In a world where personal choices often conflict with public health concerns, Harm Reduction has emerged as an alternative path to minimising the negative implications of drug use. 

Harm reduction principles entail the policies, programmes and practices that aim to minimise the negative health, social and legal impacts associated with drug use, drug policies, and drug laws. It is a principle grounded in justice and human rights. It focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that people stop using drugs as a precondition of support. This approach recognises that human beings are bound to persist in risky behaviour for various complex reasons and offers a lifeline to those who find themselves trapped in harmful habits. 

With over a billion smokers globally, the impact of smoking-related diseases is staggering. It claims the lives of eight million individuals annually with most tobacco-related deaths occurring in low and middle-income countries. According to a 2022 study done by the Global State of Harm Reduction, the estimated number of people who die from tobacco smoking every year is 205,857, accounting for 2.3% of all deaths in comparison to an average of 20% of preventable deaths globally. While these figures might paint a gloomy picture, the situation presents a huge opportunity for Tobacco Harm Reduction (THR) efforts on the continent, where populations are more vulnerable. 

THR encompasses a range of products that can be used to reduce the harm from tobacco use. This includes vaping products, heated tobacco products, unheated nicotine products and snus. Despite the opportunities presented by Tobacco Harm Reduction, there exists a myriad of factors that impede the uptake of less harmful Nicotine Products and the implementation of THR in sub-Saharan Africa. The factors range from tobacco control measures, the WHO Framework Convention on Tobacco Control, lack of consumer awareness, bans, taxes and regulations, misconceptions about nicotine, disinformation, media sensationalism and concerns about youth nicotine addiction.

The use of THR has stirred debate in the realm of public health policy, focusing on the potential benefits and risks of alternative nicotine delivery systems. At the intersection of policy and THR, it is imperative to establish clear, evidence-based regulations that prioritise the health and well-being of the population while respecting individual choices. Despite the inherent risk trade-offs related to advancing these products, it is crucial we acknowledge the body of evidence pointing towards the reduced health risks posed by THR products. Among other studies, the 2016 report by the Royal College of Physicians, titled “Nicotine without smoke: Tobacco harm reduction,” concluded that e-cigarettes are significantly less harmful than combustible cigarettes and have the potential to help smokers quit smoking. The report estimated that e-cigarettes are around 95% less harmful than smoking combustible tobacco. Studies have consistently demonstrated that the harmful constituents of tobacco smoke are largely a result of combustion. THR products avoid the process of combustion by the use of heat, drastically reducing the harm associated with smoking.

Several states have taken a progressive stance on THR with Sweden blazing the trail in this regard by embracing snus as a harm reduction tool. As a result, Sweden is at the cusp of achieving a smoke-free status, boasting one of the lowest smoking rates in the world with the 5% milestone being within reach by the end of 2023. In 2016, Japan became the first country to allow the sale of heated tobacco products. The significant reduction in smoking rates in both Japan and the UK has been attributed to the quick adoption of THR products and regulations to guide their use. These countries have illustrated that embracing THR products will lead to a reduction in tobacco-related diseases and significant public health benefits. 

The key to navigating the intersection of policy and THR products lies in evidence-based regulations. African governments should rely on robust scientific research to shape their approach to THR. African governments ought to invest in these research studies. Failure to exercise caution may lead to the continent becoming a destination for the disposal of combustible tobacco products, which could ultimately jeopardise the health of the continent’s predominantly youthful population. Policy and Tobacco Harm Reduction products can coexist harmoniously when guided by scientific evidence. By following their lead and grounding policies in solid scientific research, other nations can make informed decisions that prioritize public health, empower individuals, and reduce the burdens of smoking-related illnesses. The intersection of policy and THR products is a space where health, science, and individual choice can find common ground to create a healthier future.

Needless to say, policymakers find themselves sailing uncharted waters as they navigate a future clouded by uncertainty, with the lack of substantial evidence on the long-term consequences of policies promoting e-cigarettes for harm reduction. We cannot see or model far enough into the future to have credible projections of the impact of regulatory decisions made now, decisions that will undoubtedly have long-term, generational repercussions. To this end, the apprehension surrounding potential risks must be carefully balanced against the substantial benefits offered by harm reduction.