A ridiculous but revealing conference declaration

In the perpetual global contest for the dumbest public health conference declaration, European tobacco control activists are going for gold.

The graphic above summarises the declaration of the European Conference on Tobacco or Health 2026, held in Milan on 20-22 May.

No doubt the conference will have been a lovely, rejuvenating experience for Europe’s top tobacco control activists. But the declaration confirms my theory that large groups of activists are capable only of producing dumb, and embarrassingly simplistic ideas. This declaration is Exhibit A.

Let us take the 10 points of this declaration one by one and apply only mild levels of critical scrutiny to the output from all of the collective brain power that produced this fanciful work.

1. Making cities nicotine-free by default

It is unclear what a nicotine-free city even means. Does it mean that no one should make or sell nicotine products within the perimeter of a city? Or no one should use nicotine? Or no one should possess nicotine? Or is it that the nicotine molecule is no longer welcome?

It matters because it is not the banishment of a molecule; it is a restrictive measure applied to people who live and work in a city. The molecular framing dehumanises the idea, making it seem neat and technocratic, like cleaning water, providing street lights, or connecting to a power grid. But it’s not: it’s a direct intervention on the personal behaviours of about one quarter of the adult population in Europe.

Here’s one version from the Chair’s welcoming address:

…our cities must become more than just places to live — they must be environments that actively promote health, well-being, and sustainability. To achieve this, we must clear our urban spaces of tobacco, nicotine, and all emerging products — from schools and parks to streets and public transport hubs.

If it’s about use, does it apply everywhere, indoors and outdoors? Does it apply to nicotine products that have no emissions, like pouches or smokeless tobacco? Is the outdoor “street” use of a pouch or vape banned? What if someone wants to allow people to vape nicotine on their premises? Will they be committing an offence?

I think it is right and proper to control the use of a product where it presents an environmental hazard to others. That case can be made for indoor smoking. Beyond that, the argument is, at best, tenuous.

Did anyone give any thought to the effect on people who have given up smoking by vaping, heated tobacco or pouch use? Or the 94 million European Union smokers who might be tempted to try? What does this measure feel like to them, and what impression of risk does it convey? For those who switched, it tells them that the greatest health achievement of their life is worthless and unwelcome in this city.

Oh, and what would it achieve? Nothing much. Other than some sort of “tidying up” that appeals to tobacco control activists. It does nothing to address the primary public health problem: adults who have smoked for more than two decades. In fact, it makes life harder for them if they decide they can quit smoking by switching to a safer nicotine product. And they don’t even warrant a mention in the declaration.

This idea - harm reduction - is waved away as a tobacco industry conspiracy in the conference’s welcoming message:

Yet, this vision is threatened by the tobacco industry’s growing narrative of a “smoke-free future.” While this message may appear aligned with public health, it is in fact a strategic illusion. By promoting new nicotine products under the guise of harm reduction, Big Tobacco is rebranding itself as part of the solution, while continuing to fuel addiction and obstruct tobacco control efforts.

This flawed reasoning is common among the tobacco control priesthood. Let me help here by spelling out why it is so morally repugnant.

• The demand for nicotine will persist, even in cities declared “nicotine-free”, whether we approve or not. As with other stimulants like caffeine and alcohol, the demand arises from the psychoactive experience.

• Smoke-free nicotine products are a good idea because they are far less risky than the combustible products that dominate the nicotine market. They are made by many companies, not just tobacco companies.

• A good idea does not become a bad idea just because someone else, even someone you dislike, thinks it is a good idea.

• In this case, some tobacco companies also think it is a good idea, and are, to varying degrees, aligning their business models with migration to lower-risk nicotine products. Moving away from the “merchant of death” business model is a positive development that should not face opposition.

• The bad actors are those who will happily hurt a tobacco user if it means harming a tobacco company. This moral failing applies with additional force when the tobacco company is trying to reduce the risks of nicotine use.

• The bad actors are the architects of this declaration and conference participants who went along with it, and the “nicotine-free society” fantasy on which it is built.

