Health experts call on regulators to adopt urgent tobacco harm reduction policies

Health experts call on regulators to adopt urgent tobacco harm reduction policies
Health Activist and Harm-Reduction Advocate, Dr. Kgosi Letlape

The Africa Harm Reduction Alliance says that Sweden’s approach in combining tobacco control methods with harm minimising strategies could save lives if approach adopted in South Africa.

Cigarettes will kill one in two people who smoke, said president of the African Harm Reduction Alliance, Dr Kgosi Letlape. “Today there are numerous approaches and products that can help people to quit – or to minimise harm when they consume nicotine and yet South Africa is lagging behind.”


“To help the countries millions of smokers, government must understand that it is unethical to withhold from smokers information on tobacco harm reduction products that can reduce the damage wreaked by cigarettes,” said Letlape.

“We differ to government and our county leaders to make good decisions and when the authorities are on the wrong side of the truth it becomes problematic to society,” he explains. “Our leaders need to weigh-up the risk continuum; we need to scientifically look at combustion versus non-combustion and the risks and benefits associated with each and then act accordingly.”

“Stop painting everything with the same brush, we are urging our president to secure a smoke-free country and to save the lives of millions of cigarette smokers,” Letlape added. “We should go beyond the smokescreen about the industry. The focus should be on the interests of the smoker.”

“My message is that we can learn a lot from countries who are achieving public health revolutions,” he says. “Just look at Sweden who didn’t ignore the plight of smokers or combining different strategies for those smokers unable to quit – they’ve achieved astounding results.”

Letlape explained, “In fact my colleague Delon Human has stated, Sweden will drop below a 5 percent tobacco smoking prevalence rate in the next few months where the rate was more than 15 percent fifteen years ago.”

“With harm reduction strategies we see a human face,” said Letlape. “Instead of smokers being treated as if they do not exist.”

He added that the science of nicotine has advanced rapidly in the past decade. “While nicotine is what smokers are addicted to, it is not what kills them.”

Letlape continued: “Adult smokers switching to non-combustible alternatives is highly recommended and we are pleading to government to reconsider their current stance in the interest of the South African public. Where governments have allowed these alternatives into their environment, the use of combustible cigarettes has come down, and health benefits are clearly being derived.” 

“We need to stop killing smokers by protecting combustible cigarettes,” he added. “Non-combustible products produce fewer and lower levels of toxicants than cigarettes and have clear benefits for people who smoke and those around them., they should be accessible and affordable for smokers, especially those in low-to-middle income (LMIC) countries.”

“South Africa has an opportunity to become a leader in tobacco control through regulating non-combustible products differently from cigarettes,” he said. “It is something worth fighting for and will be achieved, just like health activists fought to provide antiretroviral therapy in the country in the HIV/AIDS epidemic.” 

“Regulators need to look at the science and see where alternatives to smoking have entered other countries and how the prevalence of smoking declines with these strategies,” he explained. 

“Common sense should not escape us; government should provide information and access to harm-reduction initiatives in order to reduce the harms of smoking,” he added. “When the World Health Organisation’s (WHO) FCTC was created many years ago, there were very few alternatives to smoking and now years later there are a plethora of scientifically proven alternatives, but the approach remains the same. It needs to be brought up to date and leverage the potential of reduced risk products.” 

Letlape explained that as health activists they are looking to the country’s leaders as we approach the Conference of the Parties meeting in November later this year to be open and transparent and ensure proper dialogue from South Africa on this critical issue.

“The essence of public health is to prevent disease and to prevent premature deaths linked to any infection or non-communicable diseases such as lifestyle issues like smoking, and to promote health,” he adds. “One key message is that harm reduction should be accepted as a basis for regulation. It’s not unknown to public health – it is practised in every country.”

He stresses that what is needed is a sensible, risk-based system of regulation which is achievable, and it should address the differences of products. “This is possible. It should address the difference between combustibles and non-combustibles. Its primary focus should be to prevent youth initiation or use. There should be clear standards for products and a risk-based framework in place for marketing, pricing and tax,” he says.

“Policy-makers can make things worse if they close down the fire escapes,” he concludes.