The second edition of Africa Tobacco Harm Reduction forum was held online on 14 February 2022 in Nairobi, Kenya. Convened by Campaign for Safer Alternatives in collaboration with Africa harm reduction alliance., the forum is aimed at providing a platform to engage, challenge and exchange ideas, where pivotal issues on ending smoking in Africa are discussed and where delegates can learn from the experience, opinions and perspectives of sector leaders and their peers. The forum was an engagement and communication platform to discuss and advocate for evidence-based regulation as opposed to a ban of alternative reduced risk products.

The concept of tobacco harm reduction refers to policies, programs and practices aiming at minimizing health, social and legal impacts associated with use of tobacco products. There is fierce opposition between those advocating for the use of less harmful product as a pragmatic and realistic approach and those who think prevention and cessation are the only solution to stop the use of harmful products.

The conference, which was attended by over 50 delegates from across Africa and international and Kenyan medical experts, heard that the current approach of governments in Africa is not working. Despite the fact that nine out of ten smokers think nicotine pouches or vapes/e-cigarettes are the most effective quitting tool, countries in Africa continue to have regulatory environment that is unsupportive of these products.

Tobacco harm reduction is known as a public health strategy to reduce health risks and diseases related to tobacco. Its principle relies on the fact that a large number of smokers who want to quit fail to succeed. Thereby, alternatives have emerged these lasts years, notably innovative ones such as electronic cigarettes and heated tobacco. Tobacco harm reduction is viewed by those who advocate for it, as a pragmatic approach to reducing the harm of smoking related disease and thus, saving millions of lives.

"Instead of adopting a dogmatic, unscientific stance against tobacco harm reduction, Africa should be embracing it as an exciting opportunity to save thousands of lives lost to cigarettes" remarked Dr. Kgosi Letlape. "We have got to get out of the colonial mindset, and just following the mandates of Western authorities" he added.


The COVID-19 Pandemic illustrated the importance of trusting science, accepting evidence and listening to experts. The science is clear, tobacco harm reduction saves lives and Africa’s current anti-harm reduction policies will cost lives. Instead of adopting a dogmatic, unscientific stance against tobacco harm reduction, policymakers in Africa should be embracing it as an exciting opportunity to save thousands of lives lost to cigarettes" said Dr. Human, a renowned physician and harm reduction enthusiast.

We need to take an approach that places risk reduction at its heart and move away from an all or nothing absolutist perspective. Otherwise, we will continue to see thousands of smokers persisting in a habit that will ultimately lead to their death.


International public health specialists, scientists, medical practitioners, tobacco control experts, industry and investment analysts and consumers are convening for the Global Forum on Nicotine 2021 (#GFN21) on Thursday 17 and Friday 18 June in Liverpool, UK and streaming free online, to highlight the vital role of safer nicotine products in the fight to reduce global smoking-related death and disease.


Since the start of the pandemic, the world has lost an estimated 3.75 million people to COVID-19; a devastating figure that remains under half the annual death toll from smoking. Every day, 1.1 billion smokers still light up around the world, a figure that has stalled for over 20 years despite decades of tobacco control efforts. Eighty per cent of the world's smokers live in low- and middle-income countries (LMIC), least able to cope with the disease burden of smoking, and in higher income countries, smoking is a major cause of health inequalities.


People smoke to obtain nicotine, a comparatively low risk substance, but are harmed by thousands of toxins released when tobacco burns. Experts at the Global Forum on Nicotine will discuss an approach called tobacco harm reduction; people who cannot quit nicotine are encouraged to switch from dangerous combustible or oral products to safer nicotine products including vapes (e-cigarettes), pasteurized snus, non-tobacco nicotine pouches and heated tobacco products. Compared to continued smoking, all are significantly less harmful to health.


Despite an estimated 98 million adult smokers having already switched to safer nicotine products worldwide, public health and tobacco control remains deeply divided on the role of tobacco harm reduction. The Global Forum on Nicotine gives consumers a voice, with many participating as speakers and delegates and a consumer-focused panel on day two. GFN also offers a platform for debate and information-sharing - while remaining focused on the ultimate goal: accelerating the end of smoking-related death and disease.


Speaking ahead of the conference, GFN director Professor Gerry Stimson, emeritus professor at Imperial College London, said, "Up to 98 million consumers worldwide have already made the switch to safer nicotine products. In England, health authorities support vaping to quit smoking and vapes are now the most popular quit aid. Tobacco-related mortality in Sweden, where snus has almost replaced smoking, is the lowest in Europe. And in Japan, cigarette sales have dropped by a third since heated tobacco products came to market. Manufacturers must now ensure safer alternatives are affordable to people in LMIC, not just consumers in high income nations.


