As Africa grapples with a sharp rise in tobacco consumption and its toll on fragile healthcare systems, Nairobi hosted the fourth Harm Reduction Exchange Forum this week. The event, held at the JW Marriott Hotel in Nairobi’s upscale Westlands district, brought together healthcare professionals, policymakers, and journalists to discuss science-led innovations in reducing tobacco-related harm.
Under the theme “Enabling Innovation in Harm Reduction through Science-Led Regulation and Policymaking,” the forum tackled strategies to mitigate the health consequences of unregulated tobacco use.
Africa has seen a worrying rise in tobacco production and consumption. A 2020 World Health Organization (WHO) report highlighted this alarming trend, noting a 35 percent increase in tobacco production in Africa at a time when global production decreased by 4.6 percent. By 2023, tobacco farming on the continent had risen by nearly 20 percent, underscoring the urgent need for solutions.
“Whether we are addressing the impacts of tobacco, drugs, or alcohol, the core principle is the same: reducing the negative consequences associated with use, while acknowledging the realities of individual behaviors and societal contexts,” said Mercy Korir (MD), a Kenyan medical practitioner, during the forum.
In Ethiopia, where contraband nicotine products dominate the market, harm reduction faces significant hurdles. Despite pledges from the Customs Commission and the National Tobacco Enterprise to curb the illicit trade, the problem persists, exacerbating public health challenges in a country of nearly 130 million people.
“People feel that the risk-reduced products are simply moving someone from one risky product to another. Yet, it is actually about engaging with the lesser evil,” remarked Cedric Namegabe (MD), a Congolese physician. “Someone staying alive for one more year than they would have…. that is harm Reduction.”
Japan Tobacco International, a key player in Ethiopia’s tobacco industry, estimates that over 40 percent of the market operates illegally. This undermines harm reduction efforts and costs the government valuable revenue that could be reinvested in the health sector.
The human cost of addiction
The principles of harm reduction are not just theoretical—they resonate deeply with families grappling with the fallout of nicotine addiction. Many have found harm reduction strategies to be the most practical approach to mitigating addiction’s devastating effects, not only for users but for their loved ones.
One father in Addis Ababa exemplifies this struggle. At 63, he has spent years trying to save his only son, a 41-year-old chain smoker whose life has been ravaged by drug and alcohol abuse.
Desperate, the father sought help from hospitals and even admitted his son to Ammanuel Hospital, the countries oldest mental health institution. But his efforts proved futile. With mounting debts and estrangement from his son, he once resorted to having him arrested to cut off access to drugs. The move failed, leaving him with a chilling expectation: a phone call announcing his son’s death from an overdose.
A chance encounter with a Canadian doctor visiting from British Columbia proved to be a turning point for the father desperate to save his son from the grip of addiction. For years, the father had watched his 41-year-old son succumb to a life destroyed by smoking, drug use, and alcoholism. Conventional interventions had failed, leaving him emotionally and financially drained.
British Columbia, a global leader in harm reduction strategies, has pioneered progressive policies aimed at rehabilitating drug addicts. The province’s Health Services Authority emphasizes a holistic approach, describing harm reduction as going “beyond the distribution and recovery of supplies” to include “community engagement and service delivery that can be applied in any community, health, or social services setting.”
The Canadian doctor’s guidance reshaped the father’s perspective. “My conversation with the doctor changed my life. I was no longer forcing my son to stop smoking or doing drugs but focusing on finding a safe and healthy way for him—like providing sterile syringes,” he said.
The shift to harm reduction transformed both their lives. “This strategy has not only saved my life but also rescued me economically and helped my son transition from a trapped existence to one that is productive and happy,” he added, requesting anonymity due to the stigma surrounding drug use in Ethiopia.
Such success stories reinforce the arguments of harm reduction advocates who see it as a realistic and compassionate alternative for families grappling with addiction.
A shared struggle
A neighbor, Henok Haile-Giorgis faced a similar ordeal. His 21-year-old daughter had dropped out of university and fallen into addiction, hiding her struggles from her parents. Henok turned to religion, praying and using holy water in a desperate attempt to “cure” her. When that failed, he resorted to punitive measures, including locking her in her room and using physical discipline, but these efforts only deepened the rift in their relationship.
“I cried for days. Her addiction brought shame to my family and strained my marriage,” Henok recalled. But inspired by his neighbor’s experience, he embraced harm reduction as a last resort.
“I now work with her, supplying her with what she needs, giving her a supportive environment to continue to smoke without any prejudgment or conditions as my hope is to reduce the harm, instead of pushing her to quit, which was a failed effort, like a lofty dream,” he said.
By focusing on reducing harm rather than enforcing abstinence, Henok has seen remarkable progress. His daughter has since returned to university, where she is completing her engineering degree and is set to graduate this year.
Henok has also joined a peer group in his Ayat neighborhood, sharing his story and supporting others facing similar challenges.
At the Nairobi forum, Egyptian psychiatrist Mohamed S. Eltaweel highlighted the psychological complexity of addiction and smoking cessation. He explained the struggle with addiction among smokers and the benefit of finding unique ways that their loved ones can employ to help them overcome the challenge.
“Extremely complex and nuanced psychological approaches are needed to help patients quit smoking. It is crucial to handle each patient very carefully, as smoking and smoking cessation is an extremely sensitive matter with a multitude of contributing factors and roadblocks”, Mohamed concluded.
