The Sunday Mail
Sunday Mail Reporter
Coronavirus health protocols meant to reduce the risk of infections and vaccines that significantly prevent the likelihood of severe disease and death have helped significantly reduce the number of people who succumb to the pandemic, especially in Africa, experts have said.
It is believed that the same approach can be used to lower the scourge of smoking-related deaths.
“Africa is less affected by Covid-19 and there are many reasons for that,” said Dr Imane Kendili, who is currently the vice president of the African Centre for Health Research, at the recent Harm Reduction Exchange webinar.
She is also the president of the Moroccan Association for Addictive Medicine and Associated Pathologies.
“Mask wearing, vaccines and social distancing are meant to reduce risk. We have to give people the best option possible . . . I think in Africa, more than elsewhere, we know our limitations in health and infrastructure budgets compared to other countries. I think harm has been the main approach. It is not about having the best infrastructure possible, but having good behaviour . . . Harm reduction works across a spectrum of issues.”
The Harm Reduction Exchange aims to create awareness and promote dialogue on the concept of harm reduction across the continent.
In essence, harm reduction refers to policies, programmes and practices aimed at minimising negative health, social and legal impacts associated with the use of harmful products.
According to Dr Kendili, people, especially those facing increased risk of harmful and addictive products, can be assisted to accept better and safer alternatives through exposure to evidence- and science-based information.
“People are reluctant to take many things, but when you engage and involve them, that might help. Communication is key . . . We must take this into account. The issue is how to give people information and let them decide . . .
“It’s not about forcing people to take the vaccine. When you impose it, it doesn’t work.
“We need public policy based on harm reduction . . .
“The all-or-nothing approach does not work. “If you have a person who has been smoking for years, even lung cancer will not force them to stop.”
Scientists are increasingly pushing for the same approach to be adopted to reduce smoking-related deaths.
While the coronavirus pandemic has killed about 5,6 million people in the past two years, smoking continues to claim eight million lives annually, especially in middle- to low-income countries. Africa is estimated to have more than seven million smokers, of which 250 000 die annually.
The World Health Organisation, through the Framework Convention for Tobacco Control (FCTC), has tried to ban tobacco but with little success.
Switching to harm-reducing alternatives, therefore, is thought to be a pathway to safer alternatives with favourable health outcomes, particularly for those who cannot quit.
“Quitting (smoking) is by far the best option, but it is not always possible,” Professor David Khayat, a French oncologist, told the same webinar. “Smoking is an addiction, and it is difficult to stop an addiction . . .
“Accepting that some level of bad behaviours are inevitable and therefore target to minimise the harms people suffer as a consequence, not the behaviour, becomes important.”
Studies have proven that prohibitionist interventions being pushed by the FCTC, which came into force in 2005, have met with little success.
At one time, France, which took aggressive measures to prevent smoking, saw a 1,5 million decline in smokers before they relapsed a year later, proving that it was increasingly difficult for some smokers to quit. But experts believe alternative nicotine-delivery systems such as heat-not-burn products (for example, IQOS), snus and e-cigarettes, among others, could provide a way to reduce risk.
Burning tobacco generates smoke, which contains more than 6 000 chemicals and ultrafine particles.
Ninety-three of the chemicals are listed by the United States Food and Drug Administration (FDA) as harmful and potentially harmful constituents.
The majority — almost 80 — are carcinogens or potential carcinogens.
Prohibition has been empirically proven to be ineffective.
In the US, for example, the national prohibition of alcohol between 1920 to 1933 was a failure.
“The elephant in the room for Africa is the WHO,” said Dr Kgosi Letlape, who is the president of the Africa Medical Association and co-founder of the Africa Harm Reduction Alliance.
He noted that the FCTC has inherent limitations since it focuses solely on combustible cigarettes and does not take into consideration the efficacy of safer alternatives that significantly reduce the harm caused by tobacco.
But policymakers around the world seem to be moving in the right direction.
In July 2020, the FDA, which is considered as the gold standard, allowed Philip Morris International (PMI) to market IQOS in the US.
In October last year, it also approved e-cigarette for sale for the first time.
There is now a general push for public health experts to not only consider tobacco harm-reducing alternatives, but to make them readily accessible at reasonable prices.