2. Applying the same strict regulations to all products, closing loopholes across tobacco, e-cigarettes, heated and emerging non-therapeutic nicotine products

Why the same strict regulations when the products have radically different risks to both users and bystanders? When products with different risks are regulated differently, that is not a “loophole”; it is an incentive structure. The intention should be to shape the “choice architecture” so that people who intend to use nicotine use it in ways that cause far less damage at the individual and population level.

I agree that all consumer nicotine products (and nicotine analogues) should fall within a coherent regulatory framework. Such a framework should impose the most restrictive measures on the most dangerous products. For the far less dangerous, non-combustible products, the focus must be on consumer protection. As usual, tobacco control activists push undifferentiated strict regulations for safer products that will:

1. favour the incumbent cigarette trade

2. drive illicit trade in unregulated products

3. stimulate workarounds by suppliers and consumers, some of which may be risky, such as DIY mixing and flavour additions

3. Strengthening price and tax policies on all tobacco and non-therapeutic nicotine products to reduce affordability, particularly among youth

It does not “strengthen” a tax system to make it incentivise continued smoking, aggravate poverty, or promote illicit trade. The tobacco tax system should have several aims:

• to collect revenue efficiently

• to incentivise desirable behaviour change (see: IMF, Taxing harmful habits, 2026)

• to communicate and address risk proportionately

• to avoid inflicting punitive regressive burdens on people already experiencing poverty and disadvantage

• to disincentivise the creation of illicit markets and the related criminality.

The subtle balancing of these ideas cannot be captured by the word “strengthening” and is not reflected in the declaration, which implies that higher is always better.

The IMF report mentioned above takes it as a given that there are substantial differences in risk across nicotine products and rightly argues that tax policymakers should exploit the opportunities those differences create.

Graphic on nicotine products relative risk from the IMF report: Taxing harmful habits, 2026)

How could a tax system NOT be responsive to these differences? That should be obvious, but evidently not to the declaration drafters.

Yet failing to address such challenges would cause more harm than good. A good, pro-health tax system that takes account of the objectives above would impose moderately high taxes on cigarettes and other combustibles and low or no additional taxes on non-combustible nicotine products. This economic incentive to switch to less damaging products is important for people who already smoke, but also for people who are likely to take up nicotine use.

4. Protecting nicotine non-users, including children and young people, by reducing exposure, attractiveness and accessibility of all non-therapeutic nicotine products

The primary tobacco-related public health problem is not even mentioned in the declaration. The population at the greatest and most immediate risk is middle-aged adults who still smoke. For them, the option to switch to a safer product has to be simple, appealing, and cost-effective, and be encouraged by clear messaging from respected authorities. The declaration does the opposite of what would work for older smokers.

Young people are unlikely ever to suffer the major tobacco-related disease burdens, as these arise primarily from decades of smoke inhalation. Even young people who smoke today will likely switch to non-combustible nicotine products well before they have smoked for long enough to become seriously ill. They will all have that option, provided tobacco control activists do not obstruct them.

We need to focus on real public health problems: adults who smoke for decades. The declaration obstructs the most viable and rapid options for addressing their risks.

5. Regulating retail through licensing, zoning and limits on points of sale

There are good reasons to license retail vendors and to aim for age-secure and responsible retailing, with fines, sanctions and the possibility of license loss for malpractice. Responsible licensed retailing can only work if legitimate retailers can stock the products adults wish to buy, including a wide range of flavoured vapes, satisfying nicotine pouches, and heated tobacco products. Too many restrictions or prohibitions, and legitimate retailers become irrelevant.

But the arguments for zoning and limiting retail outlets are far less persuasive and mostly based on flawed studies or misinterpretation of geospatial data. These generally treat a higher density of retail outlets as a causal driver of tobacco use. In fact, a higher density is usually a sign of one or more of: an area with higher smoking prevalence (i.e. a poorer area); a place where people converge to buy things (a high street or central business district); smaller convenience retailers, but more of them (a feature of the property market); people more likely to travel on foot or public transport (i.e. urban areas). In this situation, retailers could assist with the migration to safer products, given the right regulatory and economic incentives.

