Cigarette smoking is deeply rooted in North Macedonia. Smoky cafes are the rule rather than the exception in a country where tobacco is one of the main agricultural crops and smoking is one of the leading causes of death. Five days after New Year’s Day, the Ministry of Health published draft amendments to the Tobacco Control Act, which once again sparked intense public debate.
If the proposed changes are adopted, strict rules will be introduced for places where cigarettes and other nicotine products are allowed, with high fines for violations. In restaurants, smoking will only be allowed on completely open terraces without barriers. The ban will apply to all public buildings, areas around kindergartens, schools, and medical facilities, as well as private cars when children are present. The measures will also cover electronic cigarettes.
The draft also provides for a complete ban on advertising and promotion of tobacco products, as well as sponsorship by the tobacco industry of cultural and entertainment events, including awareness campaigns. The law is scheduled to come into force on March 1 and provides for fines of €150 to €300 for individuals and €2,000 to €5,000 for legal entities, depending on their size.
The health argument
The Ministry of Health states that the main objective is to strengthen the protection of public health and prevent tobacco use, especially among children and young people. “The message is clear – the system helps smokers quit without stigmatising them. Nicotine addiction is a medical and public health problem. Prevention is more effective and cheaper than treatment. The aim of this law is not to punish, but to prevent the consequences of smoking,” said Health Minister Azir Aliu.
According to the World Health Organization, 45% of the adult population in North Macedonia smokes, the highest rate in Europe. The average rate in the European Union is 24%. In Serbia and Bulgaria, 39% of people smoke, in Croatia – 38%, and in Bosnia and Herzegovina – about 35%.
National statistics are alarming: nearly 4,000 people die each year as a result of smoking cigarettes or other nicotine products. Smoking is responsible for over a third of lung cancer cases and a significant proportion of cardiovascular diseases.
The medical community unsurprisingly supports the changes. “Smoke-free laws have rapid and measurable health effects—a decline in acute cardiovascular events and improved respiratory health among vulnerable groups. Restricting tobacco in public spaces also changes social norms: some smokers cut back or quit, and it becomes more difficult for young people to take up the habit,” explained Dr. Alexander Mitov, a public health specialist.
The economic stakes
The other side of the argument is the economy. Tobacco and the related industry account for 3.2% of the country’s gross domestic product. North Macedonia is among the thirty largest producers in the world, with tobacco accounting for about 20% of exports. In 2024, producers received nearly €40 million in state subsidies – a record amount.
Among the most active opponents of the project are small traders – owners of kiosks, specialty shops, and neighborhood grocery stores. They warn of the risk of closure of over 4,000 small family businesses that are heavily dependent on the sale of cigarettes and nicotine products. “Changing a business model does not happen overnight. Without a transition period, we face contract terminations, financial losses, layoffs, and for many, permanent closure,” they warn.
The government is determined to push through the changes without compromise. The opposition, led by the Social Democratic Union of Macedonia, accuses the ruling VMRO-DPMNE party of using the law to divert attention from the country’s structural problems. The declaration of this “legislative war” on smoking has polarized public opinion, and on social media, the debate is mainly between smokers and “passive smokers.”
In a comment for the Prisma website, journalist Zvezdan Georgievski describes the law as misguided and discriminatory. In his words, it is a normative act that protects non-smokers, rather than a law against smoking, with no real benefit for people who have been smoking for decades and have consciously made that choice.
Producer and radio host Kostadin Shurbanovski defends the opposite position, stating that non-smokers are a discriminated minority who have been exposed to daily suffering in public spaces for too long, and that a radical change is necessary if the country wants to catch up with the civilized world.
On the subject of passive smoking, Dr. Mitov is categorical: “There is no safe level of exposure. For those working in establishments, exposure is repeated and systematic. Neither ventilation nor the separation of spaces can completely eliminate the toxic substances in tobacco smoke.”
The first law on protection from tobacco smoke in North Macedonia was adopted in 1995. The current legal framework is already relatively strict, but it is often circumvented and applied only formally. The new amendments will only have a real effect if they are consistently and strictly enforced. | BGNES