Professor Stimson continued, "Worryingly, international tobacco control leaders are doggedly pursuing an irresponsible prohibitionist approach to tobacco and nicotine, while the WHO actively perpetuates misinformation on new nicotine products. Public health will not be served nor lives saved by a war on nicotine, as doomed to failure as the war on drugs. The WHO must refocus its efforts on supporting 1.1 billion adult smokers to quit by all available means."


Paddy Costall of KAC Communications, conference organiser added:

"At GFN, we offer an inclusive platform to discuss all aspects of nicotine use and we believe it's important that no one is excluded from the debate. It's a fallacy that tobacco control and harm reduction are irreconcilable as many believe – they are complementary. With one billion smoking-related deaths predicted by the end of this century, it's time ideology makes way for pragmatism in order to save lives."


Three keynotes will be delivered to honour the memory of Professor Michael Russell, psychiatrist, research scientist and pioneer in the study of tobacco dependence and the development of treatments to help smokers quit. Russell's observation in the British Medical Journal in 1976 that "people smoke for nicotine, but they die from the tar" remains highly influential within the field. Speakers and their respondents will discuss:

  • Science and politics: an often fractious relationship - with Fiona Patten MP (Aus) and respondent Christopher Snowdon (UK) (Thurs 12:00 BST)
  • Investment in nicotine innovation: risks and rewards for public health - with Jon Fell (UK) and respondent David Sweanor (Can) (Thurs 17:00 BST)
  • Why has the WHO FCTC failed to reduce adult smoking and its health impact? - keynote with Derek Yach (US) and respondent Cliff Douglas (US) (Fri 12:00 BST)

Presentations for the four themed panels are already accessible to watch online, with the live sessions instead prioritising discussion and questions. Links to all available presentations are below:

Details of all sessions are online and the full programme can be downloaded here. GFN is self-funding and does not receive any sponsorship from manufacturers, distributors or retailers of nicotine products, including pharmaceutical, electronic cigarette and tobacco companies. However, the conference operates an open-door policy. Consumers, policymakers, academics, scientists and public health experts participate alongside representatives from manufacturers and distributors of safer nicotine products. The event organizers believe that dialogue and strategic engagement of all stakeholders involved in tobacco and nicotine use, control and production is the only way to effect true, sustainable change - both to industry practices and the public health outcomes related to smoking.


The Africa tobacco harm reduction forum (ATHRF) brings together key stakeholders involved in efforts to curb conventional cigarette smoking in Africa. The platform draws together stakeholders from governments, civil society, International organizations, legislators, media, academia and national campaigners to take stock of the current state of play on cigarette smoking in Africa as well as progress made through global, regional and country level initiatives.

The forum seeks to also act as a platform to articulate problems, propose solutions and explore opportunities for collaboration and common action. This year’s forum is being organized under the theme: Safer Alternatives: A gateway to a smoke-free Africa?

This year’s forum is being co-convened by Campaign for Safer Alternatives; a pan-African organization that advocates for tailor-made solutions to end smoking in the region. It will be an interactive forum for stakeholders to engage each other and deliberate on Africa specific policy progress, challenges and solutions in curbing smoking in the region as well as emerging technologies and products that aid in quitting cigarettes.

Topics that will be covered at the event are;

  • How Tobacco Harm Reduction can prevent tobacco-related disease and premature death in Africa
  • Mental Health Aspects of THR: Opportunities and Risks in Africa
  • Why Africa is lagging behind in harm reduction
  • The Role of Oral Nicotine Pouches in Smoking Cessation and Substitution

The forum will see the launching of a new survey report on oral nicotine use in Kenya, which was done by IPSOS. Click the link below to register and attend the FREE event.

Register Here


Every year the world marks World No Tobacco Day on May 31. This year's theme is Cessation: policies and initiatives that help people to quit smoking. Governments have a responsibility to help people to stop smoking! Quitting can be challenging, especially with the added social and economic stress that have come as a result of the pandemic, but there are a lot of reasons to quit.

The benefits of quitting tobacco are almost immediate. After just 20 minutes of quitting smoking, your heart rate drops. Within 12 hours, the carbon monoxide level in your blood drops to normal. Within 2-12 weeks, your circulation improves and lung function increases. Within 1-9 months, coughing and shortness of breath decrease. Within 5-15 years, your stroke risk is reduced to that of a non-smoker. Within 10 years, your lung cancer death rate is about half that of a smoker. Within 15 years, your risk of heart disease is that of a non-smoker. If that’s not enough here are a few more reasons!

 The WHO has invested extensively in supporting policy frameworks to assist countries to combat tobacco advertising, sales and promotion. Despite these interventions, over 1 billion people actively smoke, of whom >80% live in low- or middle-income countries. Although many African countries have policies regarding tobacco control, very few have programs to support smokers who wish to quit

It is clear that Africa is not suitable to a ‘one-stop-shop approach’ to tobacco cessation given the complexities of the cultural, economic, tobacco prevalence and available resources admixture. It is also evident that the FCTC policies regarding monitoring, advertising, and smoking bans have been adopted and effectively implemented in several countries. Despite this, the capacity to undertake effective smoking cessation is limited by poor availability of basic services such as quit lines, and/or basic self-funded NRT availability.