Limiting retail outlets generally places a cost on people - a time penalty for acquisition of products - and is really a form of non-monetary taxation, and likely to fall on people who are already time-poor. The likely effect of such restrictions would be the formation of a secondary market in people selling tobacco and nicotine products, combined with courier services and online ordering, or people buying illicit products. The administrative issue of who can and cannot supply such products would be open to corruption, nepotism and endless disputes.

6. Guaranteeing consistent and adequately resourced enforcement

“Enforcement” is the magic potion beloved by prohibitionists everywhere - and there can never be enough of it. Let us be clear, there are two problems that enforcement aims to address: the first is arresting bad actors who commit crimes, and the second is preventing illicit supply. They are not the same. But they are often confused.

The problem is that the illicit supply is highly adaptable and innovative, and will flow around seizures and arrests like water flowing around rocks. Illicit supply is often chasing huge illegal profits and responds accordingly. If the police seize a container filled with illicit tobacco or vapes, another one will take its place - either supplied by the same criminal network or a different one. If one dodgy shop is shut down, another will open, or a more informal system will take its place. Close a website, another opens. The digital economy facilitates all this: encrypted messaging apps, international payment systems, cryptocurrency, social media for promotion, pop-up websites, the dark web, courier services, containerisation, etc. In the 1990s, we had a few companies, factories, warehouses, shops, and billboards. The ideas that worked then will not work now.

They want more resources for enforcement - but how much do they want, and what is this additional resource aiming to achieve? Is it to stop people switching to safer products, as in Australia? How important is this call on city finances and law enforcement resources compared to other priorities? Australia has put A$345 million (€212 m) into enforcement over two years, 2024-26 (ITEC). But the illicit supply situation has only deteriorated. How much do they think should be spent on police and border force enhancement to sustain their nicotine-free vision, and would they be okay with taking that out of budgets for tobacco control?

The big issue here is that people come to believe that tobacco control restrictions or taxes are unreasonable, disproportionate, or insane. Once that happens, self-imposed compliance declines, enforcement is impossible, and the system falls into disrepute. This disillusionment also applies to law enforcement personnel - many will be nicotine users - who resent upholding unjust or unreasonable laws.

7. Integrating tobacco and nicotine control into urban environmental and sustainability policies

I do not really know what this means. It sounds like empty words designed to nominally link disparate interest groups. Yet they are qualitatively very different kinds of problems.

Tobacco control is primarily about modifying personal behaviours to reduce personal and bystander risks, partly by controlling corporate marketing and commercial activity.

Urban environmental sustainability policy is primarily about integrating systems functions over decades (for example, transport, energy, water and wastewater, spatial planning, flood risk management, waste management, public realm, ecology and heritage).

8. Investing in accessible cessation, primary and secondary prevention services

The eighth point is a seemingly innocuous statement; who could not want more and better services? But what sits behind it is a weird and dangerous controlling reflex. Investing in (i.e., spending on) quitting smoking or not starting must be done only in ways that a tobacco control conference deems acceptable.

That generally means the way it has always been done: counselling, meds, NRT, and campaigns with captive audiences in schools.

They are not asking for an all-out effort to reduce smoking by whatever method works. While most in tobacco control will agree that the priority is to quit smoking, many are unwilling to place a sufficiently high value on the lives of others to accept that it might be best done, at least for some, by switching to low-risk nicotine alternatives. They are unwilling to countenance this sort of quitting because they don’t like the idea of tobacco or nicotine companies making money. The declaration is a covert effort to reinforce the “quit or die” proposition. To me, it looks like they are putting their own preoccupations ahead of other people’s lives.

If a person who smokes wants to do it in a way that they like or works for them (switching to a vape or heated tobacco product), then they should be encouraged to do so. What is the ethical standing of people who want to discourage smoking cessation, using the other parts of the declaration: nicotine-free cities, strong regulation, high tax, reduced retailing, and heavy policing - but then offer only the moderately effective smoking cessation services deemed acceptable by tobacco control activists?

