The Need for Tobacco Harm Reduction in Sub-Saharan Africa

    Sub-Saharan Africa must urgently embrace tobacco harm reduction, according to a new briefing paper published by Knowledge-Action-Change (KAC), a public health group based in the United Kingdom.

    “By global comparisons, smoking prevalence is relatively low across the continent of Africa,” the author, THR Malawi founder Chimwemwe Ngoma, writes. “Yet by 2025, the World Health Organization (WHO) projects the total number of tobacco users in Africa will increase to 62 [million], of whom 51 [million] will be smoking combustible tobacco. The opportunities to reduce the burden of non-communicable disease, suffering and premature deaths presented by tobacco harm reduction (THR) are therefore huge. Appropriate, accessible and affordable safer nicotine products (SNP), supported by product regulation, could help create a smoke-free Africa and, unlike most tobacco control interventions, this can be achieved at minimal cost to governments.”

    The paper calls for governments to take advantage of “the fact that smokeless tobacco has been used in the continent for centuries.”

    The briefing, which notes that there are already 200,000 smoking-related deaths per year in Sub-Saharan Africa, highlights the work being done by consumer advocacy groups in the vast region amid a swirl of misinformation perpetuated by the international health establishment, a lack of affordable safer nicotine products, weak health care systems, and not much awareness, generally, of THR. It also includes a breakdown of smoking prevalence per country (Lesotho ranks highest, and Ethiopia lowest).

    A number of African countries, including Malawi, are economically reliant on tobacco grown to be exported worldwide, complicating THR efforts and raising questions about alternative livelihoods for farmers.

    More specifically, as with many low- and middle-income countries, nations in Sub-Saharan Africa simply do not have adequate access to SNP like heated tobacco products (HTPs), snus or e-cigarettes. Many African THR advocates are calling for e-cigarettes to be made more affordable. But experts also suggest that snus, a form of oral tobacco with substantially fewer risks than smoking, can be a more realistic option than vapes in some African contexts because of its low cost and other factors. (It also allows for some continued tobacco farming.)

    “Sub-Saharan Africa needs safer nicotine products that are locally feasible, affordable, appropriate, accessible and culturally acceptable.”

    The new paper, published as part of KAC’s Global State of Tobacco Harm Reduction project, similarly calls for governments to take advantage of “the fact that smokeless tobacco has been used in the continent for centuries” and “suggests that low-risk oral products (snus and nicotine pouches) could play an important role.”

    However, governments in Sub-Saharan Africa are heavily influenced by recommendations from the WHO, which has repeatedly doubled-down on its mission to destroy safer nicotine alternatives. Under the WHO’s guidance, some countries—like Uganda, Mauritius, Seychelles and Ethiopia—have already banned the sale of e-cigarettes. Poor health care provision also makes it difficult for smokers to even access nicotine replacement therapy (NRT) products, the paper notes, and little public knowledge of THR “means that consumers and stakeholders often make uninformed decisions regarding personal and public health.”

    “To become smoke-free, Sub-Saharan Africa needs safer nicotine products that are locally feasible, affordable, appropriate, accessible and culturally acceptable, supported by sensible product regulation,” Ngoma said in a press statement. “For this to happen, governments in Africa should strive to remain independent, conduct their own social economic impact assessments and make science-based policies that embrace tobacco harm reduction.”

     


     

    Photograph of Old Town Lilongwe, Malawi by Brian Dell via Wikimedia Commons/Public Domain

    The Influence Foundation, which operates Filter, has received grants from KAC. Filter‘s Editorial Independence Policy applies.

    • Alex is Filter’s news editor. He previously worked as a reporter and copy editor at VICE, and has been published in The New York Times MagazineThe Columbia Journalism Review, The Los Angeles Times and The New Republic, among other outlets. He was also previously a freelance editorial consultant for the Foundation for a Smoke-Free World; The Influence Foundation, which operates Filter, has received grants from the Foundation for a Smoke-Free World. He is currently based in Los Angeles.

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