- However, international evidence suggests quite the opposite approach is necessary if we wish to reduce our high smoking rates.
- To reduce smoking rates in Kenya we need to adopt a robust evidence-based regulatory and enforcement system.
Image: COURTESY
New proposals before the government risk missing an opportunity to save lives and reduce the public health burden caused by cigarette smoking.
The Medium-Term Revenue Strategy (MTRS) includes a plan to harmonise taxes on nicotine-safe alternatives with those imposed on combustible cigarettes.
However, international evidence suggests quite the opposite approach is necessary if we wish to reduce our high smoking rates.
Alternative nicotine products like electronic cigarettes and nicotine pouches as well as Nicotine Replacement Therapies such as nicotine patches, nicotine gums, nicotine inhalers, nicotine sprays and nicotine lozenges are proven to be far less harmful than combustible cigarettes[1] and are the most successful method for helping smokers to quit[2].
Taxing these reduced-risk products the same as combustible cigarettes will not only send the wrong message to smokers about their risks but will also financially disincentivise smokers from moving to products that could save their lives.
The government should rather be regulating and taxing nicotine products according to their risk profile to help reduce the public health burden from smoking. It’s an approach that has been used elsewhere such as England and Sweden and it can save lives.
The strategy proposed in the MTRS is not evidence-based and is based on a false premise, that tobacco and nicotine are equal. Banning of reduced risk products as advocated by some will not work and will likely lead to the proliferation of the black market and hence the need for regulation.
But nicotine is not the same as tobacco. Nicotine does not cause cancer and has been on the World Health Organization’s (WHO) list of essential medicines for decades in the form of nicotine replacement therapies such as nicotine gums, nicotine patches and nicotine sprays.
Electronic cigarettes and nicotine pouches as well as Nicotine Replacement Therapies such as nicotine patches, nicotine gums, nicotine inhalers, nicotine sprays and nicotine lozenges do not contain any combustible tobacco as traditional cigarettes, thus are less harmful1. They also do not produce second-hand smoke as harmful as combustible cigarettes.
E-cigarettes, Varenicline and Cytisine are also much more effective than traditional methods of quitting smoking, such as nicotine gums or nicotine patches2. A recent study published by Cochrane showed that people who use modern alternatives are more likely to quit smoking for good than people who use other methods.
The best evidence of the benefits of alternative nicotine products is playing out in Sweden. In the past 15 years, the Swedes have cut their smoking rate from 15 to 5.6%.
In the next few months, they are set to become the first country to achieve ‘smoke-free’ status when that rate drops below 5%, the level at which a country is officially classified by the WHO as smoke-free.
The Swedes have achieved this historic milestone - 17 years ahead of schedule - in large part by primarily focusing on cigarette smokers and making alternative nicotine products accessible, acceptable and affordable for adult smokers.
Sweden now boasts Europe’s lowest incidence of smoking-related diseases and fewest premature deaths due to tobacco-related causes. Lung cancer fatalities in the country are less than half the EU average, and overall cancer deaths are 38% lower.
These striking figures highlight the substantial beneficial impact that alternative nicotine products can have on public health and individuals’ well-being.
Sweden is proving that alternative nicotine products help smokers to quit and thereby save lives.
To reduce smoking rates in Kenya we need to adopt a robust evidence-based regulatory and enforcement system, key focus on cigarette smokers through a Stop Smoking Services Department and a risk-based taxation system like Sweden’s, with high-risk products like tobacco being taxed the most and less risky tobacco-free alternative nicotine products taxed at a lower rate to incentivise smokers to switch to these safer alternatives under the guidance of trained health professionals under the Stop Smoking Services Department.
In September, the Swedes announced a 20% reduction in taxes on safer nicotine alternatives to further assist their smokers to quit.
The same month, the MTRS heralded higher taxes on alternative nicotine products in Kenya, where 8,000 people continue to die every year from tobacco-related illnesses.
The juxtaposition could not be more ominous. Kenya is setting itself on the wrong path, in defiance of international evidence. The chance to emulate Sweden’s smoke-free success story will be missed and many thousands more Kenyan lives will be unnecessarily lost.
Every smoking citizen should be informed of the evidence-based alternatives they have to assist them in quitting smoking combustible cigarettes and the relevant authorities need to implement a robust regulatory, enforcement and taxation mechanism for these products and accelerate the formation of a Stop Smoking Services Department.
Dr Kariuki is a medical doctor, public health specialist and the Secretary Harm Reduction Society Kenya, he can be reached on- [email protected]