20 years of tobacco control in the EU: are we moving towards a tobacco-free future

Twenty years after the European Union (EU) ratified the WHO Framework Convention on Tobacco Control (WHO FCTC), a new WHO/Europe report shows that the EU has achieved important policy progress - yet tobacco continues to claim more than half a million lives every year.

"Twenty years ago, the EU adopted this landmark United Nations convention and built its internal legal pillars in alignment with the WHO FCTC vision - to save lives and protect all people from the wide-ranging health risks of tobacco use - from cancer and cardiovascular diseases to tuberculosis and dementia," said Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

"Yet after decades of policy action across the 27 EU Member States, the overall burden of tobacco in Europe remains immense, with large variations between countries. The new WHO European Programme of Work 2026-2030 renews this vision and calls for stronger collective action on noncommunicable disease risk factors, including tobacco use."

Tobacco use remains the leading cause of preventable death in Europe

Tobacco use in the EU is gradually declining, but every year, it keeps killing more than half a million people. Of these, almost 80 000 die from exposure to second-hand smoke.

• In 2022, 26.5% of EU adults used tobacco - above the global average of 20.9%.
• Nearly 1 in 4 women in the EU currently uses tobacco - exceeding the female prevalence in the WHO European Region (18.9%) and far surpassing the global prevalence among females (7.4%)
• Tobacco use among men (29.1%) remains higher than among women (23.9%).
• Tobacco continues to cause more premature deaths than any other behavioural or metabolic risk factor for health, accounting for 17% of all premature deaths from noncommunicable diseases in the EU

United Nations Sustainable Development Goal target 3a calls for the strengthening of implementation of the WHO FCTC; accelerating this implementation will also help address the target of the Global Action Plan for the Prevention and Control of Noncommunicable Diseases: to achieve a 30% relative reduction in tobacco use by 2025. Across the EU, only 7 countries are on track to meet this global target.

E-cigarettes and youth: a threat to decades of progress

The heavy burden of tobacco harm is driven in large part by a powerful and profit-driven industry. And today, the actions of tobacco companies using a wide range of strategies to maximize profits are becoming an urgent threat for the EU's future.

The new tobacco and nicotine products, such as e-cigarettes and nicotine pouches, often designed with bright colours and sweet flavours, are deliberately marketed, including through social media, to attract children and adolescents, drawing a new generation into addiction.

The WHO European Region is already the world's leader in e-cigarette use among adolescents (13-15 years old), and the trend is on the rise and very visible across the EU. While adult smoking rates are declining, use of nicotine products among young people is rising sharply.

• Almost 1 in 4 15-16-year-old students in the EU currently use e-cigarettes - from 6% in Portugal to 36% in Poland.
• Since 2019, rates of adolescent e-cigarette use have increased in 22 of the 25 EU countries reviewed, and in every member state, girls report higher use than boys

Studies show that e-cigarette use can increase conventional cigarette uptake, particularly among nonsmoking youth, by nearly 3 times, undermining tobacco control efforts and already achieved successes.

Uneven implementation of policies: what can be done?

The implementation of evidence-based tobacco control measures across EU member states remains uneven. All EU countries monitor tobacco use and have large pictorial health warnings, but only 8 have achieved full smoke-free environments and only 4 countries have comprehensive advertising, promotion and sponsorship bans. In 14 EU countries, cigarettes have actually become more affordable since 2014, eroding progress. As of 2024, only 6 of 27 EU countries had banned e-cigarette flavours, and approximately half of the EU Members States apply partial restrictions on e-cigarette advertising.

While EU member states face diverse challenges in implementing the WHO FCTC, 2 key obstacles are consistently reported by countries: the rise of new and emerging tobacco and nicotine products taking advantage of legislative gaps in EU tobacco control directives, and persistent interference by the tobacco industry.

Over 2 decades, the EU has shown how coordinated legislative action can change public health trajectories. The forthcoming revisions of the EU directives, including the Tobacco Products Directive (TPD) and the Tobacco Taxation Directive, will be decisive for achieving the EU goal of a "tobacco-free generation" by 2040 - defined as less than 5% of the population using tobacco.

"The WHO/Europe report stresses that to address current regulatory gaps and ensure long-term public health protection, a revised and future-oriented TPD is needed. Moreover, without robust safeguards, regulatory processes remain vulnerable to industry tactics that undermine public health objectives, thus full implementation of Article 5.3 of the FCTC - protecting policy-making from industry influence -remains essential to drive further progress," said Kristina Mauer-Stender, WHO/Europe Regional Advisor for Tobacco Control.

Europe's leadership and the road ahead

According to the WHO/Europe analysis, strengthening taxation and smoke-free measures, banning all flavours, introducing plain packaging across all nicotine products and closing online advertising loopholes could accelerate progress dramatically.

"The EU's renewed leadership, strong vision and ambition in tobacco control are critical not only for protecting the health of its citizens but also for setting a global example," added Ms Mauer-Stender.

"A tobacco-free Europe means much more than just a policy goal reached. It means a future where children grow up free from addiction, where the air is cleaner, and where health and well-being are shared values for all."