Leaders in Africa must take responsibility and must trust science when making public health decisions, including in the area of tobacco harm reduction, said Dr Kgosi Letlape, president of the African Medical Association. He was speaking at a recent Harm Reduction Exchange webinar, writes Marie Camara for AllAfrica.
On 20 January 2022, a virtual Harm Reduction Exchange took place with two panels of discussions that were held around the hot topic of harm reduction. The first addressed risk reduction in various areas such as cancer, skin bleaching and drug use, while the second discussed more specifically tobacco harm reduction.
The event was organised by Integra Africa, a pan-African brand and strategy consulting company, in collaboration with Philip Morris International (PMI).
During the tobacco harm reduction panel discussion, Dr Kgosi Letlape of South Africa delivered a clear message. Among other influential positions, Letlape is former president of the World Medical Association and current president of the African Medical Association. He is a strong advocate for tobacco harm reduction, continues the AllAfrica story, published on 31 January:
“Knowledge is power. One of the major problems in Africa is lack of knowledge and the abundance of misinformation. The major problem in tobacco is the combustion of tobacco. There is vast amounts of scientific evidence that shows that it is the combustion that is the problem not the nicotine.”
Letlape said that the United States Federal Drug Administration (FDA) had been giving approvals to certain ways of receiving nicotine. Smokeless tobacco has been allowed to make claims of being less harmful than combustible cigarettes. Non-combustion and heat-not-burn technologies – such as IQOS, PMI’s heat-not-burn product – have been given the permission to communicate their reduced exposure to tobacco harms compared to cigarettes.
“These are indeed milestones for tobacco harm reduction.”
Misinformation around tobacco
It is now scientifically known that what kills smokers is not nicotine but combustible toxicants in cigarettes. Michael Russell, who is considered as the father of tobacco harm reduction, used to say: “People smoke for the nicotine, but they die from the tar.”
For Letlape, wrote Marie Camara for AllAfrica, the misinformation around tobacco is so strong that people don’t know that critical information: “So when I say knowledge is power it is about re-educating the public. It’s about creating space for truthful information to be available so people can make informed decisions.”
Letlape argued that the entity most responsible for this global misinformation is the World Health Organisation(WHO): “Remember the WHO is the very organisation that promoted the banning of snus in Europe. The elephant in the room in terms of knowledge in Africa is the WHO. When it comes to tobacco they are misinforming the world.”
In fact, WHO affirms that its main concern with nicotine alternatives to cigarettes are that they may be too risky, because they could appeal to young people. In a report published in 2020, the organisation stated:
“While cigarettes remain the most used form of tobacco products, there is a concerning trend emerging from the use of electronic cigarettes (or e-cigarettes). According to the latest available data, young people are turning to these products at an alarming rate.
“The new report reveals that in some countries the rates of e-cigarette use among adolescents were much higher than those for conventional cigarettes. In Poland, for example, 15.3% of students smoked cigarettes and 23.4% used electronic cigarettes in 2016.”
Letlape urged African leaders to take responsibility and trust science, reports AllAfrica: “We need leaders who are now going to embrace the responsibility of leading Africa and not following what comes out of our colonial masters…
“I would like our leaders to lead, and they must engage. The notion of ‘The Bible says’ or ‘the WHO says’ is something that must be set aside. It should be: ‘We have looked at what happened in Sweden,’” continued Letlape.
“As Africans we have engaged and collectively agree that this is what the science says, but we have not acted accordingly. Amazingly, many African governments have followed the science when it comes to COVID-19. We hope they will now also follow the science when it comes to tobacco harm reduction.”
African harm reduction activism
Smoking could kill eight million people each year by 2030, according to WHO, writes Marie Camara in the AllAfricastory. The prevalence rate of tobacco smoking in Africa is low at 14% but its growth rate is the highest in the world.
In spite of systemic obstacles, tobacco harm reduction activism in Africa continues to push forward. Many organisations around the continent are trying to bring about policy change that can save lives.
Harry Shapiro is director of DrugWise – an online drug information service – and managing editor of DS Daily – the daily online drug, alcohol and tobacco news service. He has worked in the drugs field for 40 years. He has been working with Knowledge-Action-Change, promoting public health through tobacco harm reduction. He said:
“There are now tobacco harm reduction consumer activists’ groups in South Africa, Malawi, Uganda, Kenya, Zambia, Democratic Republic of Congo and Nigeria. Many of the diseases attributed to tobacco smoking could be reduced by reducing exposure to tobacco toxicants that are created when it burns,” Shapiro told the webinar.
“I think it is fair to say that whatever tobacco controls are in place across the world, they are simply not enough to put a significant end to those awful projections. In the interest of global public health, a sensible and pragmatic response would be to take seriously the opportunities offered by the advent of safer nicotine products, which independent evidence shows are substantially safer than smoking.”
Joseph Magero is chair of the Campaign for Safer Alternatives, a pan-African organisation that advocates for the adoption and promotion of tobacco harm reduction policies in Africa. He agreed with Shapiro.
“We must be aware that tobacco harm reduction has great benefits both economically and for health and encouraging smokers to use safer nicotine products should be supported by governments in Africa,” Magero told the webinar.
“In order to tackle the harmful effects of tobacco in developing countries, in particular Africa, products such as snus, vaping products, heat -and-not burn products and all nicotine products that offer alternatives to smoking traditional cigarettes should be made available and affordable.”
Link to the full AllAfrica story below.
Webinar – Harm reduction as a winning strategy in Africa (Open access)
See also from the MedicalBrief archives
Tobacco harm reduction – ‘We’ll take to the streets” – Letlape
Global tobacco control ‘hugely outdated’ – Dr Kgosi Letlape
100 experts from 30 countries urge WHO to change tobacco harm reduction stance
SAMRC to implement South Africa’s First Global Tobacco Adult Survey