Tobacco harm reduction: Why not eliminate?

Tobacco use remains the greatest preventable cause of death globally, killing up to half of all its users. It is known for being the leading risk factor for most noncommunicable diseases, including heart disease and cancer.

There are over 7,000 chemicals present in tobacco smoke and among these, at least 250 are known to be harmful and at least 69 are known to be carcinogenic (World Health Organisation). Nicotine, one of these chemicals, is the addictive substance in tobacco and has hooked over 1.1 billion smokers globally among which 80 per cent live in low-and middle-income countries.

Given that tobacco kills up to half of its users, it does not come as a surprise when WHO estimates (July 2019) that about 8 million people die globally every year due to tobacco consumption.

Tobacco control has for the longest time fought the prevalence of tobacco use and exposure to second-hand smoking through prevention and treatment. These efforts have, however, been frustrated repeatedly by the tobacco industry, which continues to come up with new and innovative ways to prevail in the market, the latest of which is the introduction of the so-called “harm reduction” products. A leading cigarette manufacturer in Kenya has announced plans to build a Sh2.5 billion plant to manufacture nicotine pouches, one such product. 

“Harm reduction” is not a new strategy. Industry actors argue that cigarette filters and filter perforations are designed so as to block out chemicals such as tar and nicotine. However, the impact is insignificant as smokers draw harder from the cigarettes and cover the holes to compensate. Nicotine-based products are now common in the form of pouches and Electronic Nicotine Delivery Systems (Ends), also known as e-cigarettes.

Following intense industry marketing, these products are now popular around the world. For instance, in the US, e-cigarettes were used by over 3.6 million middle and high school children in the year 2018. This prompted a raft of regulatory measures, including a ban of use in indoor and public spaces, disclosure of ingredients, packaging and their marketing. Even with these measures, deaths were reported after an outbreak of a lung illness associated with vaping/ e-cigarette use.

There are still mixed feelings about Tobacco Harm Reduction (THR), with one school of thought supporting it on the grounds that smokers hold a right to choose to use ‘less harmful’ forms of nicotine and no ban should be imposed upon these products. On the other hand, those opposing argue that use of the ‘less harmful’ forms of nicotine may deter people willing to stop smoking from quitting, while exposing them to other unintended harm healthwise.

In Africa, smoking prevalence is growing and effects on public health is dire. “Harm reduction” products, such as e-cigarettes, are becoming increasingly popular with our youth, thanks to the power of social media advertising. More often than not, they serve as a gateway to cigarette/tobacco use and not as a safer alternative. Our regulatory systems are weak and unable to contain these products strictly as prescribed drugs (as is the case in the West). We need to be worried. 

The WHO advises that there is still no consensus on the effectiveness of “harm reduction” strategies. More research is, therefore, needed from independent, public health-driven sources. Industry-driven “harm reduction” strategies have a narrow approach and are meant to drive the interest of the industry to make profits through the sale of alternative products (including nicotine pouches and e-cigarettes) in the wake of tightening regulation on tobacco products around the world.

Rather than call for “harm reduction”, we should be arguing for “harm elimination”, which is possible through effective implementation of the WHO Framework Convention on Tobacco Control (FCTC), our Tobacco Control Act 2007.

International Institute for Legislative Affairs