Why Adopting Harm Reduction Policies for Africa is Crucial

Today, our continent is at a crossroads in its long journey to reduce the immense health toll of smoking cigarettes. Turn one way at this crossroads, and we will continue to see many, many thousands of Africans needlessly dying every year from tobacco-related disease.

Turn the other way, and along the path of tobacco harm reduction, and we will see those unnecessary deaths being prevented and millions of lives being saved in the years ahead.

At Africa Harm Reduction Alliance (AHRA), we passionately believe we should take the latter path as soon as possible before more lives are lost. We will get to the scientific evidence informing that belief later, but to begin with, let’s address the human element at the very core of this issue. That is, the cigarette smoker.

If you’re a cigarette smoker, it is incredibly difficult to give up the habit. Nearly two-thirds of Africa’s millions of smokers say they want to quit. However, only a tiny fraction succeeds in doing so.

Going ‘cold turkey’ is extremely hard. Turning away from combustible cigarettes to safer nicotine products has been doing so around the world for millions of smokers who had almost given up on giving up.

The scientific evidence in support of tobacco harm reduction products - which include nicotine pouches, snus, patches, and gums, as well as vapes - is overwhelming. Every year, the main public health body in the UK publishes an annual review of vaping’s impact.

Its most comprehensive study to date recently reaffirmed its conclusion that vapes are significantly safer than combustible cigarettes, and are the most effective tool for helping smokers to quit. It’s no wonder then that health authorities in the UK, and other wealthy countries around the world, are embracing vapes as part of their programs to reduce tobacco use to 5% or less of their population.

Consequently, as vaping rates in these countries increase, smoking rates decrease. Remarkably, Sweden is about to become the first nation to reach that 5% target – the level which is officially classed as ‘smoke-free’.

And it has done so by making safer alternatives to cigarettes - including vapes, nicotine pouches and snus - both available and affordable for adult smokers. Sweden has the highest consumption of nicotine pouches, but the lowest smoking and tobacco-related disease rates in Europe. Tellingly, Sweden’s tobacco-related mortality rate is 44% lower compared to men elsewhere in Europe.

Over in the USA, the Food and Drug Administration says pouches “will significantly reduce harm and the risk of tobacco-related disease to individual tobacco users and benefit the health of the population as a whole”.

Such success stories deserve serious consideration in Africa, where smoking rates are going in a different direction. When the Tobacco Atlas report was published in May, it was able to boast that smoking rates have declined globally for the first time on record.

Tragically, Africa could not share in any celebrations. The report found smoking rates had actually increased in 10 countries on our continent. In most other African countries, rates remain stubbornly high.

So, what is it that we can do to solve this issue? We need to correctly inform people about the risks of combustible cigarettes and potential journeys to quit, right? That would be ideal, but sadly, it’s not happening because misinformation is at home in most of Africa relating to THR solutions.

It is more than simply disappointing to see how THR products are officially regarded across our continent. These life-saving products have been met with open hostility and ignorance from some activists and pressure groups here, who mistakenly refuse to distinguish between cigarettes, tobacco, and nicotine.

Consumers in some parts of Africa have been bombarded in recent months with misinformation condemning alternative nicotine products that are helping cigarette smokers around the world to give up their deadly habit.

These dangerous myths claim – amongst other misguided allegations – that tobacco-free vapes and nicotine pouches are just as harmful as traditional cigarettes, and any evidence to the contrary is “unproven, likely false”.

Yet the real peddlers of unproven claims and falsehoods are the anti-tobacco advocates who have lost sight of the goal of saving lives. While claiming to have smokers’ interests at heart, their approach is quit or die.

Vapes and nicotine pouches offer adult smokers the chance to move away from deadly cigarettes to far less harmful products. To deny smokers access to these safer products is tantamount to condemning them to premature death.

While activists have used little science to back up their sensational claims, the evidence to support the use of alternative nicotine products is extensive and compelling. And it cannot simply be dismissed as all evidence gleaned from western nations bearing little relevance to conditions and customs on our continent.

There is a lot of work ahead in this sense for African countries. Disseminating technical information and combating misinformation, myths, and distortions about non-combusted nicotine products and nicotine itself is a fundamental responsibility that all stakeholders, both public and private, must assume.

Sadly, too many policymakers in Africa align with activists by refusing to draw a distinction between tobacco and nicotine. Taxes on alternative nicotine products are so high they are priced out of reach of smokers whose lives they could save.

Instead of these products being taxed according to their relative risk, smokers are being denied the opportunity or incentive to switch to safer options; they are forced to stick with traditional cigarettes, meaning tobacco’s immense burden on our public health increases.

In South Africa, Parliament is about to consider the Tobacco Control Bill, which for the first time will regulate e-cigarettes and other new-generation products in much the same way as tobacco.

Despite mounting evidence that vaping is a viable smoking cessation tool, the South African Health Department has lumped it in the same category as tobacco products. This is short-sighted, seeing that the Bill supposedly seeks to reduce the incidence of tobacco-related illness, disability, and death. It is likely the outcome will ultimately be the opposite.

Limited resources across our continent mean many public health systems offer severely limited options or services to help smokers quit. Often there is no toll-free quit line, no smoking cessation counseling services at hospitals, and no smoking cessation clinics.

Yet, in spite of these systemic obstacles, tobacco harm reduction advocacy in Africa continues to push forward. Many organizations around the continent are trying to bring about policy change that can save lives. Africa Harm Reduction Alliance (AHRA) is one such organization already having a positive impact.

Everyone in this debate – from politicians to the general public – needs to acknowledge that the major problem in tobacco is the combustion of tobacco. There are vast amounts of scientific evidence that shows it is the combustion that is the problem, not the nicotine.

We need to use that evidence to re-educate the public and we need to create space for truthful information to be available so people can make informed decisions. To help smokers to quit cigarettes, the relative risk of nicotine products needs to be properly understood, acknowledged, and, most importantly, communicated to adult smokers.

Only then will individuals be able to make an informed choice and use nicotine more wisely.

By Joseph Magero