While smoking rates are declining in other parts of the world, data shows that the African region and other Low-Income Countries are seeing a rise in new smokers, particularly among the young population.
According to a paper by the Global State of Tobacco Harm Reduction (GSTHR), smoking prevalence is relatively low across Africa by global comparisons. However, by 2025, the World Health Organization (WHO) projects the total number of tobacco users in Africa will have increased to 62 million, of whom 51 million will be smoking combustible tobacco.
In High-Income countries, smoking rates have been declining due to several factors ranging from public health interventions to effective Tobacco Harm Reduction (THR) efforts such as non-combustible nicotine products and cessation programs. Sweden for example, now has one of the lowest cancer death rates in the world and will soon be declared smoke-free by the World Health Organisation (WHO) criteria. Sweden has 44 percent fewer tobacco-related deaths, 41 percent lower lung cancer rates, and 38 percent fewer cancer deaths.
Whereas the lack of affordable, acceptable and appropriate Safer Nicotine Products (SNPs), weak health systems, heavy taxation of SNPs, and unfavourable policies are sustaining the the smoking rate at high levels in Sub-saharan Africa. Inconsistent regulatory environments can hinder the effectiveness of THR in Africa, the lack of education, localised information and awareness of THR also stands out as one of the major stumbling blocks to the effective adoption and implementation of THR in Sub-Saharan Africa. Data shows that many consumers, healthcare institutions and governments in Sub-Saharan Africa are unaware of tobacco harm reduction, and this knowledge gap results in consumers and stakeholders making uninformed decisions regarding personal and public health.
In an interview with allAfrica, Kenyan Medical Doctor and Health Editor, Dr Mercy Korir said effective education was the panacea to enhancing Africa’s Tobacco Harm Reduction efforts.
“Education plays a role in informing the public about the risks associated with traditional smoking versus safer alternatives like nicotine replacement therapies and encourages the adoption of these harm reduction strategies and non-combustible nicotine products. It empowers individuals to make informed choices about tobacco use and decide whether to stop use or not, in addition to challenging misinformation and myths about tobacco products,” said Dr Korir.
She added that there have been Public Health Campaigns by Governments and NGOs to raise awareness about the dangers of smoking and promote cessation resources and many countries have adopted smoke-free laws and regulations on tobacco advertising to reduce exposure. These efforts have been supported by organizations such as the World Health Organization (WHO) and the Global Fund.
“Awareness of tobacco harm has increased in many regions due to widespread educational campaigns and international support, though the uptake of non-combustible nicotine products like e-cigarettes and smokeless tobacco has been variable. In some areas, there has been notable adoption, while in others, the uptake remains low due to lack of access and misinformation.”
Kenya has seen some success with public health campaigns and smoke-free legislation. Efforts to educate the public about the dangers of smoking have led to increased awareness and a notable drop in the number of smokers.
“In Kenya for example, the e-cigarettes and nicotine pouches are available in the grey and black markets, unfortunately also being accessed by people under the legal age.”
However, she noted that communication about non-combustible nicotine products and THR remains limited in Kenya despite the successes and access to SNPs products is restricted, and there is a need for more targeted educational efforts and attendant legislation.
Several THR advocacy education and awareness efforts have been implemented across Africa to reduce tobacco harm. Currently, there are tobacco harm reduction advocacy groups in Burkina Faso, the Democratic Republic of the Congo (DRC), Kenya, Malawi, Nigeria, South Africa, Uganda and Zambia. There is also a pan-African Umbrella group – the Campaign for Safer Alternatives. THR groups in these countries advocate for the availability and accessibility of safer nicotine products while also disseminating scientifically accurate information on nicotine consumption.
Joseph Magero, the Chairman of Campaign for Safer Alternatives (CASA), a Pan-African THR advocacy organisation said many people across Africa lack sufficient knowledge about the harmful effects of traditional tobacco use, as well as the availability and potential benefits of safer alternatives like e-cigarettes or nicotine replacement therapies (NRTs).
“Healthcare professionals in Africa are not adequately informed or trained on THR strategies, limiting their ability to advise patients on alternatives to smoking or encourage smoking cessation,” said Magero adding, “In some African countries, there is no clear regulatory framework for THR products like e-cigarettes or smokeless tobacco, or such products are heavily restricted. There is also widespread misinformation about the relative harms of safer alternatives.”
Most African countries are signatories to the WHO FCTC, which provides a framework for tobacco control policies. These campaigns often target both smokers and non-smokers, using billboards, radio ads, and television programs to promote awareness of smoke-free policies in areas like public transportation, workplaces, and restaurants.
While there has been some success in increasing awareness about tobacco harm reduction and promoting non-combustible nicotine products in select African countries, Magero says the overall impact remains limited.
“There is widespread confusion about the relative harms of smoking and THR products such as e-cigarettes or nicotine replacement therapies. Misinformation, sometimes perpetuated by media or poorly informed sources, causes people to equate the risks of THR products with those of traditional cigarettes. Anti-tobacco groups often emphasise total cessation, framing all nicotine products (including harm-reduction tools) as dangerous. This has created scepticism around THR products and confusion about their relative safety compared to smoking.”
Barriers such as low awareness, limited access, regulatory challenges, and the lack of localized research continue to impede widespread adoption. Additional obstacles to effective THR communication in Africa include misinformation propagated by health professionals and challenges in reaching remote areas.
Sahan Lungu, a THR Advocate from Malawi said there was a need for THR practitioners and advocates to work with community and traditional leaders to simplify the THR message and bolster uptake of THR interventions on the continent.
“Cultural and religious beliefs can hinder the acceptance of THR strategies. In certain communities, smoking is deeply ingrained in social practices, making it challenging to promote alternatives. Engaging traditional, religious leaders, and local influencers can build trust and help spread THR messages within communities,” said Lungu.
Dr Korir concurred with Lungu adding that THR advocates should develop and disseminate culturally relevant information about THR to address local needs and beliefs by localising the campaigns to reflect the different contextual set up in Africa. She also said there is a need to strengthen Healthcare Systems to enhance training for healthcare providers on THR and provide resources to support smokers seeking to switch to safer alternatives. There should also be modalities to improve the accessibility of non-combustible nicotine products through better distribution and regulation.
Healthcare Professionals also play a key role in the misinformation and disinformation regarding THR and Lungu urged advocates to engage Doctors, nurses, and community health workers as they can help dispel myths and provide accurate THR information through effective training and communication strategies.
Other stakeholders that THR advocates should engage include peer educators and school teachers as they can effectively communicate THR to younger people, Health-focused NGOs and CBOs, government officials and regulatory bodies as well as tobacco farmers and workers. In Kenya, Magero and his organisation, have run television and radio campaigns, as well as social media communication campaigns to create awareness of safer nicotine products. In his capacity, he has also engaged policymakers through direct emails and petitions and writes newspaper articles frequently to nudge the message of THR forward.
Meanwhile, Nicotine vaping products and other non-combustible nicotine products remain restricted and face legal restrictions in Sub-Saharan Africa. To date, vaping products or e-cigarettes are banned in Ethiopia, Gambia, Mauritius, Seychelles and Uganda. Sale of these products is only allowed in five countries namely Ivory Coast, Nigeria, Senegal, South Africa and Togo. There are 38 countries without specific laws on Vaping. The sale of Snus is permitted in 22 countries in Africa while 26 do not have any specific laws. The sale of heated tobacco is only allowed in three countries and is banned in Ethiopia. 44 countries don’t have specific laws on heated tobacco products.
