Dissuading smokers from harm reduction tools riskier

Proposed new taxes on e-cigarettes and other alternative nicotine products have attracted significant attention since their announcement in the national budget speech last week.

Treasury CS Ukur Yatani’s commitment to protect the health of citizens is to be commended. But there is concern among many in the public health community that his proposals to make tobacco harm reduction products less affordable will negatively affect efforts to cut Kenya’s stubbornly high smoking rates.

Harm reduction is a concept that is widely accepted in the treatment of drug addiction, yet seems to receive less support in the country when applied to the treatment of smokers. 

The provision of methadone to drug addicts is one of the most common examples of harm reduction. It is recognised by WHO as essential medicine and forms part of evidence-based strategies to wean users away from more harmful heroin or narcotic painkillers. Just last month, Kenyans celebrated the opening of a public rehabilitation centre for drug addicts in Mombasa, which is using it to treat 270 patients.

Harm reduction also plays a key role in everyday life. Bike riders wear helmets to minimise the risk of head injury, for example. Mask-wearing has recently been mandatory to reduce the threat of Covid-19 infection as we go about our daily routines.  

Unfortunately, when it comes to applying harm reduction principles to lessen the impacts of smoking, policymakers seem to adopt a negative approach that stands in the way of saving thousands of lives.  

Tobacco harm reduction is about encouraging adult smokers, who have been unable to quit, to switch to alternative sources of nicotine with lower health risks.

It is founded on a simple, scientifically established principle: People smoke cigarettes for the nicotine, but it is the burning of tobacco that causes the vast majority of the disease from smoking.

With alternative nicotine products, such as e-cigarettes and oral pouches, there is no burning. 

The common belief that nicotine products pose similar risks to cigarettes is simply not supported by science. As stated by the US Food & Drug Administration (FDA), it is the mix of chemicals in tobacco smoke—not nicotine—that causes serious disease and death in tobacco users. According to WHO, nicotine does not cause cancer.

Nicotine itself is not totally risk-free but it has been widely sold in medicinal form for many years as Nicotine Replacement Therapy (NRT), endorsed by WHO as an essential medicine.

An increasing number of bodies in the international public health community are now endorsing new nicotine products to help a billion people worldwide who continue to smoke. 

Last October, FDA authorised the marketing of e-cigarettes as a means of quitting smoking. This follows their 2019 decision to allow approved nicotine pouch products because they are less harmful than cigarettes.

An independent evidence review by Public Health England, an executive body of the UK Department of Health, has concluded the “expert estimate is that using e-cigarettes is around 95 per cent safer than smoking”. Regulators there recently paved the way for e-cigarettes to be prescribed by doctors to help smokers to quit.

Meanwhile in Kenya, we’ve just had a Budget that seeks to impose prohibitive taxes on e-cigarettes and other alternative nicotine products, equating them to the more risky combustible cigarettes. 

Such an approach directly contradicts the results of a study by the International Tobacco Council, published in conjunction with Ministry of Health in May 2021, which advocates the use of nicotine products to reduce smoking rates.

E-cigarettes and other alternative nicotine products offer this life-saving potential. To block their availability and affordability denies smokers their best chance of quitting and unnecessarily risks adding to their misery and ill health.

— The writer is a medical doctor and public health specialist. He can be contacted via — [email protected]