Data from Statista, a data-gathering platform, projects that the prevalence of tobacco smoking among adults living on the African continent will decline from 14.5% in 2000 to 7.4% in 2025. However, the World Health Organization (WHO) predicts that, due to a rapidly growing youthful population in Sub-Saharan Africa, increasing incomes, and the expanding presence of the tobacco industry, the number of young tobacco users will rise significantly.

By 1995, Zimbabwe and Malawi were the only major tobacco leaf-growing countries in Africa. However, the number of tobacco-growing nations in Africa has grown exponentially since then. WHO estimates that 8 million people globally die from tobacco use yearly, with 80% living in low- and middle-income countries (LMICs). Due to the projected increase in youthful smokers, the region is expected to face a heavier burden of tobacco-related diseases, non-communicable diseases (NCDs), and deaths in the future.

In an effort to curb the growing disease burden and reduce the harm associated with tobacco, several regulations have been introduced globally. These include the WHO Framework Convention on Tobacco Control (WHO FCTC), which has been ratified by many countries in the region. The Global State of Tobacco Harm Reduction (GSTHR) 2024 reveals that, in Africa, five of the 48 countries in the region—Eritrea, Malawi, Mozambique, Somalia, and Sudan—have not ratified the WHO FCTC.

The WHO FCTC has influenced numerous bans on tobacco and nicotine products, even those deemed as less harmful alternatives to combustible cigarettes. In Kenya, the government has introduced a tax on electronic cigarettes: 3,000 Kenyan shillings (around $30) per e-cigarette device and 2,500 Kenyan shillings per cartridge. Similarly, South Africa has been pushing for heavy taxation on e-cigarettes.

Tobacco Harm Reduction (THR) experts and advocates have raised concerns about non-scientific bans and regulations, which they believe could drive people toward using more harmful tobacco products.

In an interview with AllAfrica at the 4th edition of the  Harm Reduction Exchange IHRE) in Nairobi, Wilson Box, a Harm Reduction expert from Zimbabwe, emphasised the need for Africa to develop home-grown THR  regulations tailored to its unique challenges.

“Personally, I think that there is a need to have national or regional assessments on Tobacco Harm Reduction to identify which territories are implementing it and those that are not,” said Mr Box.

“From these assessments, policymakers can also be advised on what to do with our own data and research as African countries. That way, I think it might help our communities because we can use and rely on  local data rather than imported data which might not be of much help to local communities.”

He added that the issue of regulations is complex, as some territories have effective regulations while others face challenges in implementing and enforcing them.

“Regulations depend on each jurisdiction because, in most cases, regulations are put in place to serve the needs of those particular jurisdictions. In the United Kingdom (UK), they have their own regulations that support the use of Tobacco Harm Reduction because they are mainly worried about the effects of tobacco, especially among the youthful generations. The same applies to countries like South Africa. They also have their regulations in place, but the only challenge is that you mostly find international companies pouring  in a lot of money, which might cause the regulations in South Africa to be problematic.”

He cautioned, however, that the WHO FCTC is not relevant to the African context and needs to be amended to address the needs of modern African nicotine users.

Data shows that the African region has limited evidence on safer nicotine products (SNPs), except for nicotine replacement therapy (NRT). To date, NRT is marketed in 18 countries, not marketed in 25, and no information is available for five countries. There are also no specific laws regulating the use and sale of safer nicotine products in most African countries. The sale of snus is allowed in 22 countries, while 26 have no specific laws.

For nicotine vaping products (e-cigarettes), no specific laws exist in 38 African countries. They are allowed in five countries and banned in five. In Ethiopia, Uganda, Gambia, Seychelles, and Mauritius, e-cigarettes are legal to use but illegal to sell, though the Seychelles government announced in 2019 its intention to lift the ban and regulate e-cigarettes. For heated tobacco products, no specific laws exist in 44 countries; sales are allowed in three countries and banned in one.

Evidence also indicates a slight increase in the availability of Harm Reduction services since the Global State of Harm Reduction report in 2022.

“However, substantial regional differences still exist, so first of all, Africa must be united for Africa to be able to address tobacco-related challenges in different communities,” said Samuel Hanu of the Harm Reduction Alliance of Ghana.

He added that 108 countries include Harm Reduction in national policies. However, criminalisation and punitive responses to drug use remain dominant in most places. These approaches undermine Harm Reduction efforts, fuel stigma and discrimination, and deter people who use drugs from seeking vital, life-saving services.

He emphasized that the stigmatisation and criminalisation of drug users, smokers, and users of nicotine products remain significant issues in Africa.

“This impedes access to existing Harm Reduction services and undermines the political and financial support needed to implement and expand these services,” said Hanu.

He further stated that the biggest funding boost for Harm Reduction in Eastern and Southern Africa would come from governments halting funding for punitive approaches to drug use and instead investing in Harm Reduction. He also called for leveraging technology and innovation to combat THR misinformation and disinformation.

“The Overdose Risk Information Tool (ORION) is an innovative e-health tool implemented in clinical settings across Europe. It incorporates overdose risk assessments and provides individuals with information on future Harm Reduction practices and behaviors aimed at reducing overdose rates.”

The Scottish Government launched the Digital Lifelines Scotland (DLS) program to enhance the provision of digital technology in Harm Reduction and other support services.