Public Health vs. Public Health; May, Part 2
Cartographies of Control: Fragments, Frontiers, and the Fear of the New
Public Health vs. Public Health is not merely a series about tobacco control policies. Above all, it is an exploration of the internal fractures within public health itself: a field that, though guided by science, is often shaped by ideological tensions, institutional inertia, and unresolved disputes over which lives should be protected—and at what cost.
In the previous installment, we traced the most significant events from the early weeks of May 2025—a month marked by announcements, reforms, and narrative battles over the future of tobacco and nicotine control. In this second part, we turn our gaze to the close of the month, when tensions sharpen, discourse grows more polarized, and certain decisions begin to solidify, revealing not only what is being banned but what each society is ultimately willing to allow in the name of health.
Europe is navigating a regulatory crossroads that can no longer be concealed beneath the veneer of legal technicalities. What’s at stake is not merely how laws are written, but for whom they are written, and with what principles collective care is prioritized.
From Brussels to Warsaw, governments face a long-delayed and urgent question: how to respond—sensibly and responsibly—to the unstoppable rise of new nicotine products—vapes, heated tobacco systems, oral pouches—without defaulting to prohibitionist reflexes or hollow rhetoric?
The spread of these technologies has laid bare an ideological fracture that runs not only through institutions but also through the very core of modern public health. On one side, those who champion bans as a display of moral resolve and sacred protection of the young; on the other, those, grounded in science and decades of hard-won experience, who argue that harm reduction is not surrender, but a sober reckoning with the complexity of human behavior and consumption pathways.
At the heart of the dilemma lies an uncomfortable truth: the suffering of those who cannot quit smoking can no longer be rendered invisible, pushed to the margins of health discourses that forget that, before numbers, there are bodies—and before statistics, there are lives.
A Fragmented Bloc Facing the Challenge of Innovation
On May 26, fifteen European Union member states—including Germany, France, Spain, and the Czech Republic—called on the European Commission to revise the Tobacco Taxation Directive without further delay. In a joint letter, they warned that “the current scope and provisions are insufficient to address the challenges of the European tobacco market,” which is increasingly strained by the rise of alternative products that evade traditional tax frameworks.
But the letter reveals more than just a tax concern: it reflects a growing sense that Europe’s regulatory framework has become outdated in the face of innovations that evolve faster than politics can keep up. In this mismatch, the risk goes beyond tax evasion—it’s the deeper disconnect that occurs when institutional design clings to the past and forgets that public health is not defended by chasing shadows, but by understanding how consumption reinvents itself.
The fragmentation of the European bloc in the face of this challenge is not merely administrative—it’s conceptual. And it leaves millions of citizens trapped in a regulatory limbo where the new is punished not for its proven harm, but for its power to unsettle the status quo.
Just hours after the call to review tobacco taxation, the Netherlands and Belgium revived an initiative first launched in March 2024: a joint letter, initially signed by twelve member states, urging the European Commission to mandate plain packaging, ban flavors, and impose a uniform nicotine cap on vapes and oral pouches.
The gesture is neither incidental nor trivial. Amid a regulatory landscape in crisis, some governments appear to seek normative uniformity as a way to regain control they feel they've lost.
Yet the drive toward uniformity is not always rooted in evidence—it often stems from fear: fear of technological uncertainty, fear of losing authority over bodies, fear of moral judgment cast upon any policy that doesn’t ban the new. Beneath the rhetoric of protection—legitimate in its intent—lurks an authoritarian temptation: to strip citizens of their capacity for discernment, as if public health could only be preserved through obedience, rather than through understanding.
On May 27, policymakers from both countries—Dutch State Secretary Vincent Karremans and Belgian Minister Frank Vandenbroucke—met with EU officials to take things a step further: turning their March petition into concrete proposals within Brussels’ legislative machinery.
It was a coordinated move, though not necessarily a coherent one. Two fronts, united by the urgency of the moment, but divided in diagnosis and direction. One—focused on fiscal architecture—seeks to update tax frameworks in light of a reality that has rendered past criteria obsolete. The other, rooted in a moral architecture, pushes to neutralize products visually and sensorially, as if the issue were the color of the packaging rather than the absence of a mature public debate on the right to choose less harmful alternatives.
This fork in the road reveals a deeper dilemma: whether regulation should accompany the transformation of consumption or punish its shift into new forms that unsettle the reflexes of traditional politics.
