Tobacco harm reduction belongs to the people, not the industry, not the donors

For years, the global debate on Tobacco Harm Reduction (THR) has been framed as a battle between public health and the tobacco industry. But this framing has misled the world and harmed the very people we claim to protect. Harm Reduction does not belong to the tobacco industry, no matter how much it tries to hijack the narrative. It belongs to ordinary people — to communities, to families, to nations fighting to preserve life, dignity, and sovereignty.

The World Health Organization (WHO)’s Framework Convention on Tobacco Control FCTC, COP 11 meeting is currently in progress in Geneva.  The FCTC has often been criticised for not basing its articles and decisions on science and therefore making decisions that are not evidence-based.  It was encouraging to hear parties at COP11 calling for the convention to give science a chance - Mozambique called for balanced and science-based decisions at COP11 to ensure effective tobacco control. Professor Muhammadou Kah, the Ambassador of The Gambia to Switzerland stated the following in his address – “The Gambia reminds the parties that effective tobacco control requires science-based decisions and practical harm-reduction tools.  This is the kind of leadership global health needs. By advocating for harm-reduction tools to be part of quitting strategies, you are promoting a more intelligent and humane approach than the one currently endorsed by the WHO”. 

At its core, Tobacco Harm Reduction is a human rights issue. It is about the freedom to access safer options, the right to accurate information, and the right of governments to design policies rooted in local realities rather than global ideology. It is about acknowledging that human behaviour — including risky behaviour — cannot be eradicated by decree, but it can be guided, supported, and made safer.

Tobacco Harm Reduction is just one branch of a much larger philosophy that the world already accepts in other domains. We use condoms to prevent HIV. We provide methadone and needle-exchange programs to prevent overdose and infection. We promote safer sugar alternatives to combat diabetes. We offer sunscreen and regulate skin-lightening creams to reduce harm. harm reduction is everywhere — except, bizarrely, where it could save millions of smokers’ lives.

What Are We Trying to Do — Fight the Industry or Save Lives?

Over 8 million people die each year from smoking-related illnesses, according to the World Health Organisation. That is not a political statistic. It is a human tragedy. Every number represents someone’s mother, father, child, teacher, friend or neighbour.

So we must ask: What is the goal of tobacco control? Is it to defeat the tobacco industry? Or is it to save lives?

The current global system, led by those who elevate ideology above impact, appears more focused on punishing the industry than helping the people who smoke. Fighting the industry is not the same as protecting public health. When the obsession becomes “defeat Big Tobacco at any cost,” the cost is too often measured in human lives.

To be absolutely clear: nicotine addiction must be addressed, and delivery systems — especially unregulated ones — can indeed cause harm. But the solution is not prohibition. It is pragmatic, step-by-step, evidence-driven regulation.

We need to sit down and ask:

• What mechanisms genuinely reduce harm?
• What pathways help people transition away from deadly cigarettes?
• How do we regulate nicotine in a way that protects youth while giving adult smokers safer alternatives?

This is not ideological. It is practical. It is humane.

Tradition Matters — Tobacco Harm Reduction Is Not New in Africa

One of the great myths of global tobacco control is that tobacco use and tobacco harm reduction are foreign inventions imposed on Africa. The truth is the opposite.

Across the continent, tobacco has existed for centuries, long before the modern cigarette industry. It has been used ceremonially, medicinally, socially and culturally. With these traditions came indigenous harm reduction practices long before the acronym “THR” existed.

In Zimbabwe, snuff (bute) has been used for generations over rolled cigarettes as it was said to be healthier. In Malawi, people historically smoked tobacco through pipes with natural inbuilt filters. Across West and Central Africa, tobacco and herbal mixtures were inhaled or used orally in ways that reduced the harshness of smoke. And globally, we see similar patterns: Swedish snus worked because it emerged from a local, indigenous tradition. It succeeded not because of industry manipulation, but because it made cultural sense.

The idea that countries should ignore their own traditions and wait for external instruction is patronising. African nations do not need permission to innovate. They have been innovating for centuries.

Do We Really Need COP?

There is no global COP for HIV.

There is no COP for malaria.

There is no COP for alcohol, despite its enormous societal harm.

So why is there a COP for tobacco?

Because a billionaire decided there should be — and the world followed. Because that’s where the money is.

This is not to deny the importance of global coordination. But power dynamics matter. The current COP system has become an arena where donor-driven agendas override the lived realities of low- and middle-income countries. The conversation is dominated by Western organisations far removed from the communities most affected.

This is why harm reduction is dismissed, ignored, or condemned at COP gatherings — not because the science is weak, but because it is ideologically inconvenient. Tobacco control has become a political battlefield, and as the proverb says:

“When elephants fight, it is the grass that gets hurt.”

In this case, the grass is the world’s poorest smokers — those who cannot quit, who cannot afford cessation services, and who are denied access to safer options that could reduce, even halve, their risk of death.

Harm Reduction Is a Steppingstone, Not a Surrender

Rejecting harm reduction is like the church refusing to hand out condoms to teenagers for fear that it would ‘encourage promiscuity.’ History has proven such moralistic approaches to be dangerous, counterproductive, and deeply unethical.

Tobacco Harm Reduction is not an endorsement of risk — it is an attempt to minimise it. It is a steppingstone toward quitting altogether. It denormalises smoking by replacing the deadliest form of nicotine consumption — combustible cigarettes — with alternative modes that dramatically reduce harm.

We must stop pretending that withholding safer options will magically produce abstinence. It has never worked in any field of public health, and it will not work here. If we continue to deny people harm reduction, then let us be honest: We are choosing ideology over life. We need a new hashtag. 

#SmokersLivesMatter.