Tobacco endgame goals and measures in Europe

Very low nicotine content (VLNC, denicotinization) regulations aim to make products non-addictive or less addictive. The VLNC policy for cigarettes is among the most studied tobacco endgame policies.  Evidence suggests positive effects on reduction in cigarette smoking, smoking prevalence and related harm, potential benefits in vulnerable groups, and public support. In Europe, no countries have yet adopted VLNC policies. In the EU, the Tobacco Products Directive regulates nicotine levels and could potentially move towards VLNC regulation.

Product standards that regulate the pH-level (which influences inhalation and nicotine absorption) and prohibit flavours (which influence inhalation, nicotine absorption, toxicity and increase attractiveness) aim to make products unappealing or to remove the most toxic products from the market. The guidelines for the implementation of Articles 9 and 10 of the WHO FCTC state that from the perspective of public health, there is no justification for using ingredients that increase attractiveness, such as flavouring agents.

There is evidence of public support for the policy for flavor bans (such as banning menthol). In the EU, the Tobacco Products Directive (TPD) and the delegated directive 2022/2100 prohibit characterizing flavours, including menthol, in cigarettes, roll-your-own, and heated tobacco products. At least Belgium, Finland, Germany, Hungary and the Netherlands have also prohibited menthol completely in combustibles as an additive that facilitates inhalation. Some countries have also prohibited most or all other than tobacco flavours in electronic cigarettes.

This measure aims to protect future generations by prohibiting sales by year born, instead of maintaining an age-of-sales regulation. In Europe, the United Kingdom first adopted this in 2023, and it will become an offence to sell tobacco products to anyone born on or after 1 January 2009. In Norway, the national strategy from 2023 includes a goal that children born since 2010 do not use tobacco and nicotine products, but no regulation has yet been adopted.

If combined with policies of denicotinization and substantial retail outlet reduction, this policy could have major impacts on reducing inequities in health. It is rare to initiate the use after 20 years of age, so even a single increase in the age limit may also have a substantial impact in the European context, where most countries have an age limit of 18. Ireland has decided in 2024 to introduce an age limit of 21 for tobacco sales, and Latvia an age limit of 20 for tobacco and related products (including e-cigarettes and tobacco substitutes such as nicotine pouches).

Restrictions aim to substantially reduce availability through regulations that limit the number, type, or location of retailers. Several European countries have recently adopted or announced measures in this category. Stepwise reductions in sales are being implemented in the Netherlands and Belgium. In the Netherlands, the online sales of tobacco and related products became prohibited in July 2023, supermarket sales will be banned from July 2024, and a sales ban in petrol stations will be implemented starting in 2030.

This means that only specialist stores will be allowed to sell tobacco and related products from 2032 and e-cigarettes from 2026. Belgium has prohibited temporary points of sale, including festivals from January 2025, tobacco and e-cigarette sales in large supermarkets (>400m2) from July 2025. In France and Hungary, only specialist shops can sell tobacco. In Hungary, this applies to tobacco products, e-cigarettes, e-liquids, nicotine pouches, and herbal products for smoking, and the number of shops is limited to 1 shop/4000 people.

Retail sale licensing is an effective way to control the supply and availability of tobacco and related products. It provides the platform to introduce supervisory fees that gradually reduce the sales points. In Europe, Finland has introduced high annual supervisory costs to tobacco and e-cigarette retail sale license holders, resulting in a substantial decrease in sales points.

Article 17 of the WHO FCTC requires countries to promote, as appropriate, economically viable alternatives for tobacco workers, growers and individual sellers. Incentives to sellers are generally rare. In Europe, France has established a protocol between the confederation of tobacconists (specialist shops that are allowed to sell tobacco) and the Ministry of Finance to support tobacco retailers in transforming to other local shops.

From the perspective of consumer protection standards and human rights, there is no justification for allowing the deadliest consumer product, cigarettes, to be on the market. Some of the transnational tobacco companies have claimed that they will stop selling cigarettes in the future in some countries, but industry self-regulation rarely works.

Given the increasing product portfolio of transnational tobacco companies, it is possible to obligate them to gradually end cigarette sales. This is feasible, especially in countries where smoking prevalence is lower and smoking cessation services are available. This approach has sometimes been called ‘abolition’ instead of prohibition.

This model focuses on the transfer management of tobacco supply to an agency with a mandate to phase out tobacco sales or whose goals are consistent with the overall aims of tobacco control, or state takeover of tobacco companies by non-profit entities with a public health mandate. In Europe, Austria, France, Hungary, Italy and Spain have a state monopoly on tobacco sales.

Performance-based regulation means, for example, that tobacco companies are required to meet smoking prevalence targets or be fined; companies are fined based on the quantity of their products consumed by minors; or manufacturers pay a levy based on sales volume similar to ‘polluter pays’ schemes.

Tobacco taxation is one of the most effective tobacco control measures. In tobacco endgame, the difference with regular tobacco taxation – the WHO recommended level of at least 75% total tax – is to introduce substantial increases that make tobacco products generally unaffordable in the long term, or to introduce taxation that targets industry profits (e.g., tobacco supplier profits surtax).

For example in France, a Social Affairs Committee, part of France's Senate, has proposed a 5% annual increase in cigarette prices until 2040. If implemented, this would result in a single pack costing 25 EUR in 2040.

Set a regularly reducing quota on the volume of tobacco products manufactured or imported into a country (’sinking lid’). Another connected issue, not addressed much even in tobacco endgame, is the free trade of tobacco.