France Between National Prohibition and Community Disagreement
While calls for a coordinated response multiply in Brussels, Paris is moving ahead on its own. The French government has notified the European Commission of a decree intended to ban the sale, import, and possession of nicotine pouches within its territory.
This isn’t merely a technical divergence. The move—blunt, symbolic signals a widening political rift between national ambitions and the shared commitments of the single market.
The backlash came swiftly. Sweden—the birthplace of these products—along with Romania, Greece, Hungary, Slovakia, Italy, and the Czech Republic, objected that the measure would “seriously harm the free movement of goods” within the Union. But beyond the treaty clauses, the episode highlights a deeper fracture: Europe’s growing inability to speak with one voice when the issue isn’t traditional tobacco, but its technological and cultural reconfiguration.
Meanwhile, on May 21, a deputy from La République En Marche introduced a bill in the National Assembly that, while stopping short of a full ban, proposes strict regulation of nicotine pouches: flavors would be limited to mint, menthol, and fruit; health warnings would cover 30% of the packaging; all advertising would be banned; sales to minors prohibited; and nicotine content capped at 16.6 mg per gram.
France appears torn between two impulses—not mutually exclusive, but certainly revealing: one of absolute control, which seeks to eliminate risk by outlawing its very existence; the other, of meticulous regulatory order, deeply distrustful of both the market and individual judgment. In both cases, the result is the same: a state that acts more from mistrust than pedagogy, more from symbolism than efficacy.
New National Trenches in Eastern and Northern Europe
As the European debate becomes tangled in letters, notifications, and counterproposals that rarely escape the page, some countries have chosen to move forward alone, digging new regulatory trenches at the national level. In Warsaw, the Lower House passed a bill limiting nicotine concentration in pouches to 20 mg per gram and banning all forms of advertising. The measure, already sent to the Senate, would take effect two weeks after publication, with a six-month grace period for specific provisions.
The message is clear: in the face of Europe’s regulatory void, legislative self-determination becomes the only viable course of action, yet also a political statement. When Brussels hesitates, capitals act, even at the cost of fragmentation. Today’s Poland—like Denmark a few weeks ago—seems to say that waiting for consensus is no excuse for inaction.
In the distant north, in Iceland, the debate has taken on a tone as unexpected as it is revealing. MP Halla Hrund Logadóttir announced she will introduce a bill this fall to subject nicotine pouches to the same restrictions as traditional tobacco.
Her motivation reflects a certain ambiguity: on the one hand, she seeks to curb the rising use of these products among young people, which, according to preliminary data, may reach 30% of Icelandic teenagers. Yet, on the other hand, she inserts a regulatory equivalence into the public discourse between substances with substantially different risks. This equation not only erases scientific nuance but also muddles the health message by replacing precision with symbolic impact.
In contexts where legal voids become commercial havens and inadvertent magnets for minors, regulatory urgency often emerges as a practical and tactical necessity, often accompanied by moral lessons. But it is also—perhaps more importantly—a symbolic assertion of authority.
The problem is that in the rush to close gaps, there’s a risk of legislating from alarm rather than understanding. And so the question arises: are we building informed and effective public policy, or merely erecting a moral levee that reassures politics without necessarily protecting people?
There is a fine line between protection and overprotection, and crossing it is no small matter. It can mean replacing the pedagogy of risk with a logic of punishment—one that rarely deters, but almost always alienates—and doubly punishes those who most need support.
Latin American and Asian Contrasts
The battle over control of new nicotine products knows neither borders nor ideological consensus. It unfolds across diverse latitudes but raises shared questions: How do we regulate what is still being understood? How do we legislate without repeating the mistakes of the past?
In Santiago, Chile, a law that took effect on May 20 marks a turning point. Vaporizers and heated tobacco products (HTPs) are now legally treated as conventional cigarettes. The law bans sales to minors, restricts their use in public spaces, and prohibits all advertising on radio, television, and within 400 meters of schools and health centers. An additional decree mandates health warnings: 20% on vapes and 50% on tobacco products.
The institutional message is unambiguous: normalize their legal treatment to neutralize their cultural and commercial appeal. Yet the strategy reveals a deeper dilemma: Is it appropriate to apply a regulatory framework designed for a historically different harm to new technologies? Can a legacy control model respond effectively to a landscape of accelerated innovation, where symbolism matters as much as chemistry?
