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Friday, September 29, 2023

Lawmakers should throw a lifeline to Africa’s smokers

While global smoking rates decline, the figures for Africa are some of the highest in the world.

Tobacco smoking
Tobacco smoking

Cigarette consumption on the continent rose by 52 percent between 1980 and 2016, from 164 billion cigarettes to 250 billion.

Lesotho’s smoking rates soared from 15% of its population in 2004 to 54% in 2015.

Tunisians are estimated to smoke 4.4 cigarettes per day for each person over the age of 18.

Such statistics make for depressing reading.

They should drive smart thinking about how to reduce the 250,000 lives lost to tobacco every year across the continent.

But ill-advised policies fed by misinformation, especially on nicotine and harm reduction, and the unaffordability of safer nicotine products are condemning Africa’s 77 million smokers to early deaths.

The problems run deep. Some sections of society in Africa still believe that people who smoke are weak, and they deserve to be punished.

That attitude informs the ‘quit or die’ approach to tobacco control that is still so prevalent here.

But evidence-based research suggests that Africa and other lower- and middle-income countries (LMICs) – where 80% of cigarette smokers live – should embrace tobacco harm reduction as a matter of urgency.

Global studies have shown that there are three main driving forces behind reduced smoking. They are an increased awareness of the dangers associated with smoking, an increase in the price of cigarettes with taxes included, and finally, the availability of low-risk alternatives.

One of those safer alternatives – the oral nicotine pouch – appears to be particularly pertinent for Africa, where there is a tradition of using oral stimulants.

Sweden, the country with the highest consumption of nicotine pouches, reports the lowest smoking rates in Europe, while the ratio of Swedish men suffering tobacco-induced cancers is less than half of the EU average.

Yet, in defiance of such science, authorities in my home country Kenya last year chose to suspend the sale of nicotine pouches. And last week the anti-tobacco lobby in Kenya renewed its calls for pouches – and other alternative nicotine products – to be priced beyond the reach of most consumers.

Instead of our smokers being given their best chance of quitting their deadly addiction, the lobbyists seek to have that opportunity placed beyond their reach.

To be fair to our policymakers, many simply take their cue from the World Health Organisation (WHO).

This guidance is proving to be a curse for LMICs when it comes to smokers.

Higher-income countries have seen their smoking rates decrease rapidly in recent years.

Significant disparities in health outcomes around the world are driven by unequal access to essential health products.

Affordability of these products is usually the main culprit, but higher-income countries also have access to a wider range of information.

International research shows that alternative nicotine products are 95% less harmful than traditional cigarettes, which release dangerous toxicants through the burning of tobacco.

Organisations such as Public Health England, the Royal College of Physicians, the US National Academies of Science Engineering and Mathematics and the influential anti-smoking pressure group Action on Smoking and Health advocate that smokers use alternative nicotine products to give up cigarettes.

But LMICs often do not have the resources to carry out the kind of evidence reviews conducted in the UK and the USA. Instead, they rely on agencies such as the WHO to set the agenda.

And WHO, as revealed in its latest global tobacco report, is dead set against alternative nicotine products.

The WHO’s own Framework Convention on Tobacco Control (FCTC) explicitly defines “tobacco control” as “a range of supply, demand and harm reduction strategies” to reduce tobacco consumption. But its practical endorsement of tobacco harm reduction is woefully absent.

While it has been strongly supportive of harm reduction in other contexts, such as the use of condoms to reduce HIV transmission, the WHO gets tobacco harm reduction very wrong.

Its qualified support for products such as nicotine gum and nicotine patches rings particularly hollow in Africa, where they are priced well beyond the reach of most smokers.

The only LMIC that offers a full cessation programme is Senegal. NRT programmes are expensive and for Africa they are a costly and unrealistic aspiration. Nicotine pouches and e-cigarettes by comparison cost governments nothing.

Safer nicotine products are working in developed countries. They helped me quit and I believe they can work in Africa and other LMICs if we allow them to.

Legislators must listen to the science and not the dogma and make these lifesavers affordable and accessible.

By Joseph Magero (Chair of the Campaign for Safer Alternatives – CASA)

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