On the World No Tobaccọ Day, Marked on 31st May, Kenya appeared to be further than ever from reducing cigárette sales and smọking. Its decision not to have any smọking reduction plan or policy since 2015 is proving to be good news for the smọking industry. For, without it, the government’s cocktail of ignoring nicọtine replacement therapies and banning tobaccọ alternatives is leading to a surge in cigárette sales, according to global market researchers, in an unexpected windfall for the country’s cigárette producers.
For those of us who clamour for nicọtine alternatives, the irony is we are frequently silenced by campaigners who claim we are lobbying for tobaccọ firms – as if saving thousands of Kenyans dying every year could never be our sincere motive. But it’s a journey of policy contradictions that as early as 2016 saw one group of academics conclude in Oxford University Press’s Health Policy and Planning Journal that the Kenyan experience in tobaccọ control ‘offers useful lessons in the pitfalls of institutional incoherence’.
At the time, the country had just concluded a five-year plan on tobaccọ control. The 2010-2015 plan set a target of a 30 per cent reduction in smokers. A year before its inception, in 2009, the World Health Organisation had classed as ‘essential medicines’ the tobaccọ alternatives that had been shown repeatedly to be the best and most certain way of turning smokers into ex-smokers.
As pastilles, patches, lozenges and even pouches, these nicọtine replacements and smọking alternatives don’t have tobaccọ in them and are not combustible – people don’t burn or light them – but they do stop the craving and withdrawal symptoms that come as smokers try to stop smọking cigárettes.
Yet, despite the WHO’s moves, the 2010 Kenyan plan, in all its 30 pages, never once mentioned nicọtine replacement. Instead, it covered banning smọking in public places and medics telling smokers that smọking is harming their health: in case they didn’t know. Inevitably, the plan didn’t meet its smọking reduction targets.
It was followed, in 2015, by a five-year strategy to stop non-communicable disèases, which reiterated the 30% reduction target for smokers, now to 2020. The following year, in 2016, the WHO launched a Global Hearts Initiative which placed curbing smọking center-stage, supported with technical packages. But Kenya stayed with a caller line to advise smokers cigárettes were dangerous, and the maintenance of restrictions on ads and public smọking.
This limited program failed, once again, to meet its target, but smọking had at least fallen. By 2019, according to market researchers GlobalData, Kenyans were consuming an average of 160 cigárettes per head, down 39.4 per cent on the levels of 30 years earlier.
However, that rate of decline has now all but disappeared, with GlobalData forecasting that cigárette volumes will rise in Kenya by 22.2 per cent from 2020 to 2030, to reach 10.02bn cigárettes a year, while per capita consumption will fall by just 0.3 per cent over those 10 years, to an average 153 cigárettes per person per year.
Dr Jumaa Bwika of the Aga Khan University Medical College last year observed in the Nation that smọking kìlls more people every year than the Covid-19 kìlled worldwide and throughout its entirety.
For this reason, the WHO is working tirelessly to stop tobaccọ use, while also working to make nicọtine replacements available to smokers who want to quit. In Kenya, by contrast, the anti-tobaccọ lobby has fused tobaccọ and nicọtine into one and decries any voice seeking tobaccọ harm reduction or reduced smọking as a paid party.
Thus, nicọtine pouches are being produced in Kenya that are selling across Africa and globally, but, in Kenya itself, they are banned.
As reviewed at our recent Africa Tobaccọ Harm Reduction Forum, studies show an almost constant two-thirds of smokers want to stop smọking, and that nicọtine substitutes are the most successful way of achieving that. Indeed, without them, barely 3 percent of smokers a year do manage to stop. In the UK, smokers can even now get e-cìgárettes from the government for free, because they deliver such health savings.
Yet, when BAT’s Lyft pouches were banned in Kenya in October 2020, the health minister asked the Pharmacy and Poisons Board to explain the basis for approving them as a pharmaceutical product. The minister never shared the answer with the public. But the board may just have used the WHO’s classifications, since in Kenya there is no policy on smokers’ health gains – despite the fact that stopping smọking cigárettes, within 24 hours, starts reducing health risks and déaths.
Elsewhere in the world, tobaccọ harm reduction is seen as a cause worth pursuing. But as our rising cigárette sales and ongoing smọking dèaths bear testament, in Kenya, it’s not about stopping dèaths. It’s about stopping nicọtine replacements.
Joseph Magero is the Chair, Campaign for Safer Alternatives