Chile is not just regulating products; it is producing meaning about risk, youth, and the authority of the state. What’s at stake goes beyond public health; it’s a contest over who gets to redefine the thresholds of the permissible.
Across the Pacific, a leap toward total criminalization. In Hanoi, the approach is different—and far more radical. The Ministry of Health has proposed extending the ban in place since 2005, which currently covers importation and sale, also to include the possession and use of e-cigarettes and heated tobacco products. If enacted, Vietnam would become one of the few countries in the world to criminalize not only supply but also demand.
The proposal, expected to be reviewed by the executive in the second quarter of 2025 ahead of parliamentary debate, doesn’t just aim to redraw regulatory lines—it seeks to erase them altogether. Here, the goal isn’t to navigate the complex tension between consumption and protection, liberty and health, but to eliminate it outright. The logic is stark: if it can’t be controlled, it must be eradicated.
Yet this logic—efficient in form, severe in substance—raises unsettling questions. What role remains for the individual in a public health policy that treats use as a crime? What kind of pedagogy is possible when the state chooses punishment over understanding? Instead of developing harm-reduction tools or frameworks for safe access, Vietnam appears to be betting on a pedagogy of expulsion, where risk isn’t managed but banned by decree, as if that could make it disappear.
The End of a Generation in the Indian Ocean
Perhaps the most radical decision hasn’t come from a regional power or a European capital, but from a small archipelago in the middle of the Indian Ocean. On May 21, Maldivian President Mohamed Muizzu ratified an amendment to the Tobacco Control Act that sets a global precedent: no one born on or after January 1, 2007, will ever be allowed to purchase tobacco products at any point in their life.
With this measure, the Maldives becomes one of the first countries in the world to implement what’s known as the “generational ban fully”—a strategy aimed at breaking the intergenerational chain of smoking not through campaigns or incentives, but through a sharp legal cutoff in time.
Hailed by some public health advocates as a visionary and far-reaching act, the policy has also drawn fierce criticism from the harm-reduction field, which views it as an extreme experiment—more moral than pragmatic—and rife with unintended consequences, including the progressive stigmatization of consumers and the inevitable expansion of black markets.
Caught between the dream of a tobacco-free generation and the persistent reality of informal economies, the Maldives is making a bold wager—one that is both symbol and warning: a vision of the future that raises not just the question of what risks we seek to avoid, but what forms of control we are willing to normalize in the name of health.
South Asia Deploys Its Full Public Health Arsenal
In Kathmandu, Nepal’s Ministry of Health issued a measure on May 21 as forceful as it is symbolic: beginning August 17, 100% of the front and back surfaces of all tobacco packaging must be covered with graphic health warnings. With this move, Nepal not only strengthens its regulatory framework but also reaffirms the pioneering stance it took in 2015, when it became one of the first countries in the world to mandate high-impact pictograms.
In a region where consumption rates remain alarmingly high—and where regulatory authority contends with a robust informal economy and ongoing institutional pressures—Kathmandu is betting on a strategy of visual saturation. The aim is clear: to neutralize tobacco’s aspirational narrative from the packaging itself, to dismantle its aesthetic, and to strip it of its symbolic power as an object of desire.
But this pedagogy of visual shock, which operates through impact rather than understanding, also has its limits. What happens when graphic warnings stop triggering aversion and become part of the everyday backdrop? How long can visual terror serve as public policy once the cultural environment has normalized the risk?
The measure is bold, no doubt. But it also raises a vital question for the entire Global South: Is it enough to flood consumption with images, or must we rebuild—from the ground up-the narratives that sustain it?
Washington: Steady at the Regulatory Helm
While much of the world scrambles—urgently or inconsistently—to rethink its policies on the new generation of nicotine products, the United States has chosen to stay the course. On May 19, the Food and Drug Administration (FDA) appointed Bret Koplow as acting director of its Center for Tobacco Products. With this decision, the agency reaffirms its commitment to institutional continuity in enforcing the Family Smoking Prevention and Tobacco Control Act—a law that, despite criticism for its slow evaluation of reduced-risk products, has laid the foundation for the U.S. regulatory model.
In a global landscape increasingly fractured—with generational bans, visual saturation, criminalization of use, and the rise of gray markets—Washington, surprisingly, represents a form of balance: not without flaws, not without delays, but grounded in the belief that regulatory coherence is, in itself, a way to protect.