Advocating for the Swedish experience – A consumer-friendly harm reduction approach works better than one-size-fits-all policies

As the world continues to grapple with the devastating health impacts of smoking, countries like Nigeria must consider Sweden’s groundbreaking approach to tobacco harm reduction. Sweden’s model has revolutionised the fight against smoking, and there are invaluable lessons to be learnt.

Recent research highlights the effectiveness of various alternative products. Among respondents, 60 percent perceive nicotine replacement therapy (NRT) as the most effective alternative product, while 26.7 percent consider e-cigarettes to be the most effective. Furthermore, 73.3 percent believe NRT is safer than smoking tobacco, and 48.3 percent hold the same belief for e-cigarettes. Additionally, 70.8 percent agree that alternative products aid in smoking cessation. However, there remains a notable lack of awareness regarding the addictive nature and cessation efficacy of alternative products among respondents.

An unpublished study conducted among medical students in Rwanda underscores a growing awareness of tobacco harm reduction concepts. While 58 percent of respondents were familiar with these concepts, only a minority identified nicotine vapes as a cessation tool, and a mere 27 percent recognised vaping as less harmful than smoking. This highlights the need for enhanced education and support for smoking cessation initiatives among healthcare professionals.

Sweden stands out as a beacon of success in the fight against tobacco use, with smoking rates plummeting by an impressive 55 percent over the past decade. This achievement not only signifies a decline in smoking prevalence but also correlates with significant reductions in associated health risks, including a remarkable 41% lower cancer incidence and a 38 percent reduction in total cancer deaths compared to the rest of Europe. However, Nigeria continues to grapple with the devastating toll of smoking-related diseases, with nearly 30,000 lives lost in 2022 alone.

According to the Global State of Tobacco Harm Reduction, approximately 4.5 million Nigerians, constituting 4.1 percent of the adult population, are current smokers, posing a formidable public health challenge. The urgency to prioritise tobacco harm reduction (THR) strategies cannot be overstated, especially in light of the invaluable lessons to be learnt from Sweden’s successful model.

Central to Sweden’s success is the adoption of Snus, a smokeless oral fermented tobacco product, and the promotion of diverse alternatives to traditional cigarettes. Nigeria must emulate this progressive approach by launching public awareness campaigns, educational initiatives, and targeted messaging to destigmatise reduced-risk alternatives to smoking. By aligning with Sweden’s innovative stance and ensuring the accessibility, acceptability, and affordability of harm reduction tools, Nigeria can pave the way towards improved public health outcomes and a future free from the burdens of tobacco-related diseases.

Sweden’s smoking rate has declined by 55 percent in the last decade, resulting in the country having the lowest smoking rates in the world. This decline is closely linked to significant reductions in cancer incidence and deaths. Notably, Sweden boasts a 41 percent lower cancer incidence and a 38 percent reduction in total cancer deaths compared to the rest of Europe. These impressive statistics are a direct result of the country’s widespread adoption of less harmful nicotine alternatives, which have provided smokers with effective ways to quit smoking.

Currently, only about 5.6 percent of the Swedish population smokes daily, contributing to the lowest rates of lung cancer and cardiovascular disease in Europe. The country’s experience raises a compelling question: why has the rest of the world not followed suit? According to Charlie Weimers, a Swedish Member of the European Parliament, the World Health Organisation (WHO) will soon classify Sweden as Europe’s first smoke-free country.

Sweden’s success story revolves around the availability of a wide range of harm-reduction nicotine products, such as Snus, nicotine pouches, and vaping. These alternatives have proven effective in helping smokers transition away from traditional cigarettes, thereby reducing their exposure to harmful toxins.

Policy recommendations for Nigeria

The Swedish model provides a blueprint for other nations, particularly Nigeria, to reduce smoking rates and improve public health. Key to this model are the principles of accessibility, acceptability, and affordability of harm reduction products.

Accessibility: Ensure that reduced-risk nicotine products are readily available to smokers. This involves not only the physical availability of products but also the removal of unnecessary regulatory barriers that may hinder access.

Acceptability: Public awareness campaigns and educational initiatives are essential to change perceptions and reduce the stigma associated with using harm-reduction products. This includes training healthcare professionals to recognise and recommend these alternatives as viable cessation tools.

Affordability: The pricing of nicotine products should reflect their risk level, with safer alternatives being more affordable than traditional cigarettes. High taxes on less harmful products can discourage smokers from switching, thus maintaining the status quo of high smoking rates and associated health risks.

Lessons from Sweden: A path forward

Sweden’s health revolution was accomplished in just 14 years, a testament to the effectiveness of its harm reduction strategies. Notably, Sweden is the only country in Europe where Snus is legal, and 18 percent of the Swedish population uses it. This consumer-friendly approach has proven that offering multiple cessation options can significantly reduce smoking rates.

A one-size-fits-all approach to smoking cessation does not work. Smokers need various options to find what works best for them. Safer nicotine products should be less taxed than cigarettes, making them a more attractive option for those looking to quit smoking. For instance, the smoking rate in Canada is twice as high as in Sweden, underscoring the positive public health impacts of harm reduction strategies. The availability of less harmful nicotine options directly correlates with lower rates of cancer incidence and mortality.

Nigeria, with its high smoking rates and significant burden of smoking-related diseases, stands to benefit immensely from adopting Sweden’s harm reduction model. By prioritising the principles of accessibility, acceptability, and affordability, Nigeria can make substantial strides in reducing smoking rates and improving public health outcomes.

Embracing Sweden’s pioneering model is not just an option but a necessity. The transformative potential of harm reduction strategies is immense, and by adopting these approaches, Nigeria can safeguard countless lives and move towards a smoke-free future.

Gabriel Oke is the Founder of THR Journo Project. Biomedical Scientist and a healthcare tech researcher