Towards a smoke-free Nigeria: Lessons from Sweden’s success

Nigeria is one of the African countries with the highest burden of tobacco-related diseases and deaths. Unfortunately, the National Tobacco Control Act 2015 has been slow and inadequate in addressing the challenge. This apparent failure can be mitigated by awareness and acceptance of tobacco harm reduction (THR) strategies. THR aims to reduce the risks associated with tobacco use by providing safer alternatives to combustible cigarettes. Its remarkably successful adoption in Sweden accounts for the country’s lowest rates of smoking prevalence in Europe and the consequent lowest rates of lung cancer and cardiovascular diseases in the world.

Much of this outstanding smoke-free success in Sweden is primarily due to the widespread use of snus, a smokeless tobacco product that delivers nicotine without combustion, as well as the adoption of other non-tobacco alternatives to smoking. A significant body of evidence shows that these options are safer than smoking, incentivizing millions of Swedes to switch from cigarettes to these options.

Nigeria inarguably needs to emulate Sweden to become smoke-free in the shortest possible time. In a 2021 study by Marco Castrodori of the Center for the Study of Economies in Africa (CSEA), Nigeria recorded 28,876 tobacco smoking-related deaths annually, imposing an economic burden of approximately N526.4 billion in treatment costs. A glimmer of hope, however, surfaces as recorded deaths have declined to 16,137 annually as of 2023.

Again, a study on the current prevalence pattern of tobacco smoking in Nigeria by Adeloye et al. (2019), published in the BMC Public Health journal, reported similar declines in smoking rates, which fell from approximately 13 million smokers in 2012 to around 11 million in 2015. Similarly, in 2022, the Global State of Tobacco Harm Reduction report, further updated in October 2023, showed that between 2000 and 2023, Nigeria witnessed a commendable decline in smoking prevalence. The tobacco smoking prevalence dropped from 7.5 percent in 2000 to 6 percent in 2015, with an anticipated further decrease to 5 percent by 2025. While these numbers reflect progress, more strategic adoption of tobacco harm reduction techniques will accelerate these achievements.

Sweden’s strategy of reducing smoking rates from 15 percent in 2008 to 5.6 percent in 2023 is a guide for Nigeria to accelerate its decline. The country enforces policies to reduce exposure to smoke and introduces Tobacco Harm Reduction (THR) reduced-risk products to replace combustible tobacco. Sweden’s comprehensive tobacco control strategy, including increased taxes and health warnings, has contributed to its accelerated decline in smoking prevalence and global leadership in smoke-free rankings.

Tobacco heating products (THPs) are alternatives to smoking that aim to reduce the harm caused by conventional cigarettes. Examples include snus, heated tobacco, e-cigarettes, and nicotine pouches. THPs heat tobacco to generate aerosols, snus is smokeless, e-cigarettes produce vapour, and nicotine pouches offer smoke-free options. Research shows THRs can help adult smokers switch to healthier alternatives, with lower tax rates reflecting their lower risk.

Harm reduction should guide tobacco regulations in Africa, as it is a practical and transformative approach compared to prohibition-based policies. This approach aims to lessen the harmful effects of health behaviours without eliminating problematic ones, which is better than advocating for complete abstinence. Nigeria should adopt harm reduction approaches when regulating public health challenges, as complete abstinence often faces difficulties in maintaining and sustaining the practice.

An analysis of Sweden’s approach to smoke-free reveals a combination of sound THR policies and their robust implementation. First, Sweden created a foundation for collaboration among the government, health professionals, industry stakeholders, and consumers, aiming to minimise the consumption of combustible tobacco products and reduce exposure to tobacco smoke. The legal acceptance of these products and awareness campaigns targeting healthcare workers, smokers, and the general public played a significant role. Health workers actively recommended harm-reduction products as alternatives to combustible tobacco, creating a joint effort to combat smoking-related diseases.

The second was that they legalised 95 percent of the less harmful alternatives to combustible tobacco products and substantially reduced the attendant taxes on these alternative products based on the relative risk reduction of these products as compared with cigarettes. This approach provides legal options for smokers looking to quit, such as snus, heated tobacco, tobacco-free nicotine pouches, and e-cigarettes. Importantly, these alternatives were made readily available, with extensive advertising to raise awareness.

Nigeria faces challenges in achieving Sweden’s success in reducing smoking rates due to a lack of awareness among medical students and pharmacists, inadequate media education, cultural disparities, and affordability. To replicate Sweden’s success, Nigeria needs a multifaceted approach including higher taxes, public smoking bans, and tobacco advertising regulations.

First, the government should design and enforce effective tobacco harm reduction policies, ensuring access to non-combustible tobacco alternatives. These measures include regulatory frameworks, public awareness campaigns, and collaboration with the media.

Second, there is a need to strengthen knowledge among healthcare professionals and the general public about THR methods and products. This measure could involve training programmes, educational initiatives, and integrating THR into existing healthcare systems. Again, promoting the affordability of harm-reduction products is crucial to ensuring their accessibility to the population.

The call for fresh deliberations on tobacco harm reduction regulations in Africa underscores the importance of prioritising THR as a public health strategy. By adopting harm reduction approaches and ensuring access to non-combustible tobacco alternatives, Nigeria can make significant strides in reducing the burden of smoking-related illnesses and improving public health outcomes.

Finally, Nigeria stands at a pivotal juncture, challenged to revolutionise its public health landscape by embracing tobacco harm reduction (THR) products. These alternatives to smoking present a unique opportunity to diminish smoking rates and enhance public health outcomes. THR products provide smokers with a less hazardous avenue to satiate their nicotine cravings, offering a potential paradigm shift in harm reduction strategies. Unlocking the full potential of THR in Nigeria requires confronting prevailing challenges, including insufficient awareness, cultural disparities, and affordability issues.

A concerted effort is necessary, involving collaboration with the media, healthcare professionals, and policymakers. The dissemination of accurate information through the media can dispel misconceptions surrounding THR, fostering a more informed public. Engaging healthcare professionals ensures that these alternatives are integrated into the broader healthcare framework, encouraging smokers to consider THR as a viable option.

Policymakers play a crucial role in crafting regulations that facilitate the accessibility and affordability of THR products. By addressing these challenges collaboratively, Nigeria can pave the way for a healthier, smoke-free future, demonstrating a commitment to public well-being and global leadership in tobacco harm reduction.

Nnanyelugo Ike-Muonso wrote from Lagos