There is unanimity across the world on the need to reduce smoking rates among people. Whether it is the ubiquitous cigarettes, or cigars or water pipes known locally as shisha in Nigeria, every concerned stakeholder wants a drop, indeed a continuous drop in smoking rates. While cigarettes have always received the most attention, people are beginning to also realise the danger that shisha portends especially to young people among whom it is increasingly popular.
However, the manner of achieving the desired drop in smoking rates has continued to breed contention among different parties.
The popular African adage “there are different routes to a destination” was a subtle way our forebears chose to remind us all that the destination was the ultimate objective. It stands to reason that rather than foible over routes, it is all fair and good, so long as one arrives at the desired destination or achieves the set objective.
Indeed, never has this adage been as relevant as it is today in Africa’s quest to achieve a reduction in smoking rates. As the arguments continue over the route to this destination, prohibitionists, the school of thought that believes that smoking rates will be achieved only by getting smokers to quit altogether, continue to vilify tobacco harm reduction advocates and simultaneously deny the success of tobacco harm reduction programmes.
Tobacco Harm Reduction (THR) is a public health strategy aimed at lowering the health risks to individuals and the wider society associated with combustible tobacco products. It is based on the understanding that most of the harm associated with combustible tobacco results from the mix of chemicals that are released and subsequently inhaled when tobacco is burned(smoked), but if you take the smoking/burning element away, the risk from tobacco consumption is reduced.
THR also takes into cognisance, the fact that many adults who smoke, and wish to stop smoking, find it difficult or are unable to quit, while several others wish to continue enjoying nicotine without the harmful effect it poses.
Consequently, THR advocates posit that such smokers should switch to alternative products, which will still deliver nicotine without the combustion of tobacco.
For THR advocates, switching is the operative word. Hence, the freedom to switch; the availability of options to switch to; and access to information on alternative or reduced risk products to enable adult consumers make informed choices are key drivers of an effective THR strategy.
Lately, proponents of THR have increased their advocacy for its adoption across Africa arguing for its efficacy by explaining the science behind the concept and citing successes recorded in countries that have accepted the ideology of Tobacco Harm Reduction.
Notably, THR advocates also agree that quitting remains the best option and regularly underscore this fact. But they have chosen a pragmatic approach with the understanding that quitting and switching will both achieve the objective of reducing smoking rates.
Science and evidence from more advanced economies supports the position of THR advocates that smoking rates can significantly reduce through the adoption and effective implementation of tobacco harm reduction strategies.
The United Kingdom for instance, has recognised the efficacy of tobacco harm reduction or alternative tobacco products in driving down smoking rates such that the National Institute for Health and Care Excellence (NICE), which issues evidence-based guidance on the most effective methods of prevention, diagnosis and treatment of diseases and ill health, published a guidance on tobacco harm reduction. The guidance recognizes that quitting smoking is always the best option for smokers but it supports the use of licensed nicotine containing products (NCPs) to help smokers not currently able to quit to switch to a less harmful option.
The United States of America’s (USA) food and drug administration (FDA) has begun to license alternative products as “modified risk tobacco products.” This is a clear indicator that the country is relying on its science and empirical evidence to provide guidance on tobacco harm reduction.
Smoking rates are reported to have reduced by 34% in Japan, chiefly on the back of the introduction of alternative products in the country; products that avail the citizens the opportunity to switch to less risky options and not straight jacketing them to quitting only. This was detailed in a December 2020 report by Frost & Sullivan, a world renowned consulting firm who noted that the establishment of effective regulation was vital.
In Canada, the government through Health Canada has issued science backed statements such as “Completely replacing cigarette smoking with vaping will reduce your exposure to harmful chemicals” and “Vaping products and e-cigarettes deliver nicotine in a less harmful way than smoking cigarettes” among several others as advise to adult smokers in a bid to move them away from combustible tobacco products. The Canadian Public Health Association also recognises the efficacy of alternative products and has since 2018 issued statements that acknowledge that alternative nicotine delivery products are less risky than combustible tobacco.
Also, the ministry of health of New Zealand launched a website called Vaping Facts, in 2019 to educate citizens on the facts about vaping with the objective to help smokers quit. The website encourages smokers to vape as a means to quit and has widely published content that indicates that vaping is less risky than smoking. This is another clear example of a country with a science and facts-based approach to tobacco harm reduction.
African countries need to independently assess every route that can lead to the desired destination of reduced smoking rates. Their ministries of health and other health agencies, including members of the academia, must begin to commission independent studies not just on tobacco harm reduction but on myriad public health issues that affect their citizens.
This is what would enable the development of optimal policies and regulatory frameworks that will effectively drive concurrent cessation and tobacco harm reduction programmes.
Who is bold enough to take the lead on Tobacco Harm Reduction among the African nations?
Nojeem Adetuberu is a public health advocate based in Lagos.