Africa: Tobacco Harm Reduction in Africa – Sovereignty Under Siege

In recent years, Africa has increasingly found herself at the crossroads of global health politics. On one side stand Western philanthropists and international organisations with deep pockets and strong convictions about how tobacco control should look.

On the other side stand African governments and public health advocates who argue that the continent’s unique realities demand local solutions — not imported ideologies and policies.

At the centre of this debate is Tobacco Harm Reduction (THR): the pragmatic public health approach that acknowledges the persistence of nicotine use and seeks to reduce the harm caused by smoking, rather than insisting on total abstinence. Yet, while countries such as Sweden, the United Kingdom and New Zealand have made significant progress by embracing safer nicotine alternatives such as nicotine pouches and vapes, Africa remains caught in a huge tug of war between sovereignty and foreign influence.

The Outsized Influence of Philanthropic Power

Few figures symbolise this global imbalance more clearly than American billionaire Michael Bloomberg. Through Bloomberg Philanthropies, he has poured hundreds of millions of dollars into global tobacco control initiatives, including substantial grants to African governments and NGOs. While the intention – to reduce smoking – may be noble, the approach has often been heavy-handed and dogmatic.

In many African countries, Bloomberg-funded programs have pushed for blanket bans on vaping and other reduced risk tobacco products. These specifications are often implemented without meaningful consultation with local scientists, policymakers, or even the communities affected by smoking. The result is a one-size-fits-all policy framework that mirrors western and upper income nation’s preferences but ignores African realities.

The problem is not philanthropy itself, but the way it is exercised. When foreign donors set conditions that dictate how African countries must legislate or regulate, the sovereignty of nations is compromised. Health policy becomes less about what works for Africa and African people and more about satisfying donor expectations. As the Kenyan public health advocate Joseph Magero put it, “We cannot keep letting billionaires decide what is best for our people from thousands of miles away.”

The Local Context: Different Realities, Different Needs

Africa’s tobacco consumption landscape differs dramatically from that of wealthier first-world nations. Smoking rates in most African countries are relatively low – around 8-10% on average, compared to 23% in Europe – but the continent’s population is young and growing fast. Without pragmatic policies, smoking prevalence could easily double in the next two decades or less.

At the same time, African healthcare systems are already overstretched. Many countries spend less than 5% of their GDP on healthcare, and preventable diseases like tuberculosis and malaria still consume a large share of annual resources. Preventing smoking-related diseases through harm reduction, rather than treating late-stage lung disease or cancer, is not only humane but economically sound.

In South Africa, for example, the government’s 2020 ban on cigarette sales during the COVID-19 lockdown, applauded by some international organisations, backfired spectacularly. The illicit tobacco market boomed, costing the state an estimated 6 billion Rand in lost tax revenue and making cigarettes even easier for young people to obtain. This experiment should have been a lesson in the unintended consequences of prohibition. Yet, similar proposals continue to surface across the continent, often supported by donor-funded lobby groups.

The Case for Harm Reduction — and Sovereignty

Countries like Sweden demonstrate that Harm Reduction works. By replacing cigarettes with smokeless products like snus, the Swedes have achieved the world’s lowest smoking rate (4,5%) and correspondingly low rates of tobacco-related diseases. The World Health Organisation classifies Sweden as a ‘smoke-free’ society, yet ironically, WHO-funded and guided campaigns across Africa oppose and dismiss similar strategies.

This contradiction exposes a deeper issue: power. For decades, Africa has been treated as a policy recipient rather than a policy innovator or even contributor. However, as nations from Kenya to Nigeria to Malawi begin to re-examine their health frameworks, a quiet revolution is underway. African leaders and scientists are increasingly asking: who should decide what health interventions are right for Africa — foreign donors or African experts?

True sovereignty means the right to chart one’s own course. That does not mean rejecting philanthropy or international partnerships. It means setting priorities based on local evidence, culture, and capability. Harm Reduction should be part of that conversation and not dismissed simply because it does not fit the Western template of total abstinence.

It’s Time for Africa to Decide

Africa’s tobacco policy future must be built on realism and dialogue, not dictates. Governments should welcome funding, but with the condition that such funds respect local autonomy and are based on evidence and local policymaking. Regional bodies, such as the African Union (AU), could play a vital role in coordinating independent research and crafting continental guidelines rooted in the African experience.

As the WHO FCTC COP11 in Geneva commences it is clear that this meeting will be a decisive moment for this sovereignty debate. For many African member states, the meeting that is taking place this week in Geneva represents far more than a technical policy discussion — it is a test of whether the global tobacco control establishment will finally recognise the continent’s right to adopt strategies that make sense for its own people.

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