Stakeholders in the health sector have been challenged to consider harm reduction as a key guide in driving public health strategies in Africa.
Speaking during the third annual Harm Reduction Exchange held in Nairobi on October 19, the President of the African Medical Association and the Association of Medical Councils of Africa Dr Kgosi Letlape challenged African governments to adopt harm reduction approaches when regulating public health challenges.
Harm reduction, Dr Letlape noted, is a more transformative strategy than prohibition-based policies and is better than simply advocating for complete abstinence. Harm reduction is a better approach to reducing tobacco-related death and disease.
According to the World Health Organisation, tobacco kills more than 8 million people each year, including an estimated 1.3 million non-smokers who are exposed to second-hand smoke.
Around 80 per cent of the world’s 1.3 tobacco users live in low- and middle-income countries.
And, in a bid to address the tobacco epidemic, WHO Member States adopted the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2003. Currently, 182 countries are parties to the treaty.
Earlier, Dr Kgosi observed: “Harm reduction is a practical and transformative approach that incorporates community-driven public health strategies including prevention, risk reduction, and health promotion to empower people who use drugs and their families with the choice to live healthy and self-directed,”.
“We hope that our lobbying efforts will spark renewed conversations on tobacco harm reduction among all stakeholders, including regulators and policymakers, which could lead to effective regulation and access to noncombustible product alternatives for adult smokers who are unable or uninterested in quitting,”.
However, the WHO insists all forms of tobacco use are harmful and there is no safe level of exposure to tobacco and terms cigarette smoking as the most common form of tobacco use worldwide.
Other tobacco products include water pipe tobacco, cigars, cigarillos, heated tobacco, roll-your-own tobacco, bidis and kreteks and smokeless tobacco products.
Experts who spoke at the Nairobi meeting said across the world, harm reduction strategies have been deployed in public health as a pragmatic and compassionate approach to address various issues, particularly in the context of substance use and other risky behaviors.
Some of these strategies include Needle exchange programmes, supervised injection sites, condom distribution, PrEP (Pre-Exposure Prophylaxis), Nicotine Replacement Therapy (NRT), Vaping and E-Cigarettes, and supervised consumption of medications.
Kenya’s Dr Vivianne Manyeki noted: “Organisations that practice harm reduction incorporate a spectrum 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,”.
On her part, Integra Africa Principal Dr. Tendai Mhizha emphasised the role that journalists and media houses should play in handling misinformation and disinformation in tobacco harm reduction discussions.
“The media play a critical role in accelerating the progress towards full uptake of harm reduction strategies in all spheres of health across the continent…
“With the advent of technology, we find that misinformation and disinformation are becoming increasingly prevalent with the democratization of the information space,”.
Dr Mhizha added: “Moving forward, 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,”.
At the same time, raising awareness for tobacco harm reduction (THR), as a public health strategy, Dr Mhizha noted, encourages adult smokers who are unable or uninterested in quitting tobacco altogether to migrate to noncombustible product alternatives.
“THR has the potential to bring about one of the greatest public health achievements of our time,” Dr Mhizha said.
On his part, a Public health specialist and secretary-general of Harm Reduction Society of Kenya, Dr Michael Kariuki observed: “Harm reduction is the better path forward. With harm reduction, regulators provide adult smokers with information, choice and support to expand the off-ramp from smoking – while also continuing to drive down underage use…
“Providing adult smokers with less harmful alternatives to cigarettes is a powerful step in achieving this goal,”.
Several African countries have already implemented THR policies and programs. For example, South Africa has legalized the sale of e-cigarettes and heated tobacco products. Kenya has also taken steps to regulate THR products and is considering legalizing e-cigarettes.
However, the Kenya Tobacco Control Alliance (KETCA)—which is the umbrella organisation for those involved in tobacco control and health promotion in Kenya—is opposed to the legislation of e-cigarettes in the country.
Experts who spoke at the Nairobi meeting said the harmonisation of public healthcare regulation of THR products in Africa would be a positive step towards reducing the harms associated with tobacco use.
It would also signal that African governments are committed to public health and protecting their citizens from the dangers of tobacco smoke.
