 million adults according to Santé Publique France, the national public health agency. The same source states that a vast number of these smokers come from the lower income tercile of the general population.

As the cigarettes become unaffordable, smokers turn to the parallel (illicit) market which amounts 43% of the total consumption. The price of cigarettes becoming a barrier, the customs observe that the volume of legal sales of cigarettes at the tobacconists is decreasing from one year to another: -5% in 2022, -8% in 2023, -12% in the first half of 2024, so it is accelerating. Yet, at the same time, the number of smokers remain the same which confirms the data of a KPMG report on illicit trade of cigarettes published in September this year. According to the report he parallel market is increasing every year. In 2023, it is estimated to be of 43% of all cigarettes consumed.

This creates a dual problem:

–             Smokers do not quit smoking but hey quit the legal network in the search of more affordable cigarettes – sometimes twice less expensive than the legal network – which does not incite them to reduce their consumption.

–             There is an insufficient collection of taxes by the government. It is estimated that Paris lost a revenue of 7,26 billion euros in 2023 . In this case, the hole in the budget has to be compensated by the broad population of taxpayers.

France has become the largest market for illicit cigarettes in the EU, both damaging revenue from taxation and posing a risk to national security. Illicit products are easily accessible. Around half are bought from street sellers, frequently gathered around metro stations in Paris and other cities, while the remainder are available online via social networks with a heightened risk of attracting a youth population.

In an interview with William Stewart earlier this year, the President of the polling organisation Povaddo – which made a pan-European survey exploring attitudes regarding the role of smoke-free alternatives – described France as a country that seems to have lost sight of its tobacco policy objectives, as ministers “continue to implement higher taxes time after time after time”, presumably both to raise revenue and to reduce smoking rates. “They’re achieving neither of those. Smoking rates aren’t declining and because the illicit market is getting larger, they are really not reaping any benefit of higher tax revenue.”

The problem, William Steward reiterated, is that political leaders’ thinking has not caught up. “They’re stuck two decades in the past, thinking that being anti-tobacco is going to score them political points. The reality is that the public is rather open-minded to the need of some sort of other approach to tobacco policy.”

Banning nicotine pouches will lead to the same situation of illicit trade of those products with dangerous implications for public health. Regulated alternative products from recognised producers is the only viable way of both achieving the health benefits of reduced cigarette smoking and tackling the illicit trade.

As the French model does not work, it may be time to look to Sweden for inspiration. Sweden has gone further than most to stamp out cigarettes and says this resulted in a range of health benefits, including a relatively low rate of lung cancer.

Some experts give credit to decades of anti-smoking campaigns and legislation, while others point to the prevalence of snus, a smokeless tobacco product that is banned elsewhere in the EU but is sold in Sweden as an alternative to cigarettes.

Sweden is on track to become the first smoke-free country to reach a smoking prevalence under 5% . It is the example of a country where consumers have access to acceptable alternatives to cigarettes, mainly snus and nicotine pouches, and where the harm reduction principle guides the public health policy against cigarettes.

When witnessing that France, a country with about five to six times the smoking prevalence, plans to ban nicotine pouches, the comments from Swedish politicians and doctors oscillate between astonishment and despair for the French people.

In a an interview at the Sveriges Radio,Tomas Tobé, Swedish MEP (PPE) said that, “We have managed to reduce tobacco-related smoking in Sweden and as long as we have the idea that adults can use nicotine products themselves, nicotine pouches is a much better alternative.”

Anders Milton, former chairman and CEO of the Swedish Medical Association and chairman of the Swedish Snus Commission declared at the TT NyhetsByran newsagency that, “We know that smoking kills people and half of those who smoke die from it. In Sweden, we are below the average in the European Union when it comes to lung cancer, and it is not because we do not use tobacco in Sweden, it is about 23 – 24% of Swedes who use tobacco but snus is more dominant. Unfortunately, this is not something the French bothered to listen to.”

The current tobacco control policy in France – relying profoundly on taxation, smoking bans and product regulations – has produced only incremental reductions in smoking. This outdated tobacco policy is failing and costing lives. Sweden is on the brink of achieving its smoke-free target an impressive 16 years ahead of the EU’s goal. The key to its success lies in making safer nicotine alternatives which are accessible, acceptable and affordable. The widespread availability of other options such as snus, nicotine pouches and vapes has driven smoking rates down to near smoke-free levels.

Photo by Prakriti Khajuria on Unsplash

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