Can Oral Nicotine Products Offer a Route to a Smoke-Free Africa?

In 2019, the World Health Organization predicted that to reach the goal of reducing deaths from (NCDs) among the 30–69 age group by one-third by 2030 (SDG 3.4.1), a 50% prevalence reduction in cigarette smoking worldwide is needed.

In the same year, the government of the United Kingdom set an objective for England to be smokefree by 2030, meaning only 5% of the population would smoke combustible cigarettes by then. Their roadmap has included funding the easily accessible, high-quality cessation support that smokers need to help them quit, including supporting vaping.

The U.K. set out a consumer-friendly regulatory framework set for vaping, which has reduced smoking rates by 25% since 2013, enabling the country to hit an all-time low in tobacco smoking rates. This significant success demands that we take a fresh look at our approach to nicotine.

Globally, scientists are agreeing that innovative alternative nicotine products such as oral nicotine products and vapes are the most successful way to move smokers away from traditional “combustible” cigarettes to a safer alternative. The proven success of these products shows that tobacco control should no longer simply follow the ‘quit or die’ approach, which continues to fail in Africa.

Africa is headed in the wrong direction in its efforts to reduce smoking-related deaths. Although the number of smokers on the continent may still be lower than in North America and the East Mediterranean, that number is growing at the fastest rate on the planet.

Has the W.H.O. F.C.T.C set a target on when countries in the LMICs, including Sub-Saharan Africa, should be smoke-free (i.e., less than 5% smoking rate)? W.H.O Framework Convention on Tobacco Control’s M.P.O.W.E.R. policy package is intended to assist in the implementation of effective interventions to reduce the demand for tobacco has worked to some extent, but the smoking rates in this region remain stubbornly high.

Article 14 of the W.H.O F.C.T.C. treaty promotes tobacco cessation awareness and support for tobacco dependence, including nicotine replacement therapy (NRT), which is on the WHO essential drug list. Although the MPOWER strategy includes offering help to quit, there is barely any cessation support in sub-Saharan Africa.

Unaffordable products and medications hamper smoking cessation in Africa. Can oral nicotine products be essential in achieving a smoke-free sub-Saharan Africa? Sweden has achieved the lowest smoking rate in Europe thanks to these products and is on track to become officially smoke-free.

Snus and tobacco-free nicotine pouches are currently legal in more than 90% of African countries, and this regulatory clean slate can be used to create sensible policies which help smokers make informed decisions and give smokers the opportunity to switch from combustible cigarettes to these much safer alternatives.

If the W.H.O. indeed is serious about achieving Its smoke-free targets in this lifetime, bold ideas are needed. Some of the most specific African needs in the W.H.O. F.C.T.C. have never been addressed. By totally ignoring harm reduction which initially was part of the strategy, and going in the complete opposite direction has them on a path to failure.

Last month, a conference was held in Stockholm, Sweden, in which global public health experts came together to discuss the effectiveness of oral nicotine pouches in reducing smoking rates in Sweden. Experts presented evidence for lower rates of disease and death in Sweden versus other countries that have banned such alternative cessation products.

You can click below to watch the conference: