Quit-Or-Die Approach An Ill-Advised Gamble For Public Health

Many smokers are unable – or at least unwilling – to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences.

Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die.

The third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products.

A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products.

Significant disparities in health outcomes around the world are driven by unequal access to essential health products. Scientific advances have led to the creation of new nicotine delivery products that have saved millions of lives. Yet new products may not be readily accessible to those in need due to a variety of factors, including systemic challenges caused by weak regulatory oversight, particularly in Africa.

Most African countries have ratified the Framework Convention on Tobacco Control (FCTC), an evidence-based treaty that reaffirms the right of all people to the highest standard of health. While there has been some success in its execution, this international legislation focuses primarily on non-health-related approaches to tobacco control — including price and tax measures to reduce demand, strategies to reduce smuggling, indoor air laws, and limits on tobacco advertising — but fails to directly address smoking cessation and harm reduction strategies.

The WHO’s tobacco control approach is fundamentally flawed. In 20 years, they have simply failed to make any meaningful progress to reduce tobacco consumption, with over 1bn tobacco users today and 8m people dying annually from tobacco-related illnesses.

Tobacco control efforts in Africa have mostly concentrated on increasing tobacco taxes, restricting or banning advertising, adding or expanding warning messages, and restricting smoking in public areas.

Policymakers may not be aware that tobacco harm reduction has great benefits, both economically and for health; this lack of information, in turn, hinders a reduction in smoking prevalence in the region.

As smoking rates drop in high-income regions thanks to reduced risk alternatives, smoking rates in Africa have risen 50% in over 35 years. We now have over 77 million smokers on the continent, with over 250,000 of them dying every year from smoking-related diseases.

A contributing factor is the lack of adequate policy that supports tobacco harm reduction and an inappropriate belief of policymakers that tobacco harm reduction interventions are less urgent than action on other diseases.

Tobacco harm reduction is an alternative cessation strategy for inveterate smokers. Tobacco harm reduction interventions are most effective when they meet smokers where they are, rather than requiring them to undergo many complicated steps and behavioral changes before they receive help. Keeping smokers alive and preventing irreparable damage is regarded as the most urgent priority.

Tobacco harm reduction within a regulated framework, encouraging smokers to use safer nicotine-containing products, should be supported by governments in Africa.

New and innovative products, such as nicotine pouches, e-cigarettes, heat-not-burn, and Snus can deliver nicotine at far lower risk than combustible cigarettes. Instead of moving to group e-cigarettes with tobacco products, legislation should recognize the health benefits of these products over smoking.

A lag in regulatory approval of safer nicotine products in sub-Saharan Africa can mean the difference in life or death for smokers waiting for access to these proven alternatives.

By Joseph Magero

Chair of Campaign for Safer Alternatives