By Munyaradzi Blessing Doma
The African Tobacco Control Alliance (ACTA) defines Tobacco Harm Reduction (THR) as a public health strategy aimed at lowering the health risks to individuals and society associated with combustible tobacco products. This approach is based on the understanding that most harm linked to tobacco use comes from the chemicals released and inhaled when tobacco is burned. By removing the burning or smoking element, the risks from tobacco consumption are significantly reduced.
ACTA further notes that THR acknowledges a critical reality: many adults who smoke and wish to quit find it difficult or impossible to do so, while others prefer to continue using nicotine but seek safer ways to do it.
THR advocates therefore encourage smokers to switch to alternative products that deliver nicotine without burning tobacco. For these advocates, switching is the key concept. The freedom to switch, the availability of safer options, and access to accurate information about reduced-risk products are essential pillars of an effective Harm Reduction strategy.
Growing Calls for Harm Reduction in Africa
In recent years, proponents of THR have intensified their advocacy for its adoption across Africa. They highlight scientific evidence supporting its effectiveness and cite success stories from countries that have embraced Harm Reduction. Research shows that THR is particularly relevant to Africa due to the continent’s rising smoking rates, the heavy burden on fragile healthcare systems and the difficulty of enforcing traditional tobacco control measures.
Although smoking prevalence in African countries is relatively low at around 14 percent compared to other regions, the tobacco industry continues to target Africa’s youthful population through aggressive marketing campaigns. As a result, tobacco use is increasing rapidly. Projections suggest that by 2025, the smoking rate in sub-Saharan Africa could become the highest among all World Health Organisation (WHO) regions.
According to the Global State of Tobacco Harm Reduction’s Briefing Papers, the WHO estimates that the number of tobacco users in Africa will rise to 62 million, with 51 million smoking combustible tobacco.
A number of African countries are already exploring THR as a public health intervention. These include Burkina Faso, The Democratic Republic of Congo, Kenya, Malawi, Nigeria, South Africa, Uganda, and Zambia. Advocacy groups and projects in these countries focus on promoting safer nicotine products and providing scientifically accurate information on nicotine consumption.
Prohibitive Policies as a Hindrance to THR in Africa
Tobacco Harm Reduction faces a myriad of challenges in Africa, chief among them being restrictive policies that treat non-combustible smoke-free products in the same manner as cigarettes that produce carcinogens. According to tobacco control data, countries with the most restrictive nicotine policies in Africa include Ethiopia, Gambia, Mauritius, Seychelles, Uganda, Ghana and South Africa.
In South Africa, the cabinet has approved the draft Control of Tobacco Products and Electronic Delivery Systems Bill, which proposes a ban on smoking in all public buildings and within 10 metres of buildings. The Bill extends the definition of smoking to include electronic delivery systems, including e-cigarettes and heat-not-burn tobacco products.
Dr Kgosi Letlape from the Africa Harm Reduction Alliance believes the current Bill was based on 2015 information and takes a moralistic position. Dr Delon Human, from the same organisation, also noted that the government wants to treat e-cigarettes in the same way as traditional tobacco products, falsely conflating vaping with smoking and wrongly attributing the growth of the vaping industry to tobacco companies.
Opportunities for Public Health Gains
This growing trend highlights the enormous opportunity that THR presents in reducing non-communicable diseases, suffering, and premature deaths. Access to appropriate, affordable, and well-regulated safer nicotine products could help create a smoke-free Africa at minimal cost to governments. This makes THR particularly suitable for low- and middle-income countries such as those in sub-Saharan Africa, where healthcare resources are already stretched.
In an interview with Health Times, Joseph Magero, Chairperson of the Campaign for Safer Alternatives, said THR is especially vital for Africa because millions of smokers still lack access to safer nicotine products.
“Tobacco Harm Reduction matters in Africa because millions of smokers across the continent lack access to safer nicotine alternatives, resulting in preventable disease and death, even as knowledge and technology for reduced-risk products already exist,” said Magero.
He added that when governments rely heavily on donor-driven agendas rather than local public health needs, tobacco policies often fail to reflect African realities, including high smoking prevalence, limited cessation services, and the growth of black markets.
Implementation Gaps in Tobacco Control
According to TRT Afrika, while many African countries have ratified the WHO Framework Convention on Tobacco Control (FCTC)—which calls for monitoring tobacco use, offering cessation services, placing graphic warnings on products and banning tobacco advertising—implementation remains weak.
“In Africa, only a handful of countries have taken meaningful steps to embrace and regulate safer alternatives to combustible tobacco. Others, such as Eswatini, remain quiet or show little interest in mitigating tobacco-related harm,” the report notes.
WHO data shows that there are 44 parties to the FCTC in Africa, and smoking prevalence remains around 14 percent for men. Although this is the lowest rate among WHO regions, overall numbers are rising due to population growth and tobacco industry marketing.
“Countries with the highest prevalence include Eswatini at 18 percent and South Africa at 17 percent, while Ghana, Ethiopia and Nigeria record some of the lowest rates,” reads the WHO report. “Rapid population growth and increasing purchasing power are expanding tobacco markets, aided by aggressive industry efforts to expand across Africa.”
Even the WHO acknowledges that smoking rates are increasing in Africa, a sign that Harm Reduction has never been more important for the continent.
A Double Disease Burden
While millions of Africans continue to smoke without access to less harmful alternatives, the region faces a double burden of disease—communicable illnesses such as HIV and tuberculosis alongside a growing wave of non-communicable diseases such as cancer, heart disease and stroke. Smoking is a major risk factor for these conditions, which places immense strain on under-resourced healthcare systems.
Despite many African countries ratifying the WHO FCTC, weak enforcement and limited funding mean that control laws often exist only on paper.
A Pragmatic Way Forward
THR, which involves offering less harmful nicotine alternatives such as e-cigarettes, heated tobacco products, and nicotine pouches, provides a pragmatic solution for adult smokers who are unable or unwilling to quit using traditional cessation methods. Rather than replacing conventional tobacco control strategies, Harm Reduction complements them by reducing exposure to the toxic chemicals produced by burning tobacco.
Public education also remains a major challenge. Information about the dangers of smoking is not always effectively communicated, especially in marginalised communities. Misconceptions about nicotine persist, with many believing nicotine itself causes most tobacco-related diseases.
“Harm Reduction helps clarify that while nicotine is addictive, it is the burning of tobacco that produces most of the toxic substances responsible for illness and death,” notes a research paper on THR.
A Call to Action
By adopting and integrating Harm Reduction strategies, African countries can provide adult smokers with safer options, save lives and reduce future health and economic burdens. With smoking rates projected to rise, embracing THR could mark a turning point in Africa’s fight against tobacco-related diseases. It offers a practical, evidence-based approach that complements traditional control efforts and aligns with Africa’s growing need for sustainable, locally relevant public health solutions.
