Taxed Compassion
How Brussels Decides Who Breathes and Who Pays in Its New Crusade Against Nicotine
In the name of prevention, Brussels is drafting a reform that blurs the fiscal line between traditional cigarettes and their less harmful alternatives. What at first glance appears to be a tax technicality reveals a more unsettling question: who benefits when public health dissolves into the logic of revenue?
In Brussels, open letters rarely alter the course of events.
They accumulate like dormant files in the drawers of power, or at best, are skimmed with a distracted eye before being dispatched with phrases as elegant as they are hollow. The capital of Europe has perfected a singular art: to domesticate dissent, reduce clamor to a whisper, turn conflict into bureaucratic procedure, and discomfort into protocol. Even the most impassioned protest becomes paperwork; there is a bureaucratic language that doesn't kill, but does defuse.
Yet, in early September, a manifesto signed by 83 public health experts cracked, if only for a moment, this choreography of silence. Their warning sent uneasy ripples through Brussels: taxing e-cigarettes, heated tobacco, oral nicotine pouches, and combustible cigarettes with the same rigor is not a step forward in prevention. On the contrary, it risks deterring smokers from switching to less harmful alternatives and enshrining fiscal orthodoxy over public health reasons. Their gesture exposed a machine more attuned to revenue than care, where health becomes a commodity and the citizen—before being a bearer of rights—is reduced to a mere taxpayer.
In plain terms: if the EU raises minimum excise levels and narrows the price gap between products with unequal risk, it effectively nudges smokers to stick with cigarettes or drift into the illicit market. Comparative evidence, from Sweden, the UK, and New Zealand, points in the opposite direction: where less harmful alternatives are accessible and socially legitimized, smoking rates decline significantly.
The backdrop to this dispute is a regulation with a technical name and bureaucratic façade: the Tobacco Tax Directive (TTD). After years of inertia, the European Commission revived it and, in July 2025, unveiled a draft extending taxation to reduced-risk products. Its dual goal: to harmonize the internal market and “reduce the attractiveness” of consumption. It is the most tangible measure within the European Beating Cancer Plan, conceived as a step toward a symbolic horizon: a “tobacco-free generation” by 2040. The promise echoes the utopian hygiene movements of the 19th century, when modernity sought to discipline bodies with rules and prohibitions.
But the experts’ letter sketches a different scene: if the tax floor for non-combustible products is raised too close to that of traditional tobacco, proportionality vanishes, and those trying to quit are penalized. Equating the price of the most lethal product with that of less harmful alternatives is not regulatory neutrality—it is the willful dismissal of evidence. The consequence is predictable: more people trapped in smoke, more avoidable deaths, and a system that translates pain into statistics.
What’s at stake here transcends tax codes. In recent months, official communications from the Commission have emphasized the need to “reduce the attractiveness” of all nicotine products—without distinguishing between the deadly risk of combustion and the diminished risk of smoke-free options. This equivalence, dismissed by experts as a falsehood, signals a troubling drift: from evidence-based policymaking to ideological narrative, from science to a rigid precaution that confuses protection with dogma.
At the heart of an aging, weary Europe, the nicotine debate is no longer confined to the classic tension between individual freedom and collective health. The real issue is the logic guiding public policy. Is the aim to protect health through evidence, even at the cost of embracing nuance and contradiction? Or to preserve interests that, cloaked in the guise of scientific neutrality or political precaution, serve corporate, financial, or ideological agendas?
This question echoes through history. In the 19th century, hygienist states pursued policies that, under the banner of health, disciplined working-class bodies and turned cleanliness into a tool of social control. In the 20th century, Prohibition promised to redeem America from alcohol and ended up feeding organized crime. Decades later, the “war on drugs” followed the same gospel—with devastating results: overflowing prisons, expanding black markets, and ever-deadlier clandestine use. From these failures emerged the harm reduction paradigm: a pragmatic ethic that accepts human frailty and seeks to mitigate it, rather than promising impossible purity.
Today, the TTD, this seemingly mundane directive, has become a stage for a deeper dispute. What’s being decided is how a political community governs desire, risky consumption, and dependence; whether survival will be a matter of control or an act of compassion.
The Architecture of Reform: Why It Matters
The European Commission’s latest proposal reshapes the tax architecture of the Union. It raises minimum thresholds, brings new products into the fold, and subjects even raw tobacco to electronic traceability systems (track & trace) with the stated goal of closing the loopholes that feed the illicit market. The draft asserts that these new fiscal benchmarks will “reduce the attractiveness” of non-combustible substitutes. This is not a nuance but a stance: the institution signals a preference not only to deter smoking but to disincentivize the alternatives as well.
This is a double wager. On one hand, it embeds itself within the narrative of public health; on the other, it seeks to reinforce the internal market by harmonizing a fragmented fiscal mosaic. Politically, the proposal now moves to the Council, where unanimity is non-negotiable, and to the advisory machinery of the European Parliament and the Economic and Social Committee.
