Despite the massive crackdown on smoking in the form of bans and taxes, coupled with well-coordinated misinformation around emerging Tobacco Harm Reduction (THR) alternatives, World Health Organisation (WHO) data shows that at least 8 million smokers continue to die from smoking-related diseases on an annual basis while one million non-smokers who are exposed to second-hand smoke also die from passive smoking.
By Michael Gwarisa
Overall smoking rates in Africa remain low by international comparisons, with a prevalence of 8.4 percent across the continent. While smoking prevalence is relatively low on the African continent, the World Health Organisation further states that the number of total tobacco users in Africa will increase to 62 Million, of whom 51 Million will be smoking combustible tobacco by the year 2025. The increase will largely be driven by the significant population growth the continent is experiencing as well as growing stress levels. The rest of the world, however, is expected to experience a decrease in smoking prevalence.
This is notwithstanding overwhelming scientific evidence of improved public health outcomes and declining smoking-related morbidities and deaths in countries that have adopted smoke-free and other non-combustible nicotine products. Countries such as Sweden, Iceland, and Norway have adopted Snus and have displaced cigarettes. Sweden now has one the lowest Cancer death rates in the world and is set to be declared Smoke Free according to the criteria WHO. New Zealand, the United Kingdom, and the United States of America have adopted E-Cigarettes and are also en route to displacing combustible cigarettes.
Speaking to Journalists during an Ask Me Informative Session on Tobacco Harm Reduction, Clive Bates, the Director of Action on Smoking and Health UK said current public health efforts were driving people into adopting harmful smoking practices.
If a risk-averse and precautionary approach makes e-cigarettes less accessible, less palatable and acceptable, more expensive, less consumer friendly, pharmacologically less effective, inhibits innovation, then it causes harm by perpetuating smoking. If you think you being tough on Vaping, it may turn out that you are actually being soft on smoking and you are driving people back to smoking or putting barriers in the way of quitting and that’s a really bad thing for public health,” said Bates.
Data from a study that was published by JAMA Paediatrics in 2021 shows that between 2017 and 2019, Teenage smoking increased following an e-cigarette flavors ban in San Francisco.
There are currently a number of novel nicotine products on the market and these either don’t use any heat at all or they use electricity to heat an aerosol. These include Vaping products, heated tobacco (heat not burn), unheated nicotine products, and more traditional smokeless tobacco and Snus. According to Bates, all these products are capable of delivering nicotine but without significant exposure to harm and to toxins.
“Switching is going to be a far easier thing to do than asking them to quit smoking completely. The demand for nicotine is much more robust and resilient than the demand for any particular way of taking it. What this heralds is the end of smoking. That 8 Million per year death toll. We are beginning to see how that will end now.
“When people switch to these products, they are exposed to much lower levels of all the toxicants that we know are harmful and associated with smoking. Either the toxicants are too low to detect or the levels are very much lower but generally, the studies find that there is a very much lower toxic burden and in some cases right down to the same level as non-smokers to people who quit completely.”
Bates further said when people smoke, what they really want is the nicotine and the experience of nicotine. However, contrary to the popular belief that nicotine is the disease-causing agent in tobacco, Bates said nicotine was not among these carcinogens tobacco but toxins produced during combustion have a negative effect on public health.
“People smoke for nicotine but die from the tar. People are smoking as a nicotine-seeking behavior and the demand for nicotine is very strong. People want nicotine whether we like it or not. This is where technology comes in because we now have a range of products that can give people nicotine but without the tar, without the combustion, and without the smoke. Smoking is the inhalation of the products of combustion.”
While other countries in the first world have moved on, and adopted policies that support harm reduction, Africa and other low middle income countries still maintain laws that seek to derail tobacco harm reduction efforts. South Africa is currently dealing with a proposed new tobacco bill which is moving towards
prohibiting various forms of nicotine use including vaping.
South Africa’s Dr Kgosi Letlape, Founder of the African Harm Reduction Alliance said there are currently no relevant or modern policies in Africa on Tobacco.
“When you look at the WHO Framework Convention for Tobacco Control (FCTC), you find that it was basically adopted in 2023. At the time that the FCTC was adopted, there was really only one non-combustible product that was on the market. One would either get nicotine by combusting it by chewing it or by grinding it, putting it in your mouth. Those were called smokeless tobacco. There were associated harms in relation to smokeless tobacco, these include oral cancers, etc.
“Looking at the FTCT, it is inappropriate to be used as a framework to look at alternatives to combustible cigarettes. In the FTCT, there is Article 1 D, which speaks about Harm Reduction in relation to the challenges presented by Tobacco products. If you fast-track to now, you cannot apply the FCTC as it is to the risk-reduced products. What any well-meaning nation needs to do is to look at a framework for regulating the RRPs appropriately. Regulation is necessary but must be based on evidence and must be based on science,” said Letlape.
A report by the Royal College of Physicians concluded that although it is not possible to quantify the long-term risk associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5 percent of those associated with smoked products, and may well be substantially lower than 5 percent. According to data, alternative nicotine delivery systems have the potential to disrupt the 120-year dominance of the cigarette.
