A few countries in Africa have embraced alternative means of consuming nicotine than combustible smoking. Photo: Reuters  

By Bonisile Makhubu

If all countries could establish policies and laws that protect their citizens from the harm caused by combustible smoking of tobacco, we would not be losing over 8 million people globally every year.

Of these people dying, 1. 3 million are non-smokers who are exposed to second-hand smoke, according to WHO.

Harm reduction is a more transformative strategy than prohibition-based policies and is better than simply advocating for complete abstinence and is a better approach to reducing tobacco-related deaths and diseases.

Tobacco contains about 7 000 chemicals, 250 of which cause diseases and including 69 that lead to cancer-related illnesses.

In Africa, only a handful countries have stood up to embrace and regulate the use of alternative means of consuming nicotine than combustible smoking.

Other countries, including Eswatini, are still quiet or rather not showing any keenness in mitigating the damage caused by tobacco smoking.

Quitting strategy

What they do mostly is advising users to quit. What happens if they fail to quit? Or what happens with the victims who are exposed to second-hand smoke?

Tobacco contains about 7 000 chemicals, 250 of which cause diseases. Photo: Reuters

Eswatini and 42 other African have signed the WHO Framework Convention on Tobacco Control (FCTC) whose components are monitoring tobacco use, providing cessation services to people who want to quit, placing graphic warning labels on tobacco products and banning advertisement of tobacco. But little has been implemented.

Let us look up to South Africa and several African countries that have already implemented Tobacco Harm Reduction (THR) policies and programmes. South Africa has legalised the sale of e-cigarettes and heated tobacco products.

Kenya has also taken steps to regulate THR products and is considering legalising e-cigarettes.

Such steps would also signal that African governments are committed to public health and protecting their citizens from the dangers of tobacco smoke.

African governments are challenged to adopt harm reduction approaches while addressing public health challenges.

During a Harm Reduction Exchange held in Kenya recently, under the theme, ‘Amplifying the Voice of Harm Reduction Advocacy Across Africa’, the president of the African Medical Association and the Association of Medical Councils of Africa Dr. Kgosi Letlape explained the importance of harm reduction initiatives.


“This strategy is effective and much better than prohibition-based policies and is better than simply advocating for complete abstinence,” he said.

The availability of alternatives to combustible tobacco, such as vaping and e-cigarette is seen as offering less harm at a time when millions of smokers are failing to quit.

E-cigarettes and vaping pens are not totally safe according to health experts. Photo: AP 

These options are also not totally safe, but it has been inconclusively reported that they are capable of reducing the risk associated with combustible smoking, especially where secondary smoke is concerned.

The Centre for Disease Control and Prevention (CDC) observes that e-cigarettes are less harmful for adult smokers who are not pregnant.

However, they are totally unsafe for pregnant women, youth and young adults who do not smoke.

Eswatini is one country that has not covered much ground on such harm reduction policies despite the annual loss of 600 lives to tobacco-related illnesses.

The World Health Organisation (WHO) states that, “Nearly 66 per cent of these deaths occur among individuals under the age of 70.”

Non-smoking generation

A whopping quarter of the deaths is of non-smokers, people who are exposed to second-hand smoke, with women and children forming a larger share of these victims.

The long term consequences of combustible smoking include continued economic, health and social hardship.

Women and children are the most affected by second-hand smoking. Photo: Getty images. 

In 2021 the United Nations Development Program (UNDP) partnered with the Eswatini Government to ensure that the next generation is not a generation of smokers, and to alleviate the current health and economic burden caused by tobacco.

UNDP presented a report to demonstrate how tobacco use impedes Eswatini’s efforts to improve health and grow the economy, hindering the country’s broader development priorities within its National Development Plan.

Stakeholders in the health sector, specifically, have been challenged to consider harm reduction as a key guide in driving public health strategies in the continent.

Health services pathway

Medical experts advocating for harm reduction have defined it as a practical and developmental approach that incorporates community-driven public health strategies including prevention, risk reduction, and health promotion to empower drug users and their families with the choice to live healthy and self-directed.

It is so depressing to watch the world adopting and deploying harm reduction strategies in public health as a compassionate approach to address various issues, particularly in the context of substance use and other risky behaviours.

Some of these strategies include Needle Exchange Programmes, supervised injection sites, PrEP (Pre-Exposure Prophylaxis), Nicotine Replacement Therapy (NRT), Vaping and E-Cigarettes, and supervised consumption of medications.

African countries can take a leaf and incorporate a range of strategies that meet people where they are on their own terms and may serve as a pathway to additional health and social services, including additional prevention, treatment, and recovery services.

There is a need to ensure that stakeholders are well informed with current and relevant information about the science, the changes that occur and how we can advance towards a smoke-free world.

The author, Bonisile Makhubu, is a journalist based in Eswatini.

Disclaimer: The views expressed by the author do not necessarily reflect the opinions, viewpoints and editorial policies of TRT Afrika..

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