For months, an alliance of governments, among them the Netherlands, Belgium, and Spain, has been pressuring Brussels for a swift update that includes vapes and nicotine pouches. Their aim: to curb price distortions that fuel cross-border shopping. In December, sixteen member states signed a letter demanding their inclusion. A proposal frozen since 2022 has regained political momentum, driven less by public health urgency than by the need to harmonize revenues and fortify the single market.
A favorable legal wind adds to this momentum. In June 2025, the Court of Justice of the European Union upheld Delegated Directive 2022/2100, which extended cigarette-style restrictions to heated tobacco: banning flavored additives, enforcing stronger warnings, and imposing new labeling requirements. The message was unambiguous: the Commission acted within its powers in revoking exemptions, given a “significant change in the market.” But that ruling concerned labeling and product composition, not taxation. It does not legitimize imposing equal taxes on products with unequal risks—though it does underscore how EU legal frameworks tend to privilege product control and behavioral governance over reducing health disparities.
The rise of disposable vapes illustrates this tension well. Their popularity has less to do with aggressive marketing than with their immediate appeal: low cost, ease of use, and accessibility to both young and adult smokers. In the UK, the percentage of vapers using disposables jumped from 1.2% to 22.2% between January 2021 and April 2022; among 18-year-olds, from 0.4% to a staggering 54%. The phenomenon highlights the speed at which markets evolve, and the inherent difficulty of legislating for a moving target.
The social dimension only sharpens the dilemma. In 2015, a UK study found that child poverty was significantly higher in households with smoking parents: over one million children were living under this double burden, and another 400,000 would fall into poverty if tobacco spending were subtracted from household income. In this context, making less harmful alternatives like vaping more expensive not only perpetuates the combustible tobacco cycle—it also deepens the spiral of illness and hardship already ensnaring the most vulnerable.
The letter from the 83 experts recalls a fundamental truth: not all nicotine products are created equal. Combustible tobacco kills. Smoke-free alternatives significantly reduce risk. Sweden is proof: widespread use of snus and nicotine pouches has driven daily smoking rates below 5%, with a 41% lower cancer incidence compared to the EU average. In the UK, official statistics show smoking prevalence falling from 20.2% in 2011 to 12.9% in 2022, and down again to 11.9% in 2023. The decline was even steeper among 18- to 24-year-olds, dropping from 25.7% to 9.8% in that same period—coinciding with a rise in vaping. In New Zealand, the shift was more dramatic still: smoking fell from 16.4% in 2011 to 6.9% in 2023, as daily vaping rose to 11.1% of the population.
These numbers represent lives extended, illnesses prevented, and less pressure on public health budgets. Taxing lower-risk products not only contradicts this evidence—it hits hardest those with the fewest options to quit. What does it mean for a low-income smoker in Badajoz or Łódź when the EU makes the one tool that might help them quit smoking more expensive? What does it mean for a British worker when affordable disposable vapes vanish while cigarettes remain on every street corner? What is presented as regulatory neutrality becomes, in practice, a form of social inequality, a policy that preserves access to the most lethal product while constraining escape routes toward safer alternatives.
Framed as a technical adjustment, the tax debate reveals its deeper nature: a battleground of ethics and political economy. If the data show pathways to reduce harm and ease poverty linked to tobacco, why persist with policies that flatten risk and punish safer alternatives?
In Brussels, the question lingers in the air: what weighs more—the health of Europeans or the financial, precautionary, or ideological logic concealed beneath the sanitized language of harmonization, that euphemism capable of turning public health into a negotiable variable in the political economy of the single market?
Scarecrows and Realities
Few arguments prove as politically effective as the so-called “gateway theory.” The idea that a teenager who experiments with an e-cigarette will inevitably end up smoking combustible tobacco is repeated like a mantra of fear in political speeches and official statements. Its power stems from an ancestral anxiety that children will inherit the condemnation of their parents, that fragility is destiny passed down through generations.
Evidence, however, complicates this narrative. A longitudinal study in the United States showed that, after adjusting for factors like family environment, other substance use, and predisposition toward rebellious behavior, the association between vaping and teenage smoking dropped to the point of statistical insignificance. In other words, many young people who smoke after vaping would likely have smoked anyway. The so-called gateway effect functions more as a rhetorical scarecrow than as proven causality, a convenient device to justify restrictions when the data depict a far more complex reality. Once again, fear-based policy triumphs over evidence-based policy.
In contrast, tobacco smuggling requires no metaphor. It’s a persistent, measurable reality. Every time taxes spike, the illicit market blooms. Even Commission reports acknowledge that millions of cigarette packs circulate each year outside legal supply chains, with fiscal losses in the billions and consumers exposed to unregulated, potentially harmful products.
According to a 2024 KPMG report for Philip Morris International, approximately 38.9 billion illicit cigarettes were consumed in the EU (9.2% of total consumption), amounting to nearly €14.9 billion in lost tax revenue, the highest level since 2015. France bore the brunt, with 18.7 billion illegal units; followed by the Netherlands, where smuggling reached 17.9% of consumption; and Spain, with 1.4 billion counterfeit cigarettes resulting in €263 million in lost revenue. The problem festers along borders and ports—from Poland to Portugal—and feeds on both criminal networks and the economic disparities between member states. Where the price gap widens, the shadow economy grows.
