Choosing life: Kenya told it must increase taxes on tobacco

This year marks two decades since Robert Ndegwa lost his voice.

He had life-saving surgery to remove his voice box, which had been eaten up by cancer, in 2003.

This part of the throat contains vocal cords, some stretchy bands of tissue that contract or relax to produce sounds. You can hardly be able to speak without it.

Ndegwa says his vocal cords developed cancerous tumours because of years of smoking cigarettes.

The entire voice box, or larynx, was removed in India in a 12-hour surgery.

“By the time I came out of the theatre, I didn’t have a voice box and I could not talk, I could only whisper. All these are consequences of cigarette smoking. I started smoking while in high school,” he said.

Although he lost his voice box, Ndegwa now tours schools raising his voice against tobacco.

He uses an electrolarynx, an instrument which is held to the neck to produce a robotic sound. The device costs Sh120,000.

The Ministry of Health invited him to the World No Tobacco event at the University of Nairobi last year.

He made it clear the government must raise taxes to make cigarettes unaffordable to children or be ready to buy thousands of electrolarynx for young smokers who might lose their voices later.

According to the World Health Organization, half of all tobacco users are eventually killed by tobacco-related diseases such as cancer, diabetes and heart disease.

In Kenya, tobacco use kills at least 9,000 Kenyans annually, according to the Ministry of Health

Thousands more, such as Ndegwa, are left incapacitated.

This year marked the first time the government did not raise taxes on tobacco in five years, following successful lobbying from the industry.

The WHO says tobacco taxation is the single most effective measure for reducing tobacco consumption and its associated health burden worldwide.

It saves lives while increasing revenues for the government and saving poor households money when their members quit smoking.

Taxes are a particularly effective tool for discouraging youth uptake of cigarettes.

Youth and young adults are two to three times more likely to respond to changes in prices than adults.

That is due to their lower incomes, which make them more price sensitive, and the shorter amount of time spent smoking compared to older smokers, which makes them likely to be less addicted. Higher cigarette prices also make it more likely that adult smokers will quit.

This is according to the WHO report on the global tobacco epidemic 2021.

Yet tobacco companies in Kenya continue to use their substantial financial resources to delay and undermine efforts to raise tobacco taxes.

“Tobacco taxation serves not only as a powerful tool for curbing tobacco consumption but also for generating much-needed revenue to finance the healthcare system and combat health issues caused by the use,” Tharaka Nithi Governor Muthomi Njuki, who also chairs the health committee at the Council of Governors said.

Njuki notes Kenya generates $815 million every year from tobacco taxes. However, Kenyans spend three times that amount to treat diseases caused by tobacco.

The Kenya Tobacco Control Act adds a solatium contribution of two per cent of the sales tobacco companies make, payable to the government, but it is still unclear if they pay and how this money is spent.

Muthomi says the government must ensure transparency on how tobacco taxes are spent.

He argues these taxes would make a bigger difference in promoting tobacco cessation programmes and public awareness programmes.

“It is time for the government to take bold steps to ensure that those affected benefit from the profits generated in tobacco use,” he said.

“The council of governors remains committed to supporting initiatives to curb tobacco use and its effects on the health of a population."

Peter Kubebea, chairman of the National Taxpayers Association, a governance thinktank, says increased tax offers a double solution: cessation of tobacco consumption resulting from unaffordability and higher revenue to the government.  

“Tax reform remains key in strengthening policy measures that can concurrently save millions of lives, reduce poverty, and increase countries’ domestic resources for financing development,” he said.

However, the current taxes account for about 52 per cent of cigarette retail price, far below the recommended WHO minimum of 70 per cent.

In 2019, the NTA set out to review and examine cigarette taxation in Kenya and how it affects cigarette consumption.

Using the WHO Tobacco Tax Simulation Model (TaXSiM), NTA examined the effects of cigarette tax policy changes on cigarette consumption in Kenya.

