By Akinwande Puddicombe
Tobacco use remains one of the most pressing public health challenges of our time, responsible for more than 8 million deaths annually worldwide.
Despite decades of anti-smoking campaigns, over 1.1 billion people still smoke, and the numbers remain stubbornly high, particularly in low- and middle-income countries. Globally, the healthcare burden caused by smoking-related diseases continues to strain resources, yet millions of smokers find it difficult or impossible to quit.
Sweden is on the verge of being declared Europe’s
first smoke-free country, with smoking prevalence dropping to as low as 5.6%.
This success did not occur spontaneously; rather, it was the result of
concerted public health campaigns, regulatory reforms, and the widespread
adoption of safer nicotine alternatives, such as nicotine vapes, snus, and oral
nicotine pouches. These products have become an acceptable alternative for
Swedish smokers seeking to quit or reduce their cigarette consumption
In response to this growing public health concern, the Institute for Liberty and Policy Innovation (ILAPI) recently hosted a roundtable discussion on Tobacco Harm Reduction (THR) in Ghana, a critical forum for addressing the future of tobacco regulation. As a public health advocate, I had the opportunity to speak at this event, where experts from various fields emphasized the need to adopt innovative strategies to mitigate the harm caused by combustible cigarettes.
Central to this discussion
was the Swedish model of harm reduction, a pragmatic approach that has
demonstrated remarkable success in reducing smoking rates and smoking-related
diseases. This model holds significant potential for Nigeria and other African
countries, as it presents a feasible pathway to achieving a smoke-free society.
Sweden’s progress in tobacco
control is built on the principles of accessibility, acceptability, and
affordability of safer nicotine alternatives. Rather than stigmatizing smokers,
Sweden has provided viable alternatives to help them reduce the harms
associated with combustible cigarette use. Products like nicotine vapes, snus,
and oral nicotine pouches have allowed smokers to transition away from the
harmful effects of burning tobacco, which leads to diseases like lung cancer,
respiratory issues, and cardiovascular ailments.
In addition to encouraging safer
alternatives, Sweden has implemented comprehensive public health campaigns,
introduced age limits for tobacco purchases, and established smoke-free zones
in public areas. Importantly, the Swedish approach has been collaborative,
involving regulators, health practitioners, and the broader society to drive
this success. As a result, smoking-related diseases have drastically decreased,
saving lives and reducing the burden on Sweden’s healthcare system.
This experience offers a roadmap
that Nigeria can adapt to suit its unique socio-economic and public health
landscape. Given our country’s growing population and the prevalence of
smoking, adopting a harm reduction strategy like Sweden’s could have a
transformative impact.
The reality is that many
Nigerians who smoke are unable or unwilling to quit despite knowing the health
risks. This mirrors a global challenge, where the fight against tobacco
addiction has often been met with limited success, especially in low- and
middle-income countries. Quitting smoking is an ideal outcome, but we must face
the fact that not all smokers can quit entirely. Harm reduction strategies,
which have been equally beneficial in other public health challenges such as
HIV and heroin abuse, provide a middle ground—offering safer alternatives to
mitigate the deadly consequences of smoking without forcing smokers into an
all-or-nothing choice.
In this context, harm reduction
would mean promoting scientifically substantiated, safer nicotine
alternatives—such as nicotine vapes or e-cigarettes and oral nicotine
pouches—that deliver nicotine while minimizing the health impact of cigarette
smoking. By making these products accessible, acceptable, and affordable, Nigeria
could reduce the incidence of smoking-related diseases while working towards a
smoke-free future.
Beyond the significant public
health benefits, adopting a harm reduction approach in Nigeria also makes
economic sense. Smoking-related diseases place an immense strain on our already
overstretched healthcare system. Lung cancer, chronic obstructive pulmonary
disease (COPD), and heart disease—diseases which can be associated with
smoking—are costly to treat. By reducing the prevalence of smoking through harm
reduction strategies, we can save lives while easing the financial burden on
Nigeria’s health sector.
Sweden’s success in reducing smoking rates has
resulted in considerable savings for its healthcare system. Nigeria, too, could
reap similar benefits. Reducing smoking-related diseases would free up
resources that can be redirected to other critical health challenges, improving
the overall health outcomes of our nation. As we strive to improve our
healthcare system and promote healthier lifestyles, it is essential that we
explore all avenues for reducing harm caused by smoking.
We must recognize that tobacco
harm reduction is about providing safer alternatives to adult smokers who are
unable or unwilling to quit. Our policymakers, public health experts, and civil
society must work together to implement a comprehensive harm reduction strategy
that includes the regulation and promotion of scientifically substantiated
safer nicotine products. We need to remove any misinformation around harm
reduction and recognize it as a vital public health tool.
As with Sweden, New Zealand, the
United Kingdom, and other progressive countries that have embraced harm
reduction, Nigeria must make these alternatives accessible, acceptable, and
affordable to adult segments of society, especially to those who have made the
choice to smoke. Moreover, public health campaigns need to emphasize the
benefits of completely switching to scientifically substantiated, reduced-risk
alternatives for adult smokers who would otherwise continue to smoke.
Sweden’s experience in tobacco
harm reduction offers Nigeria an invaluable lesson. By adopting a similar
approach, we can not only reduce the impact of smoking-related diseases but
also move closer to becoming a smoke-free society. The benefits are clear:
improved public health, reduced healthcare costs, and a healthier population.
However, achieving these outcomes requires coordinated action.
It is time for Nigeria to take
decisive steps toward harm reduction. By emulating Sweden’s successful strategy
and tailoring it to our local context, we can pave the way for a smoke-free
future. The stakes are too high to ignore this opportunity for change.
Based on the weight of evidence
and assuming a complete switch from cigarette smoking. These products are not
risk-free and are addictive.
*Dr.
Puddicombe, a Lagos-based public health advocate
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