Despite effort by Africa in achieving some of the Sustainable Development Goals (SDGs), reducing tobacco use has proved the hardest to deliver. Reducing tobacco use plays a major role in global efforts to achieve the SDG target to reduce premature deaths from non-communicable diseases (NCDs) by one-third by 2030.
Significant disparities in health outcomes around the world are driven by unequal access to essential health products. Scientific advances have led to the creation of new nicotine delivery products that have saved millions of lives. Yet new products may not be readily accessible to those in need due to a variety of factors, including systemic challenges caused by weak regulatory oversight, particularly in Africa.
Far too many Africans die as a result of smoking. Yet far too few Africans who try to stop smoking actually succeed in doing so. It’s clear that the “quit or die” approach to tobacco control is not working on our continent, where cigarette consumption is on the rise in stark defiance of global trends.
If we are serious about saving lives, we’d do well to look at how that fight is being won in other parts of the world. And that means rethinking the way we look at nicotine. Evidence shows that alternative nicotine products, such as tobacco-free pouches and e-cigarettes or vaping devices, can deliver nicotine with dramatically reduced risk compared to traditional ‘combustible’ cigarettes.
Most African countries have ratified the Framework Convention on Tobacco Control (FCTC), an evidence-based treaty that reaffirms the right of all people to the highest standard of health. While there has been some success in its execution, this international legislation focuses primarily on non-health related approaches to tobacco control – including price and tax measures to reduce demand, strategies to reduce smuggling, indoor air laws, and limits on tobacco advertising – but fails to directly address smoking cessation and harm reduction strategies.
In countries where these products have been embraced, smokers have been quitting in vast numbers, and hundreds of thousands of lives have been saved. Like many others, I used nicotine pouches to quit smoking entirely. It’s fair to say they saved my life and they are the reason I am a Tobacco Harm Reduction (THR) advocate.
THR is centered on a simple concept: people smoke despite the health warnings in order to get nicotine, but nicotine in and of itself is not the problem. The majority of harm caused by cigarettes is from the burning of tobacco, which releases dangerous toxicants. Tobacco harm reduction is a strategy intended to reduce the health risks associated with smoking to individuals and the wider society. This may be achieved by using an alternative product which is less harmful than cigarettes.
Nicotine is addictive but not otherwise very harmful, as shown by the long history of people safely using nicotine replacement therapy (NRT) products, such as nicotine gum or nicotine patches. Quitting is the best approach, but for smokers who can’t or don’t want to quit, alternative nicotine products help them to reduce their health risks.
Leading scientists around the world now agree on this.
Public Health England says that vaping is 95% less harmful than smoking cigarettes, and that finding is backed by anti-tobacco groups such as Cancer Research UK, the Royal College of Physicians, and Action on Smoking and Health (ASH). Health bodies in the US, France, Canada, and New Zealand also back vaping as the less harmful option.
There are millions of former smokers like myself who are deeply grateful for that option.
Vaping helps 50,000-70,000 smokers quit in the UK every year, according to a study funded by Cancer Research UK. In France, 700,00 have kicked the habit thanks to vaping, according to the French national Health Barometer.
Sweden, where there is the highest consumption of nicotine pouches, reports the lowest smoking rates in Europe, while the ratio of men suffering tobacco-induced cancers is less than half of the EU average. The evidence is compelling. And the technology for achieving such promising results is also progressing.
Smokers who vape are almost twice as likely to quit as smokers who use NRT. Around half as many Britons now vape as smoke and the majority are ex-smokers. How we wish we could emulate this sort of success in Africa, where there are 250,000 deaths every year from a smoking-related disease.
It shouldn’t be an affordability issue. Not only are vapers and nicotine pouches effective, but they also cost the government nothing while helping to reduce the disease burden from smoking. Yet policymakers in Africa appear reluctant to embrace such innovation.
Tobacco control efforts here have concentrated on increasing tobacco taxes, restricting or banning advertising, adding or expanding warning messages, and restricting smoking in public areas – advocating just quitting without offering a viable alternative. Information plays a major role. Smokers seeking lower-risk products should have easy access to communications about their benefits and safe use.
Cost is also a big factor. Many smokers cite the desire to save money as the main reason for wanting to give up cigarettes. But if an e-cigarette is the same price as a traditional cigarette or even dearer, it’s harder to break the habit and the opportunity is lost.
Safer alternatives must be affordable if large numbers of smokers are going to migrate away from cigarettes. Ready availability is also essential and reassurance is needed in the form of regulations enforcing age restrictions and quality control.
The industry is evolving and consistent collaboration is needed between regulators, scientists, and health professionals to ensure public health policy is evidence-based. Some opponents of THR claim vaping and pouches are a ‘gateway into smoking for young people. But this claim doesn’t stand up to scrutiny. Despite health officials proactively promoting nicotine products in the UK, their research shows that regular use amongst youth is rare and that most users are current or ex-smokers.
We need to ditch our dogma surrounding nicotine and open our minds to proven solutions.
A lag in regulatory approval of safer nicotine products in sub-Saharan Africa can mean the difference of life or death for smokers waiting for access to these proven alternatives.
By Joseph Magero (Chairman, Campaign for Safer Alternatives)
