BLOGS

ONE in every three Kenyan smokers has tried to quit.

Yet, only a tiny fraction succeed.

Just how do we help them kick this deadly habit? And how do we persuade other smokers that it is a good idea to follow suit?

A sensible start would be to reject calls for tobacco-style restrictions on nicotine pouches.

Advocates for Tobacco Harm Reduction, like myself, believe that such knee-jerk reactions against innovation are dangerously counter-productive and block routes to a healthier future.

This is what Tobacco Harm Reduction is all about: getting serious about saving lives by acknowledging that the majority of the harm from cigarettes is caused by the burning of tobacco, which releases thousands of dangerous toxicants.

The evidence from countries like Sweden suggests that if smokers can get their nicotine without burning tobacco, we should be able to dramatically reduce the 30,000 tobacco-related deaths seen in Kenya every year.

Get rid of the burning, reduce the harm. Better still, get rid of the tobacco altogether.

Evidence shows that innovative nicotine alternative products, such as tobacco-free pouches and e-cigarettes, can deliver nicotine with a drastically reduced toxicant profile compared to traditional tobacco products.

A tobacco-free nicotine pouch, which is placed between the lip and the gum, would appear to be a particularly relevant alternative for smokers in Kenya, and the wider east African region, where there is a long tradition of using oral stimulants.

Such pouches do not contain any tobacco. With nicotine as the only active ingredient, they would belong on a similar risk spectrum to mainstream nicotine-replacement therapies (NRTs), such as nicotine gums, sprays, lozenges and patches.

Significantly, research shows that some alternative nicotine products are up to twice as effective as NRTs when helping smokers to quit. There are a number of theories as to why this might be, but it is likely due to the fact that, in the countries where these studies were conducted, there is (a) widespread public awareness about the relative risks of such products, (b) alternative nicotine products can typically be sold anywhere cigarettes are available: their retail is not limited to pharmacies; and (c) there is a resulting lack of stigmatisation involved with using such products.

Take Sweden, for example. Swedes have the highest consumption of pouches and the lowest smoking rates in Europe. The Swedish rate of tobacco-induced cancers for men is less than half the EU average.

Or look at the UK, where the government has adopted a progressive approach to alternative nicotine products, backed by international anti-smoking advocacy groups such as Action on Smoking and Health.

In just one year, e-cigarettes helped over 50,000 people in England quit smoking, while there are more than 6 million ex‐smokers in Europe who report that vaping helped them to end their smoking habit.

This is what makes calls for the Kenyan government to regulate tobacco-free nicotine pouches as if they were the same as cigarettes so alarming and regressive.

Other than the obvious point that these pouches are tobacco free, and therefore an ill-fit for legislation targeted at tobacco, the real issue is that this outdated approach could actually end up costing lives.

If Kenyans are told that nicotine is the same as tobacco and that nicotine pouches are the same as cigarettes, there is a serious danger they will be deterred from making the switch to less risky products.

This would be a huge setback for the Tobacco Harm Reduction movement in a region that is already making slow progress in the fight against smoking.

Another problem is that anti-smoking advocacy groups in Africa routinely suggest that alternative nicotine products pose a special danger to young people.

These claims wilfully ignore international data which consistently shows that regular use of alternative nicotine products amongst young people who have never smoked is extremely rare (typically around 0.04%) and that the majority of alternative nicotine product users are current or ex-smokers.

While nicotine pouches should never be sold or marketed to under-18s, it makes perfect sense to promote them as an alternative to adult smokers by making them available wherever cigarettes are sold and subject to the same supervision.

Not only are alternative nicotine products effective, they are also cost-effective for the government. The state pays nothing when an adult smoker switches to alternative nicotine products. Compare this with costly state-run programmes. Meanwhile, by helping smokers quit, nicotine alternative products help ease the disease burden of smoking and the associated costs to the state.

Traditional measures to reduce smoking rates, such as increasing taxes, banning advertising and restricting smoking in public areas, have reduced tobacco use in Kenya by only a single percentage point in the four years to 2016.

We need a change in approach.

Alternative nicotine products represent a genuine route to a smoke-free future that has been proven to work in countries that have embraced these products.

It is therefore essential that Kenya adopts a balanced approach to such products. We cannot simply treat them like tobacco products, when they are clearly so successful at helping smokers move away from tobacco.

If we fail in this, we will all count the cost.