For vapes and nicotine pouches, the risk of parallel markets is real—though its extent will depend on the strength of traceability systems, customs enforcement, and oversight of online commerce. So far, the problem hasn’t reached the scale of the combustible market, but European experience suggests that when price gaps grow too wide, illegality spreads swiftly. What’s often described as “criminal deviation” is, in reality, a byproduct of tax policy and the socioeconomic asymmetries within the Union.
The incoherence is glaring: while the Commission issues increasingly stern warnings about a hypothetical risk—a teenager transitioning from vaping to smoking—it shows far less resolve in confronting the very real contraband that erodes public health and state revenues alike.
Between the logic of fear, which exaggerates an uncertain danger, and the logic of indifference, which downplays a documented harm, the essential is lost: the concrete lives of people who might leave smoke behind if alternatives weren’t shoved into the territory of suspicion or fiscal luxury.
In Europe’s invisible peripheries, another vulnerable group foots the bill: the poor. For them, each pack of cigarettes means less food on the table, less money for heating, fewer paths forward. And when taxes raise the cost of even the less harmful alternatives, they are trapped between two precarious choices: keep smoking or turn to the illicit market, with all its attendant risks.
Thus, young people become an excuse, and the poor collateral damage. Brussels focuses its energy on a hypothetical threat while responding tepidly to real dynamics that multiply harm and deepen inequality: overconsumption, underemployment, rising living costs, exhausting routines, intergenerational transmission of smoking, and persistent economic fragility.
The question lingers, uncomfortable and unresolved: does European policy truly protect its most vulnerable populations, or merely protect a moral narrative designed to legitimize decisions already made?
That moral narrative, repeated ad nauseam, is anything but innocent. It serves to shore up a tax regime that generates approximately €70 billion annually for EU member states—revenue so essential that, when cigarette sales decline, authorities refer to it as “lost revenue” rather than public health victories. It also protects corporate interests: pharmaceutical companies, whose nicotine patches and gums face stiff competition from vaping, see their business model threatened. And some tobacco firms lobby for a level fiscal playing field that would subject all rivals to the same regulatory burdens.
Much like in the 19th century, when hygienist policies sought to “regenerate” the working class by regulating its habits, today’s controls target youth and the poor—those with the least power to resist. Beneath the rhetoric of protection lies a political economy of addiction and dopamine markets: who pays, who collects, who profits.
The Political Economy of Taxation
On the surface, the official narrative wraps itself in the language of prevention and fiscal harmonization. Beneath this layer of good intentions, however, the redesign of the Tobacco Excise Directive (TED) follows a more prosaic logic: revenue. Tobacco has always been among the most coveted sources of state income. It is no coincidence that cigarettes—now branded as a cursed commodity—rank among the most heavily taxed products in Europe and globally. In most EU countries, prices have soared due to taxation, though the low-cost segment remains marginally accessible. In France, a review of parliamentary debates revealed that 77.2% of arguments opposed new tax hikes, primarily citing their economic and social effects, including the rise of illicit trade. Each new tax is marketed to the public as a public health investment; in national accounts, however, it’s logged as reliable income.
The problem intensifies when this fiscal logic extends to smoke-free products. The demand-side economics are clear: cigarette price elasticity is low—smokers rarely reduce consumption even when prices rise—whereas alternatives like vaping and heated tobacco are far more price-sensitive. If the price of these alternatives approaches that of combustibles, the incentive to switch disappears. Worse still, studies of cross-price elasticity show that when vaping becomes more expensive, many users not only abandon it but actually increase cigarette consumption. In New Zealand, for instance, e-cigarettes acted as partial substitutes for traditional ones, with a cross-price elasticity of 0.16. At current prices, their availability reduced cigarette consumption by 42.8%.
This dynamic is deeply entwined with corporate interests. Big Tobacco has learned to play on both boards: investing in electronic devices to position itself as an innovator in harm reduction, while continuing to derive its largest profits from traditional cigarettes. Every tax hike on vaping paradoxically extends the profitability of the most lethal product and delays smokers' transition to safer alternatives—as well as the market shift these companies profess to support. In this scenario, regulatory ambiguity does not act as a brake but as an accelerant, allowing multinational firms to capture both markets and fortify their dominance.
For small manufacturers of vapes and nicotine pouches, the picture is starkly different. Lacking the financial muscle and lobbying networks of the industry giants, they face a rigged fiscal playing field that erodes competitiveness, marginalizes product diversity, and ultimately limits consumers’ access to lower-risk options.
The tale of “fiscal harmonization” also functions as a geopolitical maneuver: centralizing authority, reducing national leeway, and strengthening the Commission’s hand in a historically sensitive domain. Here, public health serves as a legitimizing alibi—few dare challenge a tax when it arrives dressed in the unassailable garb of cancer prevention.
