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Tobacco harm reduction critical if smoking-related disease is reduced in Africa

The second edition of Africa Tobacco Harm Reduction forum was held last month in Nairobi, Kenya. Convened by Campaign for Safer Alternatives in collaboration with Africa Harm Reduction Alliance, the forum provided a platform to engage, challenge and exchange ideas, where pivotal issues on ending smoking in Africa.

Dr Kgosi Letlape
Dr Kgosi Letlape

The conference, which was attended by over 50 delegates from across Africa as well as international medical experts, heard that the current approach of governments in Africa is not working. Even though nine out of 10 smokers think nicotine pouches or vapes/e-cigarettes are the most effective quitting tool, countries in Africa continue to have regulatory environment that is unsupportive of these products.

Hare, safer nicotine alternatives are barely known, accessible, and thus, used by the population. A panel with African experts shared their experience on tobacco harm reduction in their countries and the challenges of the continent regarding smoking related diseases, policy issues and the need for a unified approach with other substance use disorders.

Dr Kgosi Letlape is a medical doctor and healthcare leader in South Africa and former president of the World Medical Association (WMA). He did not use doublespeak when mentioning accountability regarding international and national policies.

“Tobacco harm reduction is something we have to fight for. We sit in a society where our leaders have abandoned thinking for themselves. So, they are going to listen what others say like the WHO. But what the WHO says is not the right thing. I am not optimistic, but I am going to fight so that we create the right policies… At the end of June 4, million had died worldwide from Covid after 18 months and the world is panicking.

“Every year 8 million smokers lose their lives to smoking related diseases and the world is still sleeping. Smokers are human too. And I hope all of us will rise to make sure that what happens to smokers doesn’t happen. We need to convince our lawmakers to make policies appropriate for the 21st century. If we can prevent one daily death, it is something to be celebrated,” he said.

In low- and middle-income countries, indeed, access to these products remains labourious.

“We need to advocate for appropriate regulations. One of the key issues for Africa, is to ensure that the regulations that come up don’t make alternatives to cigarettes unaffordable to the ordinary people. We need to apply a different tax regime to the less harmful products so they can be price competitive with combustible cigarettes otherwise people won’t switch because they don’t have the money,” said Dr Letlape.

He also criticised the lack of information available to consumers, saying: “If nicotine was the problem, why would we have NRT? Misinformation is propagated by the WHO encouraging governments to misinform the population. In my country more than 70% of people think that e-cigarettes are more harmful than combustible cigarettes. The access to credible information that is truthful on product themselves and more importantly, the availability of products is key.

“They need to be able to make informed choices and governments need to ensure that there is availability of the different products. If you look at the FCTC, part of its recommendation is about cessation programs. But when you look in Africa, there’s a clear non availability of those. They are very few that offer cessation. And even in those cessation clinics, they need to be open to what appeals to smokers. Don’t give them what they are not going to use. Move away from ‘quit or die’.”

Tobacco is the leading preventable cause of death in the world and the African region is experiencing an increasing rate of tobacco use, according to the World Health Organisation. The WHO framework convention on tobacco control – ratified by 44 African countries – aims at reducing tobacco use, focusing on prevention and cessation mostly. Whereas tobacco harm reduction is considered as an intermediary and pragmatic solution for those who want to quit but cannot.

Unfortunately, the WHO has lost sight of this in recent years. But it is not too late, it must focus on the future of millions of smokers on the continent – a future that is much brighter should they switch to safer nicotine alternatives – rather than its own counter-productive “quit or die” dogma.

By Joseph Magero (Chair, Campaign for Safer Alternatives)

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