By OMBOKI MONAYO
Samwel Cudjoe Hanu, a leading expert on tobacco harm reduction, strikes a compassionate tone in his approach to a complex public health issue plaguing the African continent.
“When a patient comes to our treatment centers for assistance, we are compelled to suspend our judgement of his or her choices by professional principles,” says Hanu, who heads the Harm Reduction Alliance in Ghana.
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“This is because we recognize the danger of having a holier-than-thou attitude towards people that need our help. It will not only complicate the process of recovery, but also provoke a negative reaction from these individuals.”
Tobacco use remains a significant public health burden in Africa, with a 2023 report by the African Union Health Commission estimating that the continent shoulders “a significant public health burden from tobacco use.”
Hanu, in a presentation at the recent Harm Reduction Exchange held in Nairobi, Kenya, explained that the concept of harm reduction seeks to help tobacco smoking addicts manage and eventually quit smoking by providing “less harmful alternatives to combustible cigarettes, including e-cigarettes, heated tobacco products (HTPs), and oral nicotine products.”
However, Africa faces unique challenges in implementing effective tobacco control measures.
Hanu, a harm reduction advocate in Ghana and the West African sub-region who focuses on mental health and substance use disorders, identifies “inadequate funding and regulatory structures to reduce and prevent harm caused by tobacco use.”
He acknowledges the diverse regulatory landscape in Africa, “with countries adopting different approaches based on their specific contexts and capabilities.”
Some nations have implemented comprehensive tobacco control measures aligned with the WHO Framework Convention on Tobacco Control (FCTC), while others “struggle with enforcement and regulatory capacity.”
Economic disparities also play a significant role in shaping regulatory approaches to tobacco harm reduction.
Wilson Box, who is the Projects Executive Director at the Zimbabwe Civil Liberties and Drug Network, explains.
“High-income countries often have the resources to implement and enforce sophisticated regulatory frameworks, while low- and middle-income countries may face resource constraints that limit their ability to effectively regulate novel nicotine products.”
The debate around the role of the WHO-FCTC in shaping global approaches to tobacco control and harm reduction is also a central concern.
Box says, “Despite this pivotal role played by the WHO-FCTC, there is an ongoing debate about whether the FCTC’s relatively rigid stance on novel nicotine products adequately serves the interests of countries with high smoking prevalence rates.”
In Kenya, the impact of tobacco use is dire, with an estimated 9,000 to 12,000 deaths from smoking-related causes each year.
In response, the Kenyan Senate is considering the Tobacco Control (Amendment) Bill, 2024, which aims to incorporate modern nicotine products into the Tobacco Control Act of 2007, despite the fact that nicotine is not the same as tobacco.
Dr. Vivian Manyeki, a Kenyan researcher and medic at the Kenyatta National Hospital (KNH), highlights the need for a compassionate approach in combating addiction.
“We are judgmental in undermining colleagues that are addicted to various substances. It is, however, important to recognize that most of us are struggling with addiction in one form or another,” she says.
“Harm reduction is about saving people’s lives. It requires a pragmatic and compassionate approach that recognizes the diversity of human behavior, which involves meeting people at their point of need.”
She is categorical that harm reduction presents one of the workable solutions to resolving the problem of addiction, adding that regulations that seek to outlaw it will lead to the loss of lives, which goes against basic tenets of humanity and morality.
“It is immoral to watch people die from consuming something you know will kill them, especially when there is an alternative, and you could guide them through the journey,” she says.
On her part, Dr. Mercy Korir, a health journalist, medic and communication consultant, identifies areas that require improvement in Kenya’s Tobacco Control Act.
“Empirical evidence from other countries has shown that harm reduction efforts can go a long way in reducing smoking prevalence and a corresponding drop in smoking-related cancer rates,” she says.
“Our tobacco regulatory framework should move in tandem with the times and be driven by scientific evidence to support its provisions. One of the ways to do this is to include harm reduction principles and specifications in the law to provide smokers with the assistance they need to overcome and abandon the habit,” she states.
Box further notes that the global approach to tobacco harm reduction represents a complex intersection of public health policy, economic interests, and regulatory frameworks.
He cites the United Kingdom as a case study, where “the UK has adopted a progressive approach to tobacco harm reduction, actively promoting e-cigarettes as cessation tools while maintaining strict product standards and marketing restrictions.”
This approach, Box says, has led to “declining smoking rates and limited youth uptake.”
To address the unique challenges facing Africa, the experts are recommending a comprehensive and harmonized harm reduction policy across Africa when it comes to nicotine products like e-cigarettes and heated tobacco.
“This harmonization includes establishing common testing protocols to assess the chemical makeup and potential health impacts of these alternative products, as well as creating shared definitions to clearly categorize the various nicotine goods,” says Box.
He also stresses the importance of reciprocal recognition of product approvals between African countries.
“If one nation approves a particular nicotine product, it should be accepted across borders without requiring separate approval processes. This mutual recognition would help facilitate the flow of harm reduction tools and make them more accessible to smokers trying to quit,” he says.
Overall, the experts believe that a harmonized, evidence-based approach to regulating nicotine alternatives is key to curbing smoking rates and associated health consequences across Africa.
By embracing a compassionate and evidence-based approach to harm reduction, the experts are confident that Africa can make significant strides in combating its smoking epidemic and improving the health and well-being of its citizens.