Yet the contradiction is glaring. Even as Brussels promises a “tobacco-free generation” by 2040, the very tax structure it champions threatens to entrench the market it claims to dismantle. The paradox invites an unsettling question: who benefits when less harmful alternatives become fiscally unviable? European citizens—or the institutions, corporations, and investors ever ready to adapt and thrive in any given landscape?
In Brussels, power rarely plays out in public speeches. It unfolds in discreet offices, between technical papers, endless dinners, and hurried coffees. Behind the neutral language of “harmonization” lies a fierce battle among lobbies, including tobacco firms, pharmaceutical giants, public health NGOs, and national governments. Each defends its narrative, while the Commission plays both referee and arena, balancing interests that present themselves as medical but ultimately obey the cold calculus of money and influence.
Big Tobacco: The Double Game
The major tobacco companies were late to the vaping market, but they quickly learned to speak two languages at once. In reports to shareholders, they celebrate cigarette profits. In Brussels, they showcase sleek catalogs of electronic devices, cloaked in the unimpeachable rhetoric of innovation and harm reduction. Without favorable regulation, their strategy isn’t to replace one market with another—it’s to keep both alive. Every tax that raises the cost of vaping extends the profitability of cigarettes. For multinationals, regulatory ambiguity isn’t an obstacle—it’s fertile ground. They win on all fronts.
Pharmaceuticals: Guardians of Their Niche
Meanwhile, the big pharmaceutical companies jealously guard their territory. Vaping threatens a well-established business built on nicotine patches, gums, and sprays. Their lobbying efforts in Brussels invoke precaution to slow the spread of alternative products. They present themselves as stewards of public health, but each restriction on vaping also serves as a reprieve for their cessation therapy market.
Public Health NGOs: Between Evidence and Dogma
Health organizations play an ambivalent role. Some advocate for proportionality and acknowledge the value of vaping as a harm reduction tool. Others cling to a rigid reading of the precautionary principle: all nicotine products are suspect, without nuance. Their influence lies not in money, but in narrative—they provide the moral legitimacy bureaucrats need to dress fiscal policy in the garments of health. And, not infrequently, their own institutional survival depends on nicotine remaining the great public menace.
EU Member States: Addicted to Revenue
National governments, often subordinate to the weight of EU policymaking, complete the picture. Dependent on the more than €70 billion collected annually from tobacco taxes, they see the TED as a tool to balance budgets and patch holes in the internal market. Germany, France, Spain, and sixteen other member states have called for the framework to include electronic devices as well. Their priority—thinly veiled as prevention—is not public health, but fiscal security.
How Risk Is Legislated
In Brussels, the word “attractiveness” has quietly become a regulatory category. The draft of the new Tobacco Excise Directive (TED) states outright that its fiscal framework aims to “reduce the attractiveness” of non-combustible nicotine products. The term, seemingly neutral, carries a clear political decision: to disincentivize all forms of use equally, effectively erasing the distinction between a combustible cigarette and a low-toxicity vape.
In public health, the principle of proportionality should be sacrosanct: the intensity of regulation and taxation ought to correspond to the actual harm each product causes. This is not about the tired liberal cliché of individual freedom versus the common good—it’s about something more tangible: measuring and calibrating risk. No one argues that banning drunk driving or requiring seat belts saves lives. But here, a one-size-fits-all logic is being imposed, equating unequal risks and creating regulatory injustice.
To legislate without recognizing this difference is like applying the same safety standards to a bicycle and a Formula One car, a false neutrality that leads, inevitably, to more deaths and more preventable illness. Comparative evidence confirms this: where lower-risk alternatives are accessible and socially legitimate, smoking rates fall dramatically.
And yet in Brussels, the language of proportionality has been displaced by that of suspicion. Under the umbrella of “attractiveness,” the Commission implies that any nicotine use is undesirable, even when it doesn’t burn lungs or cause comparable levels of disease. This imposes a worldview not of risk management, but of attempted eradication. And history—of alcohol, drugs, even sexuality—has shown time and again that absolute prohibition tends to cause more harm than it prevents.
The underlying question is uncomfortable: who benefits from a tax framework that flattens the entire spectrum of risk? The unseen actors who ensure stable revenues—crucial but kept behind the scenes? The tobacco giants, who preserve their core business while adapting with studied slowness? The smuggling networks that thrive in every regulatory gap?
What remains unprotected, once again, are real lives: smokers who might quit, young people who might start with less harmful products, and families bearing the health and economic costs of combustible tobacco.
Legislating risk should be an act of pragmatic compassion: to reduce harm, provide exits, and protect the most vulnerable. Instead, the TED enshrines an extreme precautionary stance, masked as a fiscal technique. And when prevention severs itself from evidence, public health ceases to be science—it becomes dogma.
A Politics Spoken in Two Tongues
The letter signed by 83 experts can be read in many ways, but in any light, it speaks beyond technicalities: it is a manifesto against institutional blindness. The signatories warn that equating unequal risks is not evidence, it is dogma; that ignoring comparative experience is not prudence, it is a renunciation of science. And they remind us of the inescapable truth: each year of delay means shorter lives across Europe.
