In the bright, glass-walled conference halls of the W Hotel in Dubai’s Palm district, amid the soft hum of translation headsets and the polite applause of attendees, a hard truth was spoken aloud. Not by a politician or a lobbyist, but by a doctor — a man who has watched too many people die.
David Khayat, an oncologist and professor at Pierre et Marie Curie University in Paris, has spent his career in the company of cancer patients. He has seen the ravages of tobacco up close — the hollow faces of men gasping for breath, the tears of families left behind when the final moments come. And as he stood before a room of industry executives, his message was both clinical and profoundly human.
“The only way for your countries to face the epidemic of cancer,” he said, “is to work right now on prevention.”
The warning should have sounded familiar. For decades, the public has known that smoking kills — that tobacco remains the world’s leading preventable cause of death, claiming more than eight million lives each year, according to the World Health Organization (WHO).
Yet Khayat’s words struck a deeper chord. His message wasn’t just about cigarettes. It was about time — and about Africa’s ticking clock.
Across the continent, tobacco use is rising, especially among the young. In countries like Nigeria and Angola, and across much of sub-Saharan Africa, the average age is just 17. For now, that youthful population offers a kind of protection: most cancers strike later in life, after years of exposure to carcinogens. But that shield won’t last forever, cautions Khayat.
“When you put clean water in the taps, when you vaccinate the children, when people stop dying from infections,” Khayat explained, “they live long enough to get cancer.”
In other words, Africa’s health miracle — the remarkable progress in sanitation, vaccination, and medical care — is also setting the stage for its next great challenge. The WHO predicts that within two decades, three out of every four cancer deaths will occur in low- and middle-income countries, many of them in Africa. Few are ready.
“Most African nations have only a handful of radiotherapy centers,” Khayat said. “Some, like Namibia, have just one oncologist for the entire country. They are not prepared. They have no facilities, no trained personnel, and no systems in place. The cost of cancer is not only medical — it is economic, social, and generational.”
For a continent already burdened by infectious diseases and poverty, the coming wave of tobacco-related illness could prove devastating. And yet, as experts lament, prevention — the simplest and most cost-effective defense — rarely fits within the short political attention span of governments.
“The clock of prevention,” Khayat said, “is not appropriate for the clock of politics.” Governments think in two- or four-year cycles, while cancer prevention takes decades to show results. There are no ribbon-cutting ceremonies for a disease that never happened, he explained.
The experts who took the stage at the Dubai conference agreed on one sobering point: in much of the world, tobacco remains an accepted killer. Governments collect taxes, cigarette packs bear their obligatory warnings, and millions keep lighting up. The machinery of addiction turns quietly — profitably, relentlessly — even as science pleads for change.
At the same smoke-free event, another figure rose to speak: Jacek Olczak, Philip Morris International’s (PMI) chief executive. PMI is one of the world’s largest tobacco firms, a name long synonymous with Marlboro and global smoking culture. Yet Olczak did not come to defend cigarettes. Instead, he came with a plea — not for smokers, but for regulators.
“We have the technology,” he said. “But society — or more precisely, regulators — are not ready.”
Olczak’s argument, controversial as it may be, rests on a scientific distinction few dispute: it is not nicotine that kills, but combustion. The burning of tobacco releases a toxic brew of carcinogens. Nicotine, though addictive, is not the direct cause of cancer. Still, most tobacco laws continue to treat nicotine and cigarettes as inseparable evils.
Olczak called this a moral and scientific paradox.
“In many countries, the old, deadly cigarettes are still legal, while new, less harmful alternatives are banned or heavily restricted,” he said. “The result is millions of preventable deaths every year.”
But even as he spoke of “harm reduction,” a deeper unease rippled through the room. Can the same industry that profited from addiction now claim to lead the charge against it?
Critics call it hypocrisy. Health advocates warn that the language of “reduced risk” could be a Trojan horse — a strategy to rebrand nicotine and re-legitimize smoking culture under the guise of science. Regulators fear that embracing any product born from Big Tobacco risks opening the door to a new generation of users.
And yet, beneath the noise of accusation and defense, one pragmatic truth lingers. The World Health Organization estimates that around one billion people still smoke — and most will not quit anytime soon. If safer alternatives truly exist, should they not be part of the solution?
Khayat, for his part, makes no attempt to romanticize nicotine. He acknowledges its addictive pull but insists that lives hang in the balance.
“People want nicotine,” he said simply. “Let’s give nicotine — not tobacco.”
For him, the primary objective is to safeguard patient well-being, rather than to advocate for any particular industry.Ideology, he suggests, offers little comfort to the man dying of lung cancer who might have lived if a safer option had been available years earlier.
Both Khayat and Olczak speak of urgency — but from opposite corners of the same battlefield. The doctor talks of hospitals without equipment, of children who will grow into adults unprepared for the epidemic ahead, especially in African countries where the warning signs remain largely ignored. The executive, meanwhile, speaks of technology stranded by red tape, of regulators “waiting for a perfect world where no one smokes.”
And in between — amid the science, politics, and profit — sits society itself. A society where parents still light cigarettes after dinner, teenagers sneak puffs behind classrooms, and governments quietly balance budgets on tobacco taxes. It is a world where the lines between information and ideology blur, and where progress moves far slower than addiction.
Olczak put it bluntly: “Allowing the cigarette but banning the alternative is like allowing cars but banning seat belts.”
Khayat, less theatrical but no less urgent, responded in kind: “Every man’s death has a cost — to families, to communities, and to the economy.”
Observers argue that the world’s addiction to tobacco is not only chemical but systemic — a dependency fed by habit, policy, and inertia.
Khayat has spent a lifetime translating statistics into human stories. “I’ve seen thousands of patients die because they smoked,” he said quietly. “I’ve seen mothers and wives crying. I’ve seen children unprepared for the loss of their father.”
He paused. “Those stories are not statistics. They are warnings. And they are multiplying.”
Experts agree that tobacco is not merely a public health issue; it is a social one, thriving on poverty, youth unemployment, and the loneliness and stress of modern life. To fight it, governments will need more than policies — they will need empathy, education, and courage.
The path forward is neither simple nor pure. Harm reduction is not a moral free pass, and science funded by industry will always be met with skepticism. Yet paralysis, too, carries a cost. The lesson shared by both the oncologist and the executive is stark and shared: inaction kills.
As the lights dimmed in the Dubai conference hall and polite applause gave way to silence, Khayat offered a final reflection — a sentence that seemed to hang in the air long after the crowd dispersed.
“I do this,” he said, “because I’ve seen too many die. Maybe the next generation of oncologists will see fewer.”
