On January 20th, 2022, the virtual Harm Reduction Exchange took place with two panels of discussions that were held around the hot topic of Harm Reduction. The first https://allafrica.com/stories/202201270843.htmladdressed risk reduction in various areas such as cancer, skin bleaching and drug use,whilst the second one addressed more specifically Tobacco Harm Reduction. This event was organized by Integra Africa (Pan-African Brand and Strategy consulting company) in collaboration with Philip Morris International (PMI).
During the second panel discussion, Dr KgosiLetlape from South Africa could not have made it clearer. Among other influential positions, he is the former President of the World Medical Association and current President of the African Medical Association and a strong advocate for tobacco harm reduction: “Knowledge is power. One of the major problems in Africa is lack of knowledge and the abundance of misinformation. The major problem in tobacco is the combustion of tobacco. There isvast amounts of scientific evidence that shows that it is the combustion that is the problem not the nicotine. One of the major things that has come up from the United States is the Federal Drug Administrationgiving certain approvals to certain ways of getting the nicotine. Smokeless tobacco has been allowed to make claims of being less harmful. Non-combustion to heat-not-burn technologies from Iqos (PMI heat-not-burn product) has been given the permission to communicate about reduced exposure. These are indeed milestones for Tobacco Harm Reduction.”
It is now scientifically known that what kills people is not nicotine but the combustible toxicants in the cigarette. Michael Russell, who is considered as the father of Tobacco Harm Reduction, used to say: “People smoke for the nicotine, but they die from the tar”.
For Dr Letlape, the misinformation around tobacco is so strong that people don’t know that critical information: “So when I say knowledge is power it is about re-educating the public. It’s about creating spacefor truthful information to be available so people can make informed decisions. “
For him, the entity that is most responsible for this global misinformation is the World Health Organization (WHO): “Remember the WHO is the very organization that promoted the banning of snus in Europe.The elephant in the room in terms of knowledge in Africa is the WHO. When it comes to tobacco they are misinforming the world. “
In fact, the WHO affirms that its main concern with these nicotine alternatives to cigarettes are that they may be too riskybecausethey could appeal to the youth. In a report published in 2020, the organization stated:
“While cigarettes remain the most used form of tobacco products, there is a concerning trend emerging from the use of electronic cigarettes (or e-cigarettes). According to the latest available data, young people are turning to these products at an alarming rate. The new report reveals that in some countries the rates of e-cigarette use among adolescents were much higher than those for conventional cigarettes. In Poland, for example, 15.3% of students smoked cigarettes and 23.4% used electronic cigarettes in 2016.”
Dr Letlape also urged African leaders “to take their responsibility” and trust science:
“We need leaders that are now going to embracethe responsibility of leading Africa and not following what comes out of our colonial masters…I have been listening to the conversation around skin bleaching. When you are born dark you want to be light in order to enjoy certain benefits of lightness.The tragedy is that we have not really advancedour African society to a point where people will benefit without having to change who and what they naturally are. We have held on to western ideas of what is good because we haven’t created an environment that promotesself-love… I would like our leaders to lead, and they must engage. The notion of “The Bible says” or “The WHO says”is something that must be set aside. It should be: “we have looked at what happened in Sweden. And as Africans we have engaged and collectively and agree that this is what the science says but we have not acted accordingly. Amazingly, many African governments have followed the science when it comes to Covid 19. We hope they willnow also follow the science when it comes to Tobacco Harm Reduction.”
Smoking could kill 8 million people each year by 2030 according to the World Health Organization.In spite of all the systemic obstacles,Tobacco Harm Reduction activism in Africa doesn’t settle but continues to push forward. Many organizations around the continent are trying to bring about policy change that can save lives.
Harry Shapiro is Director of DrugWise – an online drug information service – and Managing Editor of DS Daily – the daily online drug, alcohol and tobacco news service. He has worked in the drugs field for 40 years. He has been working with Knowledge-Action-Change promoting public health through Tobacco Harm Reduction. He said:
“There are now Tobacco Harm Reduction consumer activists’ groups in South Africa, Malawi, Uganda, Kenya, Zambia, Democratic Republic of Congo and Nigeria. Many of the diseases attributed to tobacco smoking could be reduced by reducing exposure to tobacco toxicants that are created when it burns. I think it Is fair to say that whatever tobacco controls are in place across the world, they are simply not enough toput a significant end to those awful projections. In the interest of global public health, a sensible and pragmatic response would be to take seriously the opportunities offered by the advent of safer nicotine products whichindependent evidence shows are substantially safer than smoking.”
Joseph Magero is the Chairman of Campaign for Safer Alternatives (CASA), a pan-African organisation that advocates for the adoption and promotion of Tobacco Harm Reduction policies in Africa. He is one of the key leaders for Tobacco Harm Reduction in the continent:
“Reducing smoking is vital to public health. We must be aware that Tobacco Harm Reduction has great benefits both economically and for health and encouraging smokers to use safer nicotine products should be supported by governments in Africa. In order to tackle the harmful effects of tobacco in developing countries, in particular Africa, products such as snus, vaping products, heat -and-not burn products and all nicotine products that offer alternatives to smoking traditional cigarettes should be made available and affordable.“
Despite the fact thatthe rate of tobacco use is declining globally, he expressed his concerns for African farmers who may not benefit from this decrease:
“The global decline of smoking has many positive effects but can also bring negative economic consequences for farmers, many of who are, in Africa, particularly in Malawi, Zimbabwe and South Africa. In order to address the impact of smoking cessation, our governments should focus on identifying sustainable opportunities for tobacco farmers.”
Tobacco use is the most preventable death in the world. According to the WHO, the prevalence rate of tobacco smoking in Africa is 14% but its growth rate is the highest in the world.