The letter arrives at a moment when science answers some questions while resisting the oversimplification of others. Yes: vaping aerosol contains far fewer toxins than cigarette smoke. Yes: concern for adolescents is valid. Yes: illicit markets and cross-border price disparities distort any common policy. The mistake lies in thinking that a single lever—a high tax applied across the board—can solve problems as varied as these.
Beyond data and citations, the letter poses the essential question: what does it mean to protect public health? Does it mean punishing all nicotine use equally, even at the cost of preserving the deadliest products? Or does it mean accepting human imperfection and creating real pathways to reduce harm—here and now?
The signatories’ gesture is bold: it breaks the inertia of an apparatus that often prefers rhetoric to evidence. Their plea echoes with historical resonance. A society that has lived through Prohibition and the War on Drugs should have learned this much: public health is better protected by pragmatic bridges than by moral walls.
Today, the TED is not just a tax directive; it is a mirror reflecting the kind of political community the European Union aspires to be. One that clings to a precautionary reading so rigid it flattens proportionality, morality disguised as technique? Or one that dares to write compassion in the cold language of taxation?
Every directive carries an embedded set of values. And in this one, the choice is brutally simple: does Brussels prefer to keep collecting revenue on the momentum of smoke, or to save lives by differentiating between risks? The letter won’t move mountains, but it reminds us of what matters: behind each fiscal technicality, there are lungs inhaling, families slipping into poverty, and young people choosing between one product and another.
Europe, weary of its new hygienist utopias, must now decide: will it govern desire with the cold hand of control, or with the clear-eyed grace of compassion?
The letter
Dear President of the Commission and European Commissioners:
We, the undersigned experts in public health, nicotine dependence, and tobacco control, write to you out of concern over the forthcoming review of the Tobacco Excise Directive, which is expected to impose new taxes on less harmful nicotine products.
Public health policies should use the best available scientific evidence. It is, therefore, a matter of significant concern that recent EU public communications,1,2 claiming that non-combustible nicotine delivery products pose health risks comparable to combustible cigarettes, contradict the best available scientific evidence. This position is not only a significant departure from the foundational principle of evidence-based public health but also undermines the European Commission’s vital commitments to data-driven legislation and to combating disinformation.
Smoking remains the leading cause of preventable death in the EU, with nearly 700,000 premature deaths annually. Twenty-six per cent of citizens (29% among 15–24-year-olds) still smoke.3
Extensive scientific evidence has proven that non-combustible nicotine products such as e-cigarettes, heated tobacco products, and nicotine pouches are substantially less harmful than cigarettes. These products have also helped millions quit smoking.
• In Sweden, where snus and nicotine pouches are commonly used, daily tobacco use is the lowest in the EU (<5%) and cancer incidence is 41% below the EU average, despite overall nicotine use being similar to the EU average.4
• In the United Kingdom where the government encourages smokers to switch to vaping, smoking has fallen from 17% to 12% in five years.5
• In New Zealand, daily smoking dropped to 7% in 2023/24, from 16% in 2011/12, while daily vaping has risen to 11%.6
Regulation should be guided by science. Ideological or moral beliefs should not guide public health policies and must not override the facts and the goal to improve the health and lives of Europeans. Protection of minors is important, but it can be achieved by proper implementation of the already established regulation on advertising and sales, without hindering the public health objectives of reducing death and disease caused by smoking.
Smokers should have access to non-combustible alternatives. Fiscal and regulatory provisions that discourage the switch from smoking to less risky alternatives are unethical and protect the cigarette trade.
Commissioners, public health in Europe stands at a crossroads: in the coming months, the European Commission intends to advance the Tobacco Products Directive and the Tobacco Excise Directive. Implementing a “tax-raid” on potentially life-saving products will keep smokers smoking, will harm public health, and will set a bad paradigm for other countries (particularly LMICs) and regions globally.
Sources
Sincerely,
Signatories
1. Jasjit S. Ahluwalia — MD, MPH, MS, Professor, Behavioral and Social Sciences and Professor of Medicine; Center for Alcohol and Addiction Studies; Brown University School of Public Health and Alpert School of Medicine. USA.
2. Philippe Arvers — MD. Addiction & Tobacco Specialist, Army Medical Center (CMA); Administrator, Francophone Tobacco Society (SFT); Associate Researcher, University of Grenoble Alpes & University of Savoie Mont-Blanc. France.
3. Marcin Bąder — Head of the Clinical Research Support Center. National Institute of Medicine, Ministry of Interior and Administration. Poland.
4. Anastasia Barbouni — MD, MSc, PhD. Professor of Public Health, Hygiene & Disease Prevention. Vice President Department of Public & Community Health School of Public Health, University of West Attica. Greece.
5. Fabio Beatrice — MD. Professor Emeritus of Otolaryngology, Hospital San Giovanni Bosco; Scientific Board Director Medical Observatory on Harm Reduction, (MOHRE). Italy.
