The saying “Nothing Without Us is for Us” is a powerful reminder that lasting solutions can only emerge when those most affected are included in shaping them. This call for inclusion resonates deeply as Africa prepares to participate in key global policy spaces such as the 11th Conference of the Parties (COP11) to the WHO Framework Convention on Tobacco Control (FCTC), set for November 17–22, 2025, in Geneva, Switzerland.
Data shows that smoking prevalence in the World Health Organisation Africa (WHO AFRO) region remains the lowest among all WHO regions. However, the region is projected to record only a modest decline of 3.2% in smoking prevalence, one of the smallest reductions globally. A study published on the Tobacco Control platform reveals that the number of tobacco smokers in the AFRO region increased from 52 million in 2000 to 66 million in 2015 and is projected to reach 84 million by 2025. This represents a 61.5% increase compared to 2000, making Africa one of only two regions expected to see a rise in smoker numbers, alongside the Eastern Mediterranean.
Moreover, sub-Saharan Africa has become a key target for the global tobacco industry, driven by its fast-growing and youthful population, which is expected to double by 2050. The region faces a range of barriers that complicate tobacco control and Harm Reduction efforts, including low cigarette prices, weak or absent tobacco legislation, limited healthcare budgets (with only two countries meeting the Abuja 15% target), and inadequate political will to implement evidence-based Harm Reduction measures.
With COP11 around the corner, concerns are growing that the conference’s closed-door approach excludes critical voices such as independent scientists, journalists, and policymakers from Africa and other parts of the world, whose insights could bring balance and realism to the global conversation on tobacco control.
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It is this exclusion that many African voices are pushing back against, arguing that solutions for the continent must be shaped with Africa’s realities in mind. As South African Parliamentarian Dr. Kgosi Letlape observed, inclusion and healthy scepticism are essential for meaningful progress.
“I caution against relying uncritically on global bodies whose past missteps remind us that consensus often lags behind science. The World Health Organisation, which once classified homosexuality as a disease, now struggles to provide a nuanced stance on Tobacco Harm Reduction. History shows us why scepticism and scrutiny are essential,” said Dr. Letlape during the Health Portfolio Committee discussions on tobacco legislation and Harm Reduction in 2025.
African policymakers, journalists, and independent doctors are not categorically banned but face significant restrictions and selective gatekeeping through accreditation and session access limits that curtail their participation and reporting at COP11.
This selective exclusion has been blamed for fostering an ideological, closed-door environment dominated by specific interests, such as certain anti-tobacco groups aligned with the WHO’s traditional stance. Critics argue that this approach resists science-based Harm Reduction strategies. Without inclusive participation, COP11 risks reinforcing outdated policies, ignoring new evidence on safer nicotine alternatives like vaping and heated tobacco products, and failing to address the needs of millions who could benefit from Harm Reduction. The lack of transparency and open debate undermines the credibility and effectiveness of conference decisions.
Dr. Vivian Manyeki, a Kenyan medical doctor and public health specialist, urged COP11 to be transparent and open to independent scientific scrutiny and input.
“Science must inform policy, not the other way around. Excluding independent scientists and public health experts from COP proceedings risks turning complex health debates into ideological standoffs,” said Dr. Manyeki.
She added that decisions on Harm Reduction, product regulation, and public education require expertise in toxicology, epidemiology and behavioural science.
“Without scientific input, policies may be driven by fear rather than evidence, undermining both credibility and effectiveness. Including scientists ensures transparency, fosters evidence-based dialogue, and builds public trust, especially in regions where misinformation and stigma around nicotine remain widespread. The distinction between nicotine and combustion-related harm is well established in peer-reviewed literature, yet often overlooked in policy discussions. Scientists help bridge that gap.”
Tobacco Harm Reduction advocates have also described the upcoming COP11 as an echo chamber stuck in outdated, anti-science thinking that fails smokