The 4th annual Harm Reduction Exchange was held in Nairobi, Kenya, and brought together over 80 scientists, Harm Reduction experts, doctors, members of the medical and legal fraternities, industry leaders and the media. This was a truly Pan-African event with participants and speakers representing countries like the DRC, Ethiopia, Senegal, Ghana, Nigeria, Zimbabwe, Malawi, Uganda and Tanzania, among others. The theme of the event was: ‘Enabling Innovation in Harm Reduction Through Science-led Regulation.’
The event kicked off with Kenyan Harm Reduction Advocate, Dr Vivian Manyeki, who said, ‘’Let's face it, the traditional approach to tackling substance use has been rigid and judgmental. It's like trying to force a square peg into a round hole. Harm Reduction, on the other hand, is a pragmatic, compassionate approach that recognises the realities of human behaviour.” She stressed that Harm Reduction is about meeting people where they are and providing them with the tools and support to make healthier choices. This sentiment set the scene for the day.
In a powerful opening keynote address, award-winning Kenyan Medical Doctor, Journalist and Business Executive, Dr Mercy Korir, spoke of the media’s instrumental role in healthcare. She said, ‘As we look to the future, we must continue to advocate for responsible, balanced journalism in the field of Tobacco Harm Reduction. Our role is to educate and inform—not to prescribe or judge. We serve as stewards of public trust, responsible for curating a well-rounded dialogue that empowers people to make informed decisions about their health.”
The first session of the day was titled: ‘The Evolution of Harm Reduction Strategies across Africa’ In his presentation, the Founder/Executive Director of The Global Initiative on Substance Abuse (GISA)), Dr Martin Agwogie from Nigeria, stated that “Africa has been known for repressive and draconian drug-related laws and has been slow in evolving public health approaches to drug use prevention, treatment and recovery.” He further explained, “Despite evidence of its effectiveness, Harm Reduction measures remain controversial and highly contested in many African countries, facing many obstacles and barriers from governments and faith-based organisations among other socio-cultural barriers.”
The gathered participants and speakers heard from Harm Reduction Advocate, Chimwemwe Ngoma, whose presentation was titled: ‘From Smoking to Safer Nicotine Products: Global Trends, Public Health Impact, and Science-Led Regulation.’He shared some preliminary results from the Global State of Tobacco Harm Reduction Report, saying, “Existing research and data suggest that Safer Nicotine Products (SNPs) reduce smoking prevalence and overall cigarette consumption through three key mechanisms: as a smoking and nicotine cessation aid, as a long-term alternative to cigarettes and as an alternative product for new nicotine users.” He proposed that science-led regulation must guide our efforts towards healthier populations.
Swedish Professor Karl Fagerström, a world-renowned expert on cigarette cessation, shared experiences from Sweden. The country is a fantastic example of Harm Reduction in practice, as it is the first country to reach the endgame of less than 5% smoking incidence, having managed to reach 4.9%. He explained the fact that, although tobacco products are largely used because of nicotine, pure nicotine and even unburned tobacco are not the primary cause of tobacco-related morbidity and mortality. He said, “Most negative health effects are caused when tobacco is burned.”
Professor Fagerström was followed by a Kenyan Medical Doctor, Dr Michael Kariuki, who spoke about the risks of Smokeless Tobacco Products (STPs) in Kenya. He shared, “There is no significant risk of oral cancer from STP use in North America and Sweden. The low rates of oral cancer associated with STPs in the US are due to the increasing prevalence of lower-risk products like moist snuff and chewing tobacco, which have replaced the higher-risk dry snuffs, which are no longer popular.”
Samuel Hanu, an expert from the Ghana Harm Reduction Alliance, spoke about science-led innovation and regulation, describing Harm Reduction as “radical love.” He quoted a 2024 Harm Reduction Report highlighting that “108 countries have included Harm Reduction in their national policies. However, criminalisation and punitive responses to drugs remain dominant in most places. These approaches undermine Harm Reduction efforts, they continue to fuel stigma and discrimination and deter people who use drugs from seeking vital, life-saving services.” He also stated that according to the State of Tobacco Harm Reduction Report, “The biggest funding boost for Harm Reduction in Eastern and Southern Africa would be for governments to stop funding punitive approaches to drugs and invest in Harm Reduction.” Mr. Hanu further stated that science-led innovation is revolutionising Harm Reduction and related regulation, ensuring safety and effectiveness.
Mr Wilson Box, Director of the Zimbabwe Civil Liberties and Drug Network ZCLDN, addressed the topic: ‘Global Regulatory Approaches to Tobacco Harm Reduction.’ His belief on the matter was, “The global approach to Tobacco Harm Reduction represents a complex intersection between public health policy, economic interests, and regulatory frameworks.” He went on to say, “The African context presents unique challenges and opportunities in Tobacco Harm Reduction. With an estimated 77 million smokers across the continent, Africa faces a significant public health burden from tobacco use.” He recommended, amongst other remedies, an evidence-based policy framework that should include the following: mechanisms for the rapid integration of new scientific evidence, the establishment of regional centers of excellence for research, the development of shared monitoring and evaluation systems, and the implementation of standardised reporting requirements.
Harm Reduction Activist, Uche Dare Olatunji from Nigeria, weighed in on the important role of scientific evidence in shaping policy. He said, “Scientific evidence, like the highly respected and independent organization - Cochrane, has consistently shown that switching to less harmful alternatives can dramatically reduce the risks associated with smoking. Countries like England, through the National Institute for Clinical Excellence (NICE) and Public Health England (PHE), have published comprehensive draft guideline recommendations to tackle the health burden of smoking in their country.” He lamented, “Yet these findings often face resistance—not because the science is flawed, but because of deep-rooted ideologies, misinformation, and sometimes, competing interests.”
Harm Reduction expert, Professor Nnanyelugo Ike- Muonso from Nigeria, pulled all the presentations of the day together with a keynote titled: ‘Integrating Harm Reduction into Public Health Policies.’ He asked the question,“Why is Harm Reduction not mainstreamed in public health discussions?” He answered by saying, “There is a classification issue and bias. The classification issue shapes the debate on Tobacco Harm Reduction/risk reduction. Are they risk-reduction products or are they medicinal products? This classification changes the way the government and media look at Harm Reduction products.” He went on to say, “The perception of professionals in public health is that you should not give people a chance to use Harm Reduction interventions, as this will keep them in the cycle of smoking tobacco. This bias exists because they have not been exposed to enough scientific evidence to accept these alternative harm-reducing products. They need to see a robust scientific process to believe that these products actually do what they claim to do.”
A deeply insightful and highly interactive panel and open floor discussion followed the sessions and highlighted the themes of the day. Within these discussions a pertinent statement was made by Mr Samuel Hanu: “When science and policy align, the results save lives.”