6. Carolyn Beaumont — GP, FRACGP, MD, DipChildHealth, BMedSci (Dist.), Tobacco harm reduction clinician, educator and public speaker. Australia.
7. Pavel Bém — MD, PhD. Addictology Clinic, Charles University; Former Mayor of Prague. Czech Republic.
8. György Bodoky — Prof. Dr. Clinical oncologist. St. László Hospital, Dept. of Oncology. Hungary.
9. John Britton — Emeritus Professor, Former Director of the UK Centre for Tobacco and Alcohol Studies, Former Chair of the Royal College of Physicians Tobacco Advisory Group, and member of the board of trustees of Action on Smoking and Health. University of Nottingham. UK.
10. Hugo Caballero Durán — MD Former president of the Colombian Society of Pneumology. Former Clinical Scientific Director of Marly Clinic. Director of the Pneumology and Respiratory Therapy Service, Marly Clinic Bogotá. Colombia.
11. Salvatore Chirumbolo — PhD. Professor, Department of Engineering for Innovation Medicine, University of Verona. Italy.
12. Alice Alberta Cittone —Dental Hygienist, Myoralcare app project manager Scientific Director, Inter-Parliamentary Group on Lifestyles and Risk Reduction. Turin. Italy.
13. Manuel País Clemente — MD, PhD. Retired Full Professor Department of Otorhinolaryngology, Porto University School of Medicine, Vice-President European Medical Association. President World Voice Consortium, Portugal. International Association on Smoking Control and Harm Reduction (SCOHRE) Founding member. Portugal.
14. Kenneth Michael Cummings — PhD, MPH Professor of Psychiatry & Behavioral Sciences, and co-director Tobacco Research Hollings Cancer Center, Medical University of South Carolina, Charleston. USA
15. Ole Davidsen — MD. Specialist in Geriatrics & Internal Medicine. Denmark.
16. Izabella Dessoulavy-Gładysz — CEO, Mental Power- Brain Health Foundation. Poland.
17. Carmen Escrig — PhD. Genetics & Cell Biology, Autonomous University of Madrid. Spanish Medical Platform for Tobacco Harm Reduction (PRDT) Founding member. Spain.
18. Sharifa Ezat Wan Puteh — Professor of Hospital Management and Health Economics; Deputy Dean (Relation & Wealth Creation), Faculty of Medicine, UKM Medical Centre; Previous Head of International Centre for Casemix and Clinical Coding (ITCC), UKM Medical Centre, Malaysia.
19. Karl Fagerström — PhD, Lic. Psych. Professor Emeritus; President, Fagerström Consulting. International Association on Smoking Control and Harm Reduction (SCOHRE) Founding member. Sweden.
20. Andrzej M. Fal — Dr. Professor of Medicine. President, Polish Society of Public Health. Poland.
21. Konstantinos Farsalinos — MD, MPH, PhD. Researcher, University of Patras & University of West Attica; Vice-President, International Association on Smoking Control and Harm Reduction (SCOHRE). Greece.
22. Fernando Fernández Bueno — MD. Oncological surgeon at the Hospital Central de la Defensa Gómez Ulla. Professor at the University of Alcalá de Henares Madrid. International Association on Smoking Control and Harm Reduction (SCOHRE) Founding member. Spanish Medical Platform for Tobacco Harm Reduction (PRDT) Founding member. Spain.
23. José Mª García Basterrechea — MD. Associate Professor of Medicine, University of Murcia; Former Head, Addiction & Dual Pathology Unit, Reina Sofía Hospital. Spanish Medical Platform for Tobacco Harm Reduction (PRDT) member. Spain.
24. José David García Muñiz — MD, PhD. Clinical Pharmacology & Internal Medicine; Clinical Trials Coordinator & Principal Investigator, University Hospital of Ceuta. Spanish Medical Platform for Tobacco Harm Reduction (PRDT) member. Spain.
25. Guillermo González Balmaseda — MD. Specialist in Psychiatry, Madrid. Spanish Medical Platform for Tobacco Harm Reduction (PRDT) member. Spain.
26. Miguel de la Guardia — PhD. Professor of Analytical Chemistry, University of Valencia. Spanish Medical Platform for Tobacco Harm Reduction (PRDT) member. Spain.
27. Carlos Gutiérrez Rodríguez — MD. Specialist in Intensive Care Medicine. Spanish Medical Platform for Tobacco Harm Reduction (PRDT) member. Spain.
28. Peter Hajek — PhD. Professor of Clinical Psychology, Wolfson Institute of Population Health, Queen Mary University of London. UK.
29. Wayne Hall — PhD. Emeritus Professor, National Centre for Youth Substance Use Research, University of Queensland. Australia.
30. Eszter HALMY —PhD, MSc Obesity researcher, health services manager. President of the Hungarian Society for Study of Obesity. Hungary.
31. Ignatios Ikonomidis — MD, PhD, FESC, Professor of Cardiology, Member of EACVI, ex. Nucleus member of ESC WG on Aorta & Peripheral Vascular Diseases, Director of Echocardiography and the Laboratory of Preventive Cardiology, 2nd Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, Athens. International Association on Smoking Control and Harm Reduction (SCOHRE) Board President. Greece.
