Embracing tobacco harm reduction to save lives: Sweden’s experience and lessons for Nigeria

Sweden’s harm reduction strategy to combat tobacco-related deaths and improve public health is an inspiring model that has saved millions of lives. Sweden’s results towards achieving a smoke-free society is a success story and an exemplary model for countries around the world, especially in Africa to adopt in their ongoing efforts towards reducing the health impact of smoking.

Tobacco harm reduction is a public health strategy that aims to reduce the negative health impacts of smoking by providing smokers with alternative products that are less harmful than cigarettes. Its goal is to help smokers quit smoking altogether in favour of a less harmful alternative.

International health experts have urged African policymakers to adopt Sweden’s Tobacco harm reduction strategy to combat tobacco-related deaths and improve public health across the continent. For example, over the past 15 years, Sweden has reduced its smoking rates from 15% in 2008 to 5.6% today. This is the lowest smoking rates in Europe with corresponding health impact. For instance, Sweden now has a 41% lower incidence of cancer than other European countries, and a 39% lower mortality rate than the European average from all tobacco related diseases. These achievements highlight Sweden’s smoke-free strategy and underscores the potential benefits of adopting a similar approach in other societies.

A recent report – “The Swedish Experience: A Roadmap for a Smoke-free Society,” – published by Dr. Delon Human and Dr. Anders Milton, suggests that if other countries adopt similar measures, 3.5 million lives could be saved across Europe in the next decade.

The Swedish model of Tobacco Harm reduction is the acceptance of less harmful alternatives like snus, nicotine pouches, vapes, and heated tobacco products and ensuring that those alternatives are known to, available and affordable to the general public. These alternatives provide a pathway for smokers to transition away from combustible cigarettes, to non-combustible tobacco or nicotine alternatives that significantly reduce the exposure to harmful chemicals produced by smoking.

Public health experts, consumers, and policymakers converged to discuss the urgent need to implement Tobacco Harm Reduction (THR) strategies in Africa, in a THR webinar hosted by Africa Harm Reduction Alliance (AHRA) on the 28th of April 2023 . The panel highlighted the success of countries like Sweden and the United Kingdom, who have embraced lower-risk alternatives to cigarettes, resulting in reduced smoking rates and tobacco-related diseases. The webinar was an urgent wake-up call for African nations, highlighting the pressing need to adopt and leverage tobacco harm reduction (THR) strategies to effectively combat cigarette smoking and its consequences on public health.

“Sweden’s success story should be celebrated as a public health revolution. We should all be on the mountaintop shouting ‘Victory!’ and looking at Sweden as the best-case practice”, Dr. Delon Human, the Secretary-General of the AHRA said. He further added that the efforts are all about saving lives and about improving the quality of life for smokers who’ve been unable to quit. “Harm reduction is their way out; it’s their fire escape”,

Kurt Yeo, a consumer advocate, called for a rethinking of the approach to non-communicable diseases (NCDs) and the potential of THR in addressing the smoking pandemic issue.

Dr. Derek Yach, a global health consultant and founder of the Foundation for a Smoke-Free World, has stressed the need for better access to reduced risk alternatives and more accurate diagnostics for tobacco-related conditions. He warned against proposals that would regulate harm-reduction products, such as e-cigarettes and nicotine pouches, the same as combustible cigarettes. If we miss the opportunity to adopt THR “a review in a few years’ time will show that we’ve actually forgone the opportunity to save many, many lives,” Dr. Yach said.

In order to achieve meaningful progress, towards a smoke-free society in Nigeria, it is vital for us to take learnings from other countries and adapt successful strategies within the context of their/our unique cultural and socio-economic contexts.

Nigeria, needs to begin to consider implementing robust tobacco control policies that promote tobacco harm reduction and reduced risk alternatives for smokers who want to but cannot quit. Policy makers, public health professionals and the scientific community need to foster international research collaboration, ensure that accurate and evidence-based information is readily available to consumers, and actively engage in constructive dialogue among a diverse array of stakeholders.

Tobacco harm reduction, when approached with a well-coordinated and evidence-based strategy, can play a crucial role in significantly reducing the health impact of smoking in Nigeria. By taking the right steps in prioritizing and implementing THR initiatives, Nigeria and other African nations can save millions of lives, alleviate the strain on healthcare systems, and work towards a healthier future for our people. By embracing less harmful alternatives to smoking, and THR strategies, we can begin to make a tangible progress in the fight against cigarette smoking. This transformative shift will not only benefit the health and well-being of individuals but will also contribute to the overall socio-economic development and progress of Nigeria and the African continent.