Similarly, policy on its own does very little to assist highly addicted smokers to quit but even potentially worsens the situation for a heavily addicted smoker, with high costs of cigarettes and restricted areas in which to smoke. A combined strategy of effective and stringent tobacco control along with effective options to assist smokers in overcoming their addiction to nicotine is likely to be more effective for overall tobacco control. In turn, this will reduce the number of active smokers as well as the burden of smoking-related illness on the healthcare systems that can least afford it.

Broadly speaking, studies have found that in most countries the main drivers of reduced smoking rates have been some combination of: (1) increased public awareness of the dangers associated with smoking, (2) an increase in the price of cigarettes (including taxes), and (3) the availability of low-risk alternatives and cessation products/ assistance.

In Africa, tobacco use is still within the “moral debate”. This makes the promotion of the needs of people who smoke on the continent an uphill task. Some sections of society believe that people who smoke are morally weak or deserve to be punished. This is why the purported “war on cigarette smoking” is considered acceptable and easily implemented in many parts of Africa.

The W.H.O has been strongly supportive of harm reduction in other contexts — for example the use of condoms to reduce HIV transmission in Africa — however it has been far less supportive when it comes to tobacco harm reduction.  Most smokers in Africa have been priced out of WHO recommended cessation products, such as the gum and the patches, rendering them somewhat helpless. The WHO Framework Convention on Tobacco Control (FCTC) and the MPOWER strategy, instituted in 2005, have assisted governments in tobacco control efforts. Tobacco control efforts via Monitoring tobacco use, protecting people from tobacco use, offering help to quit, Warning about the dangers of tobacco, enforcing bans on advertising and sponsorship and Raising taxes on tobacco, are gaining traction globally.

It is estimated that roughly two-thirds of the world’s population is protected by at least one MPOWER measure. The uptake of each measure varies across continents and countries, but a striking discrepancy is seen in low- vs. high-income countries, where cost, governmental buy-in and resources impact on which measures are implementable.

The MPOWER strategy that is reported to be the most underutilized is that of offering help to quit tobacco use. Article 14 of the FCTC promotes tobacco cessation awareness and support for tobacco dependence, including that nicotine replacement therapy is on the WHO essential drug list. Despite this, the 2017 WHO Report on the Global Tobacco Epidemic detailed that ‘less than one-third of high-income countries offer complete cessation support, as do fewer than one in 10 middle-income countries, with only one low-income country (Senegal) offering full cessation support.

Safer nicotine products should be recommended by the World Health Organization to smokers unable — or at least unwilling — to achieve cessation through complete nicotine and tobacco abstinence; who continue smoking despite the very real and obvious adverse health consequences. We must not forget that it has been projected that 1 billion people will die from smoking this century despite the W.H.O ’s efforts. This way, more smokers to commit to quit!

Burning Issues: new GSTHR report set to launch online with free open access event on Wednesday 4 November


On Wednesday 4 November 2020 from 10:00 GMT, Knowledge-Action-Change is set to launch Burning Issues: The Global State of Tobacco Harm Reduction 2020, a major new report documenting both the advances and significant challenges facing tobacco harm reduction in 2020.

The report is the second in a biennial series from the Global State of Tobacco Harm Reduction (GSTHR), a unique project established to map the development of tobacco harm reduction and use, availability and regulatory responses to safer nicotine products around the world.

The launch event, being held in partnership with THR Malawi, will be livestreamed over three interactive sessions from London, Lilongwe and locations around the world. Guest speakers include the internationally renowned neuropsychopharmacologist Professor David Nutt, who will be providing a keynote address, along with Australian MP and Leader of the Reason Party Fiona Patten, the Counterfactual’s Clive Bates, INNCO President Samrat Chowdhery, NNA UK’s Martin Cullip and Chimwemwe Ngoma of THR Malawi.

The audience will also hear from key members of the GSTHR team, including Executive Editor Harry Shapiro and Project Director Professor Gerry Stimson, who will explore the report’s findings in detail. Burning Issues takes stock, addressing both progress and achievements in the field since the first edition was published in 2018, but also identifying the major obstacles preventing tobacco harm reduction from fulfilling its public health potential worldwide. With over 8 million deaths still attributable to smoking-related causes every year, the report authors hope that the findings, conclusions and recommendations will be of interest to policymakers at all levels, particularly during the current EU TPD review process and in advance of the WHO’s delayed COP9, now set for 2021.

Registered audience members will be invited to pose their questions live at the end of each panel. Sessions will be available for playback and the full report will be available for download from 4 November. Registration is free and all are welcome. For the full programme and to register, visit 




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