UK vs Netherlands Two THR Approaches: Pragmatic Regulation or Prohibition?

United Kingdom: A Decade of Harm Reduction Leadership

The UK Government was an early adopter in recognising the positive public health role of Vapour Products in accelerating the decline of cigarette smoking. Along with public health organisations, it has created an environment that has resulted in millions of smokers switching to e-cigarettes^[7],[8], contributing to increased reductions in smoking prevalence. Since 2015, successive governments and independent public health bodies have consistently communicated that, while not risk-free, e-cigarettes are significantly less harmful than combustible cigarettes^[9].

Public Health England’s landmark 2015 evidence review, which concluded that e-cigarettes are “approximately 95% less harmful to your health than normal cigarettes”, set the tone for policy, regulation and healthcare practice^[9]. This evidence-led stance has since been cited (and further refined through repeated independent reviews) by the Office for Health Improvement and Disparities (OHID), the Royal College of Physicians, NICE and the MHRA amongst others^{[10],[11],[12]}.

In the most recent review published by the OHID, it concluded: “Based on the reviewed evidence, we believe that the ‘at least 95% less harmful’ estimate remains broadly accurate, at least over short term and medium term periods. However, it might now be more appropriate and unifying to summarise our findings using our other firm statement: that vaping poses only a small fraction of the risks of smoking^[13].”

Public Health Integration and Smoking Decline

Independent public health advocacy supporting Vapour Products as a Tobacco Harm Reduction tool has shaped the NHS’s approach to smoking cessation, contributing to the formal inclusion of e-cigarettes within national smoking cessation guidance^[15] and their adoption by NHS Stop Smoking Services^[16]. In April 2023, following the Khan Review, the Department of Health and Social Care (DHSC) launched the “Swap to Stop” programme, offering a vaping starter kit with behavioural support to one million smokers in England^[17]. This was done despite the fact that vaping products are neither medically licensed nor marketed as smoking cessation aids.

Strong and consistent institutional endorsement has translated into real-world action and likely contributed to the increasing decline in smoking rates. Between 2014 and 2024, adult smoking prevalence fell from 18.1% to 9.1%, while vaping prevalence more than doubled from 4.2% to 10%^{[1],[14],[18]}.

Underpinned by the adoption of Tobacco Harm Reduction principles, smoking prevalence has continued to decline in the UK, placing the country on a credible pathway to achieving its 2030 smokefree target^[2],[19]. More recently, the UK government has increasingly sought to embed elements of THR within legislation, most notably through the Tobacco and Vapes Act (2026), which endeavoured to combine restrictive population level smoking controls with an ongoing role for alternative nicotine products, “enabling vapes to be accessible and effective to adult smokers seeking to quit”^[20]. Whilst the legislation aims to maintain access to Vapour Products for adult smokers, the imposed tighter controls on their sale, flavouring and marketing may ultimately constrain their accessibility and appeal as alternatives to smoking.

Netherlands: Prohibition in Practice

In stark contrast to the approach taken thus far by the UK, the Netherlands adopted a highly restrictive policy approach. In January 2024, the country implemented a national flavour ban, restricting legal Vapour Products to tobacco flavour only, accompanied by a scientifically unsupported list of just 16 permitted ingredients^[21]. In practice, the regulation rendered the vast majority of legal products non-compliant, with only around 0.2% of previously available tobacco flavoured liquids likely to meet the new requirements^[21].

The methodology used to determine the 16-ingredient list raises serious concerns about its practicality and scientific robustness. Rather than being grounded in comprehensive toxicological risk assessment, the ingredient list was derived from regulatory database filtering and statistical modelling^[21]. Because flavour perception depends on complex interactions between ingredients and their concentrations, reducing tobacco flavour creation to a short list of substances is unworkable in practice, risking the elimination of vaping products adult smokers would find acceptable as alternatives to continued smoking. Early evaluation and enforcement data from government and public health authorities suggest the prohibitionist policy in the Netherlands may have produced significant negative consequences^[5].

Behavioural and Market Consequences

Post-implementation evaluation by the Dutch National Institute for Public Health and the Environment (RIVM) revealed significant disruption among adult e-cigarette users, with over one fifth of users quitting Vapour Products entirely^[5].

Although reduced nicotine consumption may appear beneficial at first glance, this perspective is incomplete without considering the behaviours that followed vaping cessation. While many individuals, who stopped vaping, did not immediately substitute another product, a meaningful proportion did (27%); among this group, the most predominant behaviour observed was a return to smoking^[5]. This would suggest that removal of product attributes critical to the acceptability of Vapour Products for adult smokers, such as flavours, can undermine the central public health objective of reducing smoking-related harm by cigarette smoking.

The RIVM evaluation also provides clear evidence that the flavour ban displaced demand for flavours rather than eliminating it. Prior to the ban, 91.4% of users consumed non-tobacco flavours. Following the ban, this fell to 47.0%, demonstrating a substantial reduction but not elimination of flavoured product use^[5].