Smoking remains one of the leading preventable causes of cardiovascular disease across Europe. Combustible tobacco dramatically increases the risk of heart attacks, strokes and peripheral vascular disease, primarily through toxic combustion by-products rather than nicotine itself. The European Commission has unveiled its new “Safe Hearts Plan” as a flagship response to the continent’s growing cardiovascular disease burden.
Yet despite its ambitious branding, the strategy is deeply flawed, scientifically outdated and potentially dangerous. Rather than embracing tobacco harm reduction as a proven tool to reduce smoking-related heart disease, the plan frames safer nicotine products as part of the problem. In doing so, the EU risks entrenching smoking, slowing cessation, and undermining its own smoke-free ambitions. In fact, this is precisely what has been happening: EU smoking rates have barely shifted—falling by just one percentage point since 2021.
At this pace, analysts estimate the bloc’s target of reducing smoking prevalence to 5 percent by 2040 would not be met until well into the next century. Against this backdrop, the Commission’s refusal to meaningfully distinguish between cigarettes and lower-risk alternatives appears not only misguided, but reckless.
The evidence the EU insists on ignoring
Decades of independent research show that non-combustible nicotine products—including vapes, heated tobacco, snus and nicotine pouches—pose a fraction of the risk of smoking. Public Health England famously concluded that vaping is at least 95 percent less harmful than cigarettes, a finding echoed by the UK Royal College of Physicians and supported by toxicological and biomarker studies worldwide.
Real-world evidence of course reinforces this science. At the risk of sounding like a broken record, one cannot not mention Sweden, which has long embraced harm reduction through widespread snus use, and is on track to become the world’s first smoke-free nation as a result. Smoking-related cardiovascular deaths in Sweden are among the lowest in the EU. Similar patterns have emerged in the Czech Republic, Greece and Norway, where pragmatic regulation of reduced-risk products has coincided with sharp declines in cigarette consumption.
Michael Landl, Director of the World Vapers’ Alliance, has argued that these examples highlight a fundamental failure in the Commission’s approach. He highlighted that the Safe Hearts Plan fails smokers by ignoring harm reduction entirely and treating vaping and nicotine pouches as gateways to addiction rather than tools to quit smoking. Landl points out that countries like Sweden reversed smoking trends and improved cardiovascular outcomes by encouraging less harmful alternatives, not by attacking them. He described EU the plan as a missed opportunity and warned that unless the upcoming revision of the Tobacco Products Directive makes harm reduction and risk-based regulation its cornerstones, the EU will never achieve a smoke-free future.
Deadly misinformation by (of all people) EU Health Commissioner
Public health experts warn that this kind of messaging can have deadly consequences. When smokers are told—incorrectly—that switching offers no health benefit, many simply continue smoking. Multiple studies have shown that misperceptions about vaping risk are associated with lower quit rates and higher cigarette use. In this context, the Commission’s rhetoric actively undermines smoking cessation efforts.
Várhelyi has defended his position by citing cardiovascular concerns related to nicotine and rising use of novel products among young people. But this argument conflates nicotine exposure with the far greater harms of combustion. While nicotine is not risk-free, its cardiovascular effects are modest compared with the toxic cocktail produced by burning tobacco, more comparable to those of caffeine. Risk-based regulation depends on acknowledging these differences, not erasing them.
Highly problematic WHO influence
The Commission has confirmed that a comprehensive assessment of alternative nicotine products is being prepared for 2026, drawing heavily on World Health Organization material. The same material which has long been criticised for its ideologically rigid stance on harm reduction. Industry representatives and public health researchers alike, have warned that overreliance on WHO-aligned evidence risks producing a skewed analysis that downplays harm reduction and exaggerates uncertainties. Calls for transparent, independent scientific review have so far gone unheeded.
This matters because regulatory outcomes shape behaviour. Excessive restrictions, flavour bans, punitive taxation and misleading public communication all reduce the appeal and accessibility of safer products—pushing smokers back toward cigarettes or into unregulated markets.
A simple, yet overlooked, solution: follow the science
Despite its stated ambition to create a “smoke-free generation,” the EU’s current trajectory suggests it is drifting further from that goal. Survey data indicate progress is slowing, not accelerating, and the refusal to adopt risk-proportionate regulation is increasingly seen as a central cause.
Evidence from multiple jurisdictions shows that bans and blanket restrictions are counterproductive. They do not eliminate demand for nicotine; they simply remove safer options. Illicit trade expands, enforcement costs rise, and combustible tobacco remains dominant—the worst possible outcome for cardiovascular health.
Harm reduction advocates argue that the path forward is clear. Europe needs policies grounded in scientific reality: accurate risk communication, proportionate taxation, strict youth protections paired with adult access, and regulatory frameworks that encourage smokers to move down the risk continuum rather than trapping them at the top.
A recklessly missed opportunity
The Safe Hearts Plan could have marked a turning point—a moment for the EU to align cardiovascular prevention with modern tobacco control science. Instead, it appears to double down on denial. By ignoring decades of evidence and dismissing successful real-world examples, the Commission risks prolonging Europe’s smoking epidemic and the cardiovascular disease it fuels.
Unless EU institutions correct course, engage honestly with independent science, and recognise tobacco harm reduction as a core public health strategy, Europe will continue to miss its targets—while preventable deaths mount. In public health, ideology is not neutral. When evidence is ignored, the consequences are measured in lives.
Leaked WHO Documents Uncover Europe’s New Senseless Nicotine War
