Tobacco harm reduction: The imperative for alternatives

There are concerns the world over, about the health effects of tobacco, which is mostly consumed by smoking cigarettes, cigars, or pipes.

In January 2021, the company Johnson & Johnson Consumer Health, donated nicotine patches worth $800,000 to Jordan to help the country in its efforts to lower smoking rates. The donation was received by the country’s ministry of health.

This was after the public health groups sounded the alarm on the prevalence of smoking among Jordanian citizens as Jordan became the country with the highest smoking rate in the world. A government study carried out in 2019 in collaboration with the World Health Organisation (WHO) revealed that eight out of every 10 Jordanian men smoked or regularly used nicotine products.

The WHO Representative for Jordan, Maria Cristina Profili, in response to the donation stated; “We are grateful for this donation which builds on WHO’s existing efforts and a comprehensive program to fight tobacco control in Jordan. The nicotine replacement therapy will help thousands of people in Jordan quit tobacco and lead a healthier life.”

But still, WHO and several public health organizations maintain a prohibitionist approach toward tobacco harm reduction. Their position is that smokers must quit the habit or face the consequences of death or a myriad of health complications. Agreed, quitting is the best option for smokers but what alternative choices or reduced-risk products are available to consumers who cannot or do not want to quit?

A growing number of public health experts believe that providing less risky tobacco or nicotine products will achieve the same objective of reducing the health effects of smoking tobacco and in some instances help smokers quit. These experts in many ways are the proponents of Tobacco Harm reduction.

In a statement by Professor David Nutt of Imperial College London, published by Counterfactual, where he urged WHO leadership to launch a comprehensive rethink of its approach to tobacco control he says about alternative products: “There is no real scientific doubt that these smoke-free products are much safer than smoking and that they can help smokers quit. So we should be working hard to make that happen”

Tobacco Harm Reduction (THR), is a public health solution. The argument is that the harmful effect of tobacco is predominantly caused by the way it is consumed – smoking, but if the element of combustion (smoking) is removed and consumers are provided with less risky or alternative ways to consume tobacco or nicotine then the public health concern on the health impact of tobacco is reduced.

Increasingly, proponents of THR are revealing success stories. A significant number of these stories or acceptance of THR are from developed economies and hopefully, it will begin to gain acceptance in less developed ones.

For instance, In the United Kingdom (UK), tobacco harm reduction within a regulated framework, encouraging smokers to use non-combustible tobacco or nicotine products, is supported by the UK government and most of the public health communities.

The National Institute for Health and Care Excellence (NICE) which issues evidence-based guidance on the most effective ways to prevent, diagnose and treat diseases and ill health published guidance on tobacco harm reduction. The guidance recognizes that quitting smoking is always the best option for smokers but it supports the use of licensed nicotine-containing products (NCPs) to help smokers not currently able to quit to cut down and as a substitute for smoking.

Public Health England (PHE) also published an independent evidence review on electronic cigarettes which concluded that the devices are significantly less harmful than smoking.

Furthermore, in the United States of America (USA), the food and drug administration (FDA) has begun to license alternative products as “modified risk tobacco products.”

Sweden has long been considered by keen industry observers as a trailblazer in cutting down smoking rates among men. But their strategy was the use of reduced-risk tobacco products like snus. Snus is a nicotine pouch that a lot of smokers have switched to over the years. It enables smokers who are unable or unwilling to quit to enjoy nicotine without having to contend with the dangerous substances that accompany combustible tobacco products.

In December 2020, Frost & Sullivan, a consulting firm that is world-renowned for its role in helping investors, corporate leaders and governments navigate economic changes and identify disruptive technologies, mega trends, and new business models reported that Japan had recorded a 34% drop in sales of cigarettes between 2015 and 2019 (attributing this decline to the availability of non-combustible, reduced risks products, mainly heated tobacco products (HTP).

The report supports the position that the availability of non-combustible alternatives and less risky options are crucial for any society to achieve a decline in smoking among its citizens.

While the proponents of tobacco harm reduction have always called for the availability of alternative products, the response of WHO to the aforementioned donation of nicotine patches to Jordan would seem to lend credence to this notion as it openly celebrated the provision and availability of alternative products, reduced risk options to cigarettes.

It is imperative we develop a balanced approach to our polity. In seeking a drop in smoking rates in Nigeria or across Africa, what strategies do the relevant health authorities and regulatory agencies have? What is their stance on tobacco harm reduction (THR) and reduced-risk alternative products?

How well do they understand THR? What independent research and studies are they undertaking to improve their knowledge and understanding to enable an objective appraisal of this concept?

If the ultimate goal is to achieve a decline in smoking rates and reduce the adverse health impact of tobacco, evidence from countries that are succeeding continues to show that tobacco harm reduction must be pursued as a public health solution despite or in addition to ongoing smoking cessation initiatives.

Nigeria, as with other African countries (particularly in Sub-Saharan Africa) must institute robust dialogues and engagements with all relevant stakeholders to formulate effective policies and guidelines for the availability and use of reduced-risk products. Policies enacted on scientific evidence and the rights of consumers to have access to these products are not just essential but are a crucial step to reducing smoking rates and the health impact of combustible tobacco products.

Leaving things the way they are will have limited impact on the reduction of smoking incidence and will not help the government to achieve swiftly the public policy objectives of reducing the health risks associated with combustible tobacco.