32. Martin Jarvis — Emeritus Professor of Health Psychology. University' College London. UK.
33. Martin Juneau — MD, MPSc, FRCP(C), FACC. Cardiologist; Director, Observatoire de la Prévention, Montreal Heart Institute; Maître de Clinique, Faculté de Médecine, Université de Montréal. Canada.
34. Māris Jurušs — PhD. OEC. Associate Professor, Riga Technical University. Latvia.
35. Piotr Karniej — PhD. Assistant Professor, WSB Merito University, Wrocław; Collaborating Researcher, University of La Rioja. Poland/Spain.
36. Joe Kosterich — M.B.B.S WA State Medical Director for IPN, Clinical Editor of Medical Forum Magazine and Vice Chairman of the Arthritis and Osteoporosis Association of WA Perth West Australia.
37. Lynn T. Kozlowski — PhD. Professor Emeritus & Dean Emeritus, School of Public Health & Health Professions, University at Buffalo, State University of New York. USA.
38. Jacques Le Houezec — PhD. Scientist & Smoking-Cessation Specialist; Manager, Amzer Glas – CIMVAPE, training and certification organisation. France.
39. Manuel Linares Abad — PhD. Nurse Specialist in Obstetrics & Gynecology; Former Dean, Faculty of Health Sciences, University of Jaén. Spanish Medical Platform for Tobacco Harm Reduction (PRDT) member. Spain.
40. Karl E. Lund — PhD. Senior Researcher, Norwegian Institute of Public Health. International Association on Smoking Control and Harm Reduction (SCOHRE) Board Vice President. Norway.
41. Olivia Maynard — PhD. Associate Professor, School of Psychological Science, University of Bristol. UK.
42. Bernhard-Michael Mayer — PhD. Professor of Pharmacology, University of Graz. Austria.
43. Garrett McGovern — MD. GP specialising in Addiction Medicine; Medical Director, Priority Medical Clinic, Dublin. Ireland.
44. Colin P. Mendelsohn — MB BS (Hons). Tobacco Treatment Specialist; Founding Chairman, Australian Tobacco Harm Reduction Association (ATHRA). Sydney. Australia.
45. Fares Mili — MD, CTTS. Pulmonologist & Addictologist; Chairman, Tunisian Society of Tobacology and Addictive Behaviors (STTACA). International Association on Smoking Control and Harm Reduction (SCOHRE) Board Member. Tunisia.
46. Kristina Mitikj — PhD, DDS. Professor, Faculty of Dentistry, Ss. Cyril and Methodius University. North Macedonia.
47. Vincenzo Montemurro — MD. Cardiology and Internal Medicine. Head of the Cardiology Service of the CDC "Scilla d'America" (ASP Reggio Calabria) Scilla, National Secretary of the "We Are the Heart" Foundation of the S.I.C. (Italian Society of Cardiology). Italy.
48. Viktor Mravčík — MD, PhD, Assoc. Prof. Vice-chairman of the board of the Society for addictive diseases of the Czech Medical Association, Scientific advisor to national drug coordinator, head of research and innovations, Spolecnost Podane Ruce. Czech Republic.
49. Maddu Narendra — PhD. Assistant Professor, Department of Biochemistry, Sri Krishnadevaraya University. India.
50. Ethan Nadelmann — JD, PhD. Founder & former Executive Director, Drug Policy Alliance. USA.
51. Joel L. Nitzkin — MD, MPH, DPA. CEO & Principal Consultant, JLNMD Consultants, New Orleans, LA. USA.
52. Fredrik H. Nystrom — MD, PhD. Professor of Internal Medicine, Linköping University. Sweden.
53. David Nutt — Prof. DM FRCP FRCPsych FBPhS FMedSci DLaws. Professor of Neuropsychopharmacology, Imperial College London. UK.
54. Marko Ölluk — MD. Clinical Lead, Confido Health Centre; Family Practitioner. Estonia.
55. Fiona Patten — former Member of Parliament Victoria Australia. Harm Reduction speaker.
56. Uladzimir Pikirenia — MD, PhD, Psychiatrist, Psychiatric Hospital in Frombork, Frombork, Poland.
57. Wolfgang Popp — MD. Professor. Pulmonologist. Vienna. Austria.
58. Marek Postula — MD, PhD. CEO, Polish Society of Longevity Medicine; Medical University of Warsaw. Poland.
59. Hernán Prat — MD. Professor, University of Chile; Former Director Cardiovascular Department, Clinical Hospital of the University of Chile. Former President, Chilean Society of Hypertension. Chile.
60. Josep Maria Ramon Torrell — MD, PhD. Professor of Epidemiology & Public Health; Tobacco Prevention Service, Bellvitge Hospital, University of Barcelona. Spanish Medical Platform for Tobacco Harm Reduction (PRDT) member. Spain.
