ESC Calls For Action On Nicotine Harm

Dear Commissioner Hoekstra,

I am reaching out on behalf of the European Society of Cardiology (ESC) in relation to the anticipated revision of the Council directive 2011/64 on the structure and rates of excise duty applied to manufactured tobacco (Tobacco Taxation Directive).

ESC is a volunteer-led, not-for-profit medical society, uniting over 100,000 scientists, clinicians, nurses and allied professionals working in all fields of cardiology. Our mission is singular – to reduce the burden of cardiovascular disease. As the preparation of the EU Cardiovascular Health plan is underway, we wish to highlight the importance of addressing nicotine consumption as one of the main preventable risk factors for cardiovascular disease, and call on the European Commission to ensure that all necessary initiatives are taken to achieve the objective of a "tobacco free generation" by 2040 set out in the EU Beating Cancer Plan. In December 2024, the ESC has welcomed the adoption of the Council Recommendation on smoke-and aerosol-free environments, which it had previously endorsed in a press release signed jointly with the European Respiratory Society, the European Cancer Organisation and others from the health stakeholder community. The press release urged the EU not to lose momentum on tobacco policy, and besides the adoption of the Council Recommendation, called for the urgent revision of the relevant EU legislation, including the Tobacco Taxation Directive.

I wish to reiterate these recommendations and to remind you that there is no safe level of smoking, which increases the risk of death from cardiovascular disease up to three times. I would also like to draw your attention to the risks posed by emerging products, such as electronic cigarettes, heated tobacco products, and nicotine pouches. These products, due to their perceived lack of risks and aggressive marketing strategies, are increasingly prevalent on the European market, and are alarmingly attractive, especially to younger consumers.

In this regard the evidence is unambiguous: no nicotine-containing product is safe for the cardiovascular system - regardless of delivery method or dose. Newer products and "tobacco-free" labelling misleads consumers into believing that synthetic nicotine products are safer, whereas they are equally addictive. For instance, contrary to fraudulent claims by the vaping "industry", e-cigarettes are not replacing cigarettes; they are recruiting new users. Up to 75% of young adult e-cigarette users have never smoked traditional cigarettes.

All nicotine- and tobacco-containing products are harmful, and as such, they should all be taxed equally, and at a higher rate than the status-quo. Newer products must be subject to the same consumer disincentives: advertising bans, indoor use restrictions, and taxation policies, in line with combustible tobacco products to prevent another generation from lifelong cardiovascular harm.

Nicotine-containing products are not just a health hazard—they are an economic drain. Their continued use fuels hospital admissions, burdens healthcare budgets, and undermines national productivity. Banning flavoured products, raising excise taxes, and closing regulatory loopholes will yield both health and economic dividends.

We call on the European Commission to act - not cautiously, but decisively. The evidence leaves no room for compromise. The next infarction, the next stroke, the next death - may not come from a cigarette, but from a sleek pod, a flavoured pouch, or a waterpipe in a café. An ambitious revision of the Tobacco Tax Directive can ensure our tax system plays a crucial role in supporting Europe's competitiveness through improving population health, resilience, and prosperity.

We remain at your disposal and look forward to your response.

Yours sincerely,

Prof. Thomas Lüscher, FESC

President, European Society of Cardiology