Tobacco use remains one of the most pressing public health challenges of our time, responsible for more than 8 million deaths annually worldwide. Despite decades of anti-smoking campaigns, over 1.1 billion people still smoke, and the numbers remain stubbornly high, particularly in low- and middle-income countries. Globally, the healthcare burden caused by smoking-related diseases continues to strain resources, yet millions of smokers find it difficult or impossible to quit.
Sweden is on the verge of being declared Europe’s first smoke-free country, with smoking prevalence dropping to as low as 5.6 percent. This success did not occur spontaneously; rather, it was the result of concerted public health campaigns, regulatory reforms, and the widespread adoption of safer nicotine alternatives, such as nicotine vapes, snus, and oral nicotine pouches. These products have become an acceptable alternative for Swedish smokers seeking to quit or reduce their cigarette consumption.
In response to this growing public health concern, the Institute for Liberty and Policy Innovation (ILAPI) recently hosted a roundtable discussion on tobacco harm reduction (THR) in Ghana, a critical forum for addressing the future of tobacco regulation. As a public health advocate, I had the opportunity to speak at this event, where experts from various fields emphasised the need to adopt innovative strategies to mitigate the harm caused by combustible cigarettes. Central to this discussion was the Swedish model of harm reduction, a pragmatic approach that has demonstrated remarkable success in reducing smoking rates and smoking-related diseases. This model holds significant potential for Nigeria and other African countries, as it presents a feasible pathway to achieving a smoke-free society.
Sweden’s progress in tobacco control is built on the principles of accessibility, acceptability, and affordability of safer nicotine alternatives. Rather than stigmatising smokers, Sweden has provided viable alternatives to help them reduce the harms associated with combustible cigarette use. Products like nicotine vapes, snus, and oral nicotine pouches have allowed smokers to transition away from the harmful effects of burning tobacco*, which leads to diseases like lung cancer, respiratory issues, and cardiovascular ailments.
In addition to encouraging safer alternatives, Sweden has implemented comprehensive public health campaigns, introduced age limits for tobacco purchases, and established smoke-free zones in public areas. Importantly, the Swedish approach has been collaborative, involving regulators, health practitioners, and the broader society to drive this success. As a result, smoking-related diseases have drastically decreased, saving lives and reducing the burden on Sweden’s healthcare system.
This experience offers a roadmap that Nigeria can adapt to suit its unique socio-economic and public health landscape. Given our country’s growing population and the prevalence of smoking, adopting a harm reduction strategy like Sweden’s could have a transformative impact.
Read also: Embracing tobacco harm reduction to save lives: Sweden’s experience and lessons for Nigeria
The reality is that many Nigerians who smoke are unable or unwilling to quit despite knowing the health risks. This mirrors a global challenge, where the fight against tobacco addiction has often been met with limited success, especially in low- and middle-income countries. Quitting smoking is an ideal outcome, but we must face the fact that not all smokers can quit entirely. Harm reduction strategies, which have been equally beneficial in other public health challenges such as HIV and heroin drug abuse, provide a middle ground—offering safer alternatives to mitigate the deadly consequences of smoking without forcing smokers into an all-or-nothing choice.
In this context, harm reduction would mean promoting scientifically substantiated, safer nicotine alternatives—such as nicotine vapes or e-cigarettes and oral nicotine pouches—that deliver nicotine whilst minimising the health impact of cigarette smoking. By making these products accessible, acceptable, and affordable, Nigeria could reduce the incidence of smoking-related diseases while working towards a smoke-free future.
Beyond the significant public health benefits, adopting a harm reduction approach in Nigeria also makes economic sense. Smoking-related diseases place an immense strain on our already overstretched healthcare system. Lung cancer, chronic obstructive pulmonary disease (COPD), and heart disease—diseases that can be associated with smoking—are costly to treat. By reducing the prevalence of smoking through harm reduction strategies, we can save lives while easing the financial burden on Nigeria’s health sector.
Sweden’s success in reducing smoking rates has resulted in considerable savings for its healthcare system. Nigeria, too, could reap similar benefits. Reducing smoking-related diseases would free up resources that can be redirected to other critical health challenges, improving the overall health outcomes of our nation. As we strive to improve our healthcare system and promote healthier lifestyles, it is essential that we explore all avenues for reducing harm caused by smoking.
We must recognise that tobacco harm reduction is about providing safer alternatives to adult smokers who are unable or unwilling to quit. Our policymakers, public health experts, and civil society must work together to implement a comprehensive harm reduction strategy that includes the regulation and promotion of scientifically substantiated safer nicotine products. We need to remove any misinformation around harm reduction and recognise it as a vital public health tool.
As with Sweden, New Zealand, the United Kingdom, and other progressive countries that have embraced harm reduction, Nigeria must make these alternatives accessible, acceptable, and affordable to adult segments of society, especially to those who have made the choice to smoke. Moreover, public health campaigns need to emphasise the benefits of completely switching to scientifically substantiated, reduced-risk alternatives for adult smokers who would otherwise continue to smoke.
Sweden’s experience in tobacco harm reduction offers Nigeria an invaluable lesson. By adopting a similar approach, we can not only reduce the impact of smoking-related diseases but also move closer to becoming a smoke-free society. The benefits are clear: improved public health, reduced healthcare costs, and a healthier population. However, achieving these outcomes requires coordinated action.
It is time for Nigeria to take decisive steps toward harm reduction. By emulating Sweden’s successful strategy and tailoring it to our local context, we can pave the way for a smoke-free future. The stakes are too high to ignore this opportunity for change.
* Based on the weight of evidence and assuming a complete switch from cigarette smoking. These products are not risk free and are addictive.
By Dr Akinwande Puddicombe, Public Health Advocate
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