Helping smokers in Africa quit is an uphill battle and smokers on the continent have said nicotine pouches can help. But knee-jerk reactions by policymakers have removed this important lifeline, hurting people’s chances of quitting, argues Joseph Magero, Chair of the Campaign for Safer Alternatives (CASA).

Millions of Africans who are desperate to quit smoking are instead being unnecessarily condemned to an early grave.

Thanks to misguided government policies, these reluctant smokers are being denied access to alternative nicotine products that could help them to live happier, healthier, and longer lives.

While global evidence shows that innovations such as e-cigarettes and nicotine pouches can offer a route away from more harmful, combustible cigarettes, smokers on the continent too often face a single, stark, and binary choice: quit or die.

Kenya tobacco control ‘failing miserably’

Recent research conducted by the Campaign for Safer Alternatives (CASA) with IPSOS in Kenya illustrates how this approach to tobacco control is failing miserably.

CASA listened to the opinions of scores of adult smokers age 25+ who were using nicotine pouches to quit before their government suspended sales last year. They believed they had found a way to give up smoking for good – and then that lifeline was snatched away.

According to the study, “the introduction of oral nicotine pouches in 2019, which was deemed to have fewer side effects than cigarettes, resulted in quick uptake among cigarette smokers in Africa who had been struggling to quit”.

The respondents found that nicotine pouches helped them to significantly reduce their cigarette consumption, with four out of five reporting that they smoked less than they did two years ago.

Quite rightly, these people deemed oral tobacco-free nicotine pouches a safer or healthier stimulant than cigarettes. For some, they are “a great and only alternative”.

One respondent reported that “for the first time in Kenyan history I had a product that would prevent me from smoking cigarettes”.

Despite the positive impact of pouches on reducing smoking amongst its users, the suspension of the product from the market in 2020 unfortunately “resulted in them reverting to cigarettes.”

The life-changing opportunity offered by pouches was defined in this poignant sentiment from one reluctant smoker: “When they were banned, I found myself smoking even more than before. I just don’t know how to stop smoking.”

The testimony we heard was compelling and sincere – and spoken from experience. How I wish that the decision-makers who frame our health policies would pay it greater heed.

Already this year, 4,000 Kenyans have died as a result of cigarette smoking.

Nicotine pouches help smokers in Africa quit

Nearly two-thirds of the nation’s smokers want to quit, but most public healthcare facilities in Kenya don’t offer cessation services and nicotine replacement therapies are largely unaffordable.

Most of those questioned in our survey said that their motivation for using oral nicotine was the fact that the pouches helped them in their quitting journey.

And that belief is fully borne out by evidence from around the world.

Organisations such as Public Health England advocate that smokers use alternative nicotine products to give up cigarettes.

Swedish snus — another smokeless nicotine product — has grown in popularity in Sweden since the 1970s helping the country reduce its smoking rates. Today, Sweden reports the lowest smoking rates in Europe and is classified as “smoke-free” according to the WHO’s definition.

The use of snus and tobacco-free nicotine pouches as less harmful alternatives to smoking has also resulted in better health outcomes for Sweden. For example, the ratio of men suffering from tobacco-induced cancers is less than half of the EU average.

The positive impact of non-combustible, oral nicotine products on smoking rates in Sweden is widely acknowledged. “Particularly among men, the availability of snus as a substitute for smoking has helped to reduce the prevalence of smoking in Sweden, which is now by far the lowest in Europe,” states the Royal College of Physicians. 

These statistics from Sweden may be the most pertinent for Africa, where there is a tradition of using oral stimulants.

‘Nicotine pouches saved my life’

Like many others, I used nicotine pouches to quit smoking entirely. It’s fair to say they saved my life, and they are the reason I am an advocate of tobacco harm reduction.

I understand that quitting is the best approach, but for smokers in Africa who can’t or don’t want to quit, alternative nicotine products help them to reduce their health risks.

For that reason, legislators need to show a balanced approach to nicotine products, not a knee-jerk reaction that treats them like combustible tobacco. They are totally different products.

Smokers in Africa need access to safer alternatives and they need that access in places and at prices that they can afford.

CASA strongly agrees that nicotine should never be sold or marketed to under-18s, but it should be promoted as an alternative to tobacco to adult smokers and it should be available wherever cigarettes are sold.

The consumers canvassed by CASA cited high prices as a deterrent for using pouches or e-cigarettes. Similarly, the limited number of retail outlets selling alternative products discouraged their use.

Accurate information is also a factor. Consumers told us they would view health warnings on the packaging of pouches in much the same light as those on cigarette packs. But surely this advice should acknowledge that one product – the nicotine pouch – is 95 percent less harmful than the other.

If our policymakers are truly concerned about people’s health and personal welfare, they should pay attention to the experiences of the individuals who shared their stories with us.

As one said about his discovery of nicotine pouches: “For the first time in Kenyan history I had a product that would prevent me from smoking cigarettes.”

Surely everyone should be given their best chance of beating addiction and saving their lives.

Joseph Magero is Chair of Campaign for Safer Alternatives (CASA), a pan-African organisation that advocates for the adoption of tobacco harm reduction policies in Africa. In 2019, Magero was awarded Advocate of the Year by the International Network of Nicotine Consumer Organizations (INNCO).