9. Protecting policies and research from industry interference

Well, I agree that no interest group should be able to engage in abusive or deceitful practices, and that policymakers should generally be sceptical of commercial interests. And they are. But there are two problems with declaration point 9.

First, “protecting policies” does not mean excluding the views and interests of people or organisations that might differ from your own or that you have incorrectly determined to be irreconcilable with public health. That is the way to make weak policies that fail on contact with reality. In fact, the industries involved often have insights that are not known to tobacco control activists. Increasingly, they develop and validate products that are much less harmful than the market norm, cigarettes, and hold extensive consumer insights. The companies involved conduct rigorous scientific work to support regulatory compliance, product stewardship, and liability mitigation. They generally know how consumer markets function, as that is their main job. If you are a policymaker and cannot trust yourself to hear their views and assess their insights objectively, then you are simply not up to the job. Only in tobacco control do policymakers somehow think that ignorance is a strength.

Second, how about some self-awareness? The quality of supposedly independent science coming from tobacco control and public health academia is extremely poor. Take the Welcome from the ECToH 2026 Scientific Committee, a statement of bold assertions and grand sentiments. Yet, it was edited sometime between January and May this year.

Yet, progress in tobacco control remains too slow. Inaction — or insufficient action — in the face of such clear harm is no longer acceptable. [Final version, viewed 20 May 2026]

However, earlier versions of the scientific committee statement contained a very unscientific assertion (see italics below) with a particularly egregious falsehood (bold italics) embedded in it.

Yet, progress is too slow. The inaction — or insufficient action — in the face of such clear harm is no longer acceptable, especially when new nicotine and tobacco products continue to emerge, aggressively marketed and misleadingly positioned as safer alternatives. [Original version, emphasis added - archived 22 June 2025 to 17 January 2026]

The problem here is that it is deeply misleading to pretend that smoke-free products are not safer alternatives. They are safer, much safer, and it is misleading to claim otherwise. No tobacco or nicotine company would, in my estimation, publish a blatant falsehood of this magnitude, yet it is common for tobacco control activists to mislead policymakers in this way. So, who should be trusted? Then let’s throw in the financial interests of the organisations listed as supporters of the conference.

Do any of these have vested interests or prior policy positions funded by unaccountable foundations and based on no evidence? Indeed, they do.

10. Advocating for the inclusion of strong, evidence-based measures in the revised European Union tobacco-related directives

They think that “strong” measures are good measures by default. But they are not good. They reflect a tobacco control playbook that uses coercive, punitive and stigmatising measures. That approach has, in my view, reached its acceptable limits [See Lund and Saebo, 2025, for more on this]. In the context of the European Union, “strong” mostly means treating smoke-free products as harshly as possible and at least as harshly as the products that do all the harm. That means banning vape, HTP, and pouch flavours, possibly a full prohibition of pouches, reducing permissible nicotine levels, mandating plain packaging, stopping nearly all marketing, and banning internet sales. It’s a recipe for protecting the incumbent cigarette trade and nurturing organised crime groups.

Yet, you can almost feel the tumescent excitement in this declaration as these public health warriors contemplate the state-sponsored bullying of an often voiceless and disadvantaged population: for their own pitiful good. That nicotine-using population would be around one in four European Union adults who use nicotine (about 100 million people), being tormented by a few hundred cynical bureaucrats, grandstanding politicians, and weirdos in NGOs who have no interest in their welfare and no idea how to help them.

Conclusion

These conferences would be better for public health if they were not a bubble of complacent groupthink in which the ideas floated in this declaration could pass unchallenged. But the participants do not want to experience the discomfort of facing challenges or of rethinking the field they have worked in and prospered from for years. The conference organisers do not want to sell it to them, and the sponsors would flee.

So be under no illusion: conferences like this serve to reassure the participants and coach them with new narratives to cope as the world changes around them. They do nothing for real-world public health.