A key observation of the study – titled Study on Effects Of Tobacco Taxation on Tobacco Consumption in Kenya – is that Kenya uses a tiered tax structure that is inferior to a uniform tax in reducing consumption of tobacco and enhancing excise tax revenue.

Since, 2022, cigarettes with filters are taxed at Sh3,825.99 per 1,000 cigarettes and unfiltered cigarettes are taxed at Sh2,752.97 per 1,000 cigarettes.

“The government through the National Treasury and Planning Ministry should reform the tax structure to conform to best practice by introducing a uniform tax rate that gradually moves the country to achieve the 70 per cent share of tax in the total retail price of cigarettes,” the organisation recommended.

NTA CEO Irene Otieno said: “Significant efforts have been made by Kenya to increase tobacco taxes, however, the prevailing rates which account for about 52 per cent of the retail selling price, still fall below the recommended WHO minimum of 70 per cent.”

Cyprian Mostert, a health economist at the Brain and Mind Institute at Aga Khan University, has an interest in tobacco control.

He said the tobacco industry continues to employ ways to reduce the taxes they should pay.

“The industry is holding on to Sh19 billion annually by refusing to pay the fair tax advocated by the World Health Organisation.”

He said the industry has a long history of fighting taxes that would help the government and protect the public.

“The tobacco industry pushed back against the cigarette excise tax by interfering with the political process to improve taxation. The share of taxes on tobacco’s retail price fell from 75 per cent in 2008 to 23 per cent in 2020,” he said.

NTA’s Kubebea notes interference by the industry is one of the biggest challenges in Kenya.

“Despite the progress made in global recognition of the importance of tobacco control in the development agenda and to the protection of public health, new tobacco control challenges are constantly arising which include but are not limited to tobacco industry interference,” he said.

Kubebea also noted the industry has used the same tactics to introduce new, harmful products which are not regulated.

“Therefore, continuous review of our laws and regulations, specifically on tobacco control, will ensure that we progressively improve the existing regulations and laws,” he said.

The Kenya Tobacco Control Alliance (Ketca), the umbrella body for all tobacco control lobbies, says the affordability and easy accessibility of tobacco and alcohol products are some of the biggest challenges Kenya faces.

Says Joel Gitali, Ketca chairman: “A report by the Ministry of Health in Kenya stated that tobacco and alcohol products are often sold at low prices, making them more accessible to individuals of all ages, including children.”

Cigarettes have no benefit to a human being but contain thousands of chemicals and 70 of them are known to cause cancer.

On its website, cigarette maker BAT Kenya fights annual tax increases claiming they may not discourage smokers.

“While some smokers may choose to quit, or smoke less, large and sudden tax rises may not always result in reduced overall tobacco consumption. Hikes in excise tax may lead smokers to access the illegal market for cigarettes or lead to greater price differences between nearby countries, encouraging tobacco smuggling across borders,” it says.

Gitali said this is not true.

He said higher taxes on these products act as a deterrent by increasing their overall cost, making them less affordable.

“Studies have shown that higher prices can significantly decrease tobacco consumption, especially among vulnerable populations such as youth and low-income individuals. By curbing tobacco use, higher taxes contribute to reducing the burden of related health issues and associated healthcare costs.”

Ketca national coordinator Thomas Lindi says the tobacco industry must not be allowed to influence tax policies because that would be against the Framework Convention on Tobacco Control, the WHO treaty that Kenya signed in 2004.

“Allowing the tobacco and alcohol industry to have a say in setting tax rates can create conflicts of interest and undermine public health goals. The WHO emphasises the need to protect public health policies from interference by the tobacco industry," Lindi said.

When he spoke last year at the World No Tobacco Day event at the University of Nairobi, Ndegwa pressed the vibrating head of the electrolarynx to his neck and moved close to the microphone as if to speak louder.

The gadget produces a vibration that is transferred through the skin to the throat. The speaker shapes this sound into words with the mouth, tongue, lips, and teeth.

Ndegwa’s only regret was that his voice was still higher than tobacco taxes. Which means more lives were being lost. And that has not changed.