61. Solomon Rataemane — Prof. Independent Psychiatrist. Former Chairman of Department of Psychiatry Sefako Makgatho Health Sciences University. Africa regional Rep. World Association for Psychosocial Rehabilitation. Chair: Ministerial Advisory Committee on Mental Health. International Association on Smoking Control and Harm Reduction (SCOHRE) Founding member. South Africa.
62. Dimitri Richter — MD. Cardiologist, FESC. Head of Cardiac Department, Euroclinic; Vice-President, Hellenic Heart Foundation. International Association on Smoking Control and Harm Reduction (SCOHRE) Founding member. Greece.
63. Randall Rodríguez Obando — MD. Specialist in Internal Medicine & HIV Harm Reduction. Costa Rica.
64. Brad Rodu — Professor of Medicine; Endowed Chair in Tobacco Harm Reduction Research, University of Louisville, Louisville, KY. USA.
65. Benjamin Rolland —Prof. Psychiatre, Addictologue Pôle MOPHA (Médecine-Odontologie-Pharmacie-Addictologie), CH Le Vinatier Service Universitaire d’Addictologie de Lyon (SUAL), Hospices Civils de Lyon, CH Le Vinatier Service d'Accompagnement Médical des Centres de Rétention Administrative Lyonnais (SAMCRAL), Hospices Civils de Lyon. France.
66. Louise Ross — Stop-Smoking Lead, Smoke Free Digital; Former Manager, Leicester Stop Smoking Service. UK.
67. Christos Savopoulos — Professor of Internal Medicine. Director of 1st Medical Propedeutic Dept of Internal Medicine & Stroke Unit, Excellence Center of Hypertension AHEPA University Hospital. Thessaloniki. Greece.
68. Rohan Savio Sequeira — Prof. Dr. MD PhD Endocrine (HARVARD - USA) Consultant Cardio-Metabolic Physician. Specialist in Non-Invasive Cardiology, Diabetes, Endocrinology and Obesity Management Hon. Consultant Physician to the Governor of Maharashtra Professor and Head of the Department of Geriatric Medicine: Sir JJ Group of Govt Hospitals and Grant Govt Medical College. India.
69. Evangelos Sdogkos — MD. Director of Cardiology, General Hospital of Veroia. Greece.
70. Andrzej Sobczak — PhD Professor. Head of Department of General and Inorganic Chemistry Faculty of Pharmaceutical Sciences in Sosnowiec Medical University of Silesia Katowice. Poland.
71. Ranko Stevanović — MD, PhD. President, Croatian Society for Pharmacoeconomics and Health Economics; Croatian National Institute of Public Health. Croatia.
72. Roberto A Sussman — PhD. Institute for Nuclear Research, National Autonomous University of Mexico, ICNUNAM.
73. David T. Sweanor — JD. Chair of the Advisory Board, Centre for Health Law, Policy & Ethics, University of Ottawa; Legal Counsel, Non-Smokers’ Rights Association (1983-2005). Canada.
74. Andrzej W. Szawlowski — Prof. MD, PhD, FACS. Oncologic Surgeon, Warsaw. Poland.
75. Ingrid D. Taricano — Prof. PhD. Independent toxicologist. São Paulo. Brazil.
76. Enrique Terán — MD, PhD. Professor, College of Health Sciences, Universidad San Francisco de Quito. Ecuadorian Academy of Medicine. Academy of Science of Ecuador. Ecuador.
77. Umberto Tirelli — Prof. Scientific and Health Director Tirelli Medical Group Clinic. Specialist in Oncology, Hematology and Infectious Diseases. Italy.
78. Philip Tønnesen — MD. Specialist in Pulmonary Medicine; Expert in smoking cessation. Senior Consultant, Søernes Privathospital. Denmark.
79. Francisco E. Urresta — MD. Medical Director, Hospital Clínica Metropolitana, Ibarra. Ecuador.
80. Diego Verrastro — MD. Independent Specialist in Obesity and Emergency Medicine Surgeon. Argentina.
81. Kenneth E. Warner — PhD. Distinguished University Professor Emeritus & Dean Emeritus, University of Michigan School of Public Health. USA.
82. Alex Wodak — AM, FRACP, FAChAM. Emeritus Consultant, St Vincent's Hospital, Sydney, Australia.
83. Dirk Ziebolz — Prof. Dr. M.Sc. Dental, Oral & Maxillofacial Surgery Specialist. Germany.
Signatory Entities:
ETHRA — European Tobacco Harm Reduction Advocates. EU Transparency Register: 354946837243-73
MOHRE — Medical Observatory on Harm Reduction. Via Tomba di Nerone 14, 00189 Rome. Italy. https://mohre.it/
PRDT — Spanish Medical Platform for Tobacco Harm Reduction. EU Transparency Register: 166296541422-35
SCOHRE — International Association for Smoking Control and Harm Reduction, Michel Ange 12, B-1000 Brussels, Belgium.
Tobacco Harm Reduction, Inc. (THR101) — Registered 501(c)(3) nonprofit organization dedicated to promoting public health through science-based education, research, and advocacy. Florida, USA