A debate is underway in Europe and elsewhere about the place of safer nicotine alternatives in reducing smoking-related disease. At the heart of that debate is the misinformation about the comparative harms of smoke-free nicotine products. A coalition of approximately 30 scientists and public health experts from universities and research institutes across Europe recently cautioned that misleading assertions about these products could undermine public health efforts.
In an open letter to the President of the European Commission, Ursula von der Leyen, they slammed comments by the EU Health Commissioner Olivér Várhelyi, who has claimed that vapes, nicotine pouches and heated tobacco products are as harmful as smoking. Such claims lack scientific evidence and would have serious implications for the future of nicotine regulation in Europe.
What science has shown
The primary focus of the experts’ letter is whether a product is combustible or non-combustible. When tobacco burns, it releases smoke with around 7,000 known chemical compounds that have at least 158 toxic or carcinogenic components. Smoke-free alternatives operate differently. E-cigarettes, nicotine pouches and heated-tobacco products avoid combustion entirely, significantly reducing exposure to toxic compounds.
Research indicates that vapour contains more than 100 chemical compounds, including some carcinogens also present in cigarette smoke, but at much lower concentrations. This difference is widely recognised in tobacco harm reduction studies. Although these products are not without risk, several studies have shown that they expose users to much lower levels of harmful chemicals than traditional cigarettes. For adults struggling to
Summarising the issue on which he and other experts supporting this letter rely, Irish addiction specialist Dr Garrett McGovern states that there is no scientific justification for stating that smokeless nicotine products have similar risks to smoking. On the contrary, claiming that smoke-free nicotine products are equally harmful to cigarettes isn’t just a matter of interpretation — it’s a blatant misrepresentation of the evidence.
The dangers of spreading misinformation
If policymakers believe that the risks for all nicotine products are quantitative but identical, regulations may not appropriately align with the meaningful differences between combustible and smoke-free alternatives. And if the public buys into it, there will be little resistance to policies that fail to differentiate between combustible and non-combustible products.
The deteriorating state of public perception
More importantly, misinformation about nicotine products can, of course, affect behaviour. A recent study published in the journal Nicotine & Tobacco Research by scientists from UT Southwestern Medical Centre showed that a record number of Americans mistakenly think e-cigarettes are more harmful than regular cigarettes.
The researchers analysed data from 20,771 respondents to the nationally representative Health Information National Trends Survey (HINTS) administered from 2012-2022. The results show an unfortunate change in public perceptions. In 2012, only about 3 per cent of adults thought vapes were more harmful than cigarettes. By 2022, that figure had risen to more than 30 per cent. Moreover, the share of respondents who accurately regarded e-cigarettes as less harmful than smoking dropped from around 51 per cent to approximately 17 per cent.
Co-leader of the study, Dr David Gerber, Professor of Internal Medicine and Public Health at UT Southwestern, noted that these perceptions have real-world consequences. The research team noted that thinking vaping is nearly as harmful — or even more so — than smoking can deter smokers from switching to potentially lower-risk options. In some instances, it might even promote a return to combustible cigarettes for former vapers.
The importance of accurate risk communication
The study indicates that several key events helped change perceptions of risk. Public awareness campaigns like the U.S. Food and Drug Administration’s “The Real Cost” youth anti-vaping campaign, as well as the 2019 outbreak of EVALI (vaping-associated lung injury), also seem to have had a significant influence on how people view e-cigarettes. While EVALI was eventually attributed mainly to illicit THC vaping products used with vitamin E acetate rather than regulated nicotine e-cigarettes, that distinction often got lost in public communication.
Understanding how these kinds of events shape people’s beliefs is critical for designing good public health strategies, said lead author Alexander Wu. The trick, researchers say, is balancing discouraging youth nicotine use while also giving accurate risk information to adult smokers.
Unacceptable reporting
The European researchers caution that misinformation could have serious implications for policymaking. Costing the lives of around 700,000 people a year in the EU, smoking is still the leading preventable cause of death in Europe. Inaccurate risk messaging that discourages smokers from switching to less harmful products risks losing opportunities to reduce that toll. Additionally, heavy restrictions or taxes on safer alternatives, comparable to those for cigarettes, tend to force consumers back to the black market or back to combustible tobacco.
EU institutions can’t have it both ways: they either back policies based on accurate risk assessments and the accompanying regulatory frameworks, or allow misinformation to shape deceptive regulations. With a new version of the Tobacco Products Directive promised by late 2026, that choice could quickly shape European tobacco control. For public health advocates who work to reduce the harm related to smoking, the stakes couldn’t be any higher.
