In a welcome step forward from the weak text-only ‘smoking can be deadly’ and similar warnings that have thus far graced cigarette packs, Germany is set to introduce graphic health warnings.

Despite tentative progress in recent years, Germany has historically been one of Europe’s poster children for tobacco control legislative failure. That reputation may begin to change from 20 May, when gory pictures of black lungs, dead bodies and other consequences of smoking will be plastered over two thirds of the surface area of cigarette packs, in line with European Union regulations.

While the news is welcome, much remains to be done: Germany has long languished near the bottom of European countries for its many shortcomings in tobacco control policy and implementation.

Although some smoke free legislation is in place, lax advertising restrictions have allowed tobacco companies to continue to use advertising billboards in Germany – one of only two European countries which have not yet outlawed such a blatant violation of the FCTC. Even neighbouring Austria, the perennial ‘rogue state’ of European tobacco control, does not allow cigarette billboards.

According to the German Cancer Research Center, 121,000 people die from smoking-related causes each year, representing 13.5% of all deaths in Germany. There are significant regional variations in the country, with the percentage of smoking-related deaths as high as 23% in some places.

The introduction of graphic health warnings signals a pivotal moment which it is hoped will be the beginning of serious tobacco control legislation and the inexorable decline of smoking in Germany.