Kenya has a problem with cigarette smoking. Too many people are dying from tobacco-related disease as smokers repeatedly try – but fail – to give up the habit.
Although international evidence suggests that Tobacco Harm Reduction can significantly cut smoking rates and minimise the risks posed by cigarettes, too often this innovative policy is met with suspicion and opposition.
How to overcome those obstacles and start saving millions of lives was the central focus of delegates at the Global Forum on Nicotine in Warsaw, Poland, recently.
THR is a policy of moving adult smokers away from traditional combustible cigarettes, which cause the vast majority of tobacco-related illness, towards less risky alternatives, such as vaping products and oral nicotine pouches.
In many high-income countries where THR has been embraced, zero-tobacco nicotine products are improving the lives of millions of smokers who had failed to quit cigarette smoking.
According to the French national Health Barometer, 700,000 cigarette smokers in France have quit thanks to vaping.
In the UK, around half as many Britons now vape as smoke cigarettes, and the majority are ex-smokers. A University College London study funded by Cancer Research UK suggested that vaping may help more than 50,000 cigarette smokers to quit each year in England.
The effectiveness of ‘Swedish snus’, a type of modified oral tobacco pouch, in reducing smoking incidence and tobacco-related disease is evident in Sweden, where there is the highest consumption of pouches and the lowest cigarette smoking rates in Europe. Tellingly, the Swedish rate of tobacco-related lung cancer for men is less than half the European Union average.
The US Food and Drug Administration has endorsed snus as less risky than cigarettes and allowed snus to be advertised as lowering smokers’ risk of “mouth cancer, heart disease, lung cancer and stroke”. It said the benefits of introducing snus outweigh the risks of non-smokers using it.
Meanwhile, Research at Georgetown University in Washington DC shows that 6.6 million lives could be saved in the US over the next 10 years by switching cigarette smokers to vaping.
Public Health England says that vaping products are 95 per cent less harmful than cigarettes, and that finding is backed by anti-tobacco groups such as Cancer Research UK, the Royal College of Physicians and Action on Smoking and Health.
Furthermore, some nicotine products have been found to be more than twice as effective at helping smokers to quit as traditional nicotine replacement therapies such as lozenges, gums and patches, which are on the World Health Organization’s list of essential medicines.
Yet, despite such compelling evidence, policymakers have shown resistance to Tobacco Harm Reduction in Kenya and other low-income and middle-income countries, where about 80 per cent of global tobacco users live.
In many instances, misguided regulation, over-taxation and even prohibitions of THR products are foiling their life-saving potential, delegates at the GFN heard.
In one plenary session, speaker Dr Mark Tyndall highlighted the dangerous contradictions around THR by providing a telling comparison with lessons learned from HIV prevention and care.
Dr Tyndall, a former executive director of the British Columbia Centre for Disease Control in Canada, said global HIV mortality rates had fallen sharply following the introduction of harm reduction methods such as needle exchange programmes for IV drug users and condoms.
When it became apparent that drug users were getting infected with HIV through sharing dirty needles, healthcare services began to supply them with sterile needles. The transmission of HIV was significantly reduced.
It was a classic example of harm reduction in action: instead of stigmatising and isolating drug users, which might exacerbate their addiction, safer alternatives were provided, risks were reduced and lives were saved.
Dr Tyndall went on to highlight another massive disparity between the global success in tackling HIV and the efforts to combat the world’s cigarette smoking epidemic.
As a result of massive investment in HIV access to care, more than 80 per cent of people with HIV are now under treatment globally, according to UNAIDS.
In comparison, said Dr Tyndall, less than one per cent of people who smoke cigarettes are under treatment. “This is a type of structural violence,” he declared.
Denying cigarette smokers access to and information about THR amounts to an infringement of their human rights, delegates heard.
Providing smokers with the correct information on safer nicotine alternatives would enable them to make informed decisions. Denying them that information and accessibility is effectively denying them their right to life.
In short, Dr Tyndall said advocates of Tobacco Harm Reduction are fighting for the rights of cigarette smokers, who have been deprived of a say in their own future.
It is a message that our public health policymakers would do well to heed here, where too often the official approach to tobacco control amounts to a binary option: quit or die.
Almost two in every three smokers in Kenya want to quit cigarettes. Yet only a small minority succeed and our smoking rates remain stubbornly high.
For our policymakers to use the same methods over and over again and expect a different result is not only simply irrational. It is also wasting time and costing lives.
Medical doctor. [email protected]
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