Kenya’s fight against tobacco

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KENYA’s obstructive stance on innovative tobacco-free oral nicotine products (ONDS) is denying thousands of smokers desperate to quit cigarettes an extraordinary opportunity to have informed choices and save lives. That’s according to international medical experts who addressed the Africa Tobacco Harm Reduction Forum hosted by the Campaign for Safer Alternatives (CASA). “By lagging behind the rest of the world in its stance on tobacco harm reduction (THR), the Kenyan government is blocking the escape from tobacco-related disease and death for 30,000 smokers a year, with no chance of reprieve,” CASA Chairman Joseph Magero told the webinar. “Kenya’s ongoing ‘quit or die’ tobacco control policy ignores the reality that too many smokers find it impossible to quit, even when they want to. Reduced harm products such as e-cigarettes and oral nicotine pouches give them a much safer alternative, a route away from cigarettes and a better chance of a smoke-free future.”

ICT in health services, source: Um.edu.mt

The webinar event follows the release of an IPSOS study on the behaviour of oral nicotine users in Kenya. Magero said the study found that “smokers trying to quit smoking welcomed oral nicotine products as ‘an ideal substitute’ for combustible cigarettes. When nicotine pouches were banned, users reverted to cigarette smoking.” Physician Dr Delon Human, CEO of the Africa Harm Reduction Alliance (AHRA), described oral nicotine as one of the biggest lifesavers in harm reduction, remarking, “Compared to cigarettes, oral nicotine has shown its capacity to help millions of adult smokers switch from dangerous cigarettes to lower-risk products. In Africa and worldwide, it has enormous potential to prevent tobacco-related disease and premature death.” Dr Human cited the example of Sweden, where nicotine pouches (snus) use has been steadily displacing smoking.

There, adult daily smoking prevalence has already fallen to 5% – compared to an average of 26% in the European Union (EU). “Nicotine pouches have saved millions of lives in Sweden. They can achieve the same in Kenya and elsewhere, for the 1.3 billion smokers in the world,” he noted. 2 Dr Karl Fagerström PhD and Clinical Psychologist (Sweden) added that as a healthcare scientist, he would ‘like to see adult users of risky tobacco products have credible, viable and safer alternatives to their current addiction.” What is oral nicotine? Oral nicotine is a smokeless, tobacco-free version of a Swedish product called snus.

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Resembling a teabag, each small, moist nicotine pouch contains pharmaceutical grade nicotine, food-grade fillers, salt, water and different flavours. It involves no burning, vapour or any tobacco whatsoever. The pouch is placed between the gums and lip, where the moisture of the mouth releases the nicotine.

No batteries or refrigeration is required. Dr Human noted that evidence-based global research had shown alternative nicotine products to be roughly 95% less harmful than smoking cigarettes. “No nicotine product is risk-free; even medicinal nicotine replacement therapy (NRT) has certain risks.” Echoing his colleagues, he stressed, “Consumers deserve fair, proportionate and risk-based regulations so they can make the most responsible and informed choices for their health.” Smokers need affordable options to quit.

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The experts expressed concern at the high level of taxes levied on alternative nicotine products in Kenya, in particular, the government’s plan to increase tax on nicotine pouches, making them twice as expensive as cigarettes.

Dr Kgosi Letlape, AHRA president and keynote speaker, said if governments wanted smokers to quit cigarettes, they needed to give them affordable and accessible alternatives. “Smoke-free oral nicotine products offer a simple, safer simple, tobacco-free substitute for combustible tobacco.” Dr Letlape noted Kenya’s apparent plan to “become the only country in the world to make reduced-risk products more expensive than harmful tobacco products,” adding, “This policy will simply keep consumers smoking and probably please cigarette manufacturers. It makes no sense economically; nicotine pouches are effective, cost government nothing and will help reduce the disease burden from smoking.”

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According to data by the World Health Organisation, the tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year around the world. More than 7 million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.

Smokeless tobacco use is highly addictive and damaging to health. Smokeless tobacco contains many cancer-causing toxins and its use increases the risk of cancers of the head, neck, throat, oesophagus and oral cavity (including cancer of the mouth, tongue, lip and gums) as well as various dental diseases.

Over 80% of the 1.3 billion tobacco users worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco use contributes to poverty by diverting household spending from basic needs such as food and shelter to tobacco.

Some countries have put in place measures to control the use of tobacco and WHO also says that tobacco taxes are the most cost-effective way to reduce tobacco use and health care costs, especially among youth and low-income people, while increasing revenue in many countries.

“The tax increases need to be high enough to push prices up above income growth. An increase of tobacco prices by 10% decreases tobacco consumption by about 4% in high-income countries and about 5% in low- and middle-income countries.” says WHO adding that despite this, introducing high tobacco taxes is a measure that is least implemented among the set of available tobacco control measures.

Studies show that few people understand the specific health risks of tobacco use. However, when smokers become aware of the dangers of tobacco, most want to quit.

Illicit trade of tobacco products

According to WHO, the illicit trade in tobacco products poses major health, economic and security concerns around the world. It is estimated that 1 in every 10 cigarettes and tobacco products consumed globally is illicit. The illicit market is supported by various players, ranging from petty traders to big tobacco companies, and in some instances even organized criminal networks involved in arms and human trafficking.

Yvonne Kawira is an award winning journalist with an interest in matters, regional trade, tourism, entrepreneurship and aviation. She has been practicing for six years and has a degree in mass communication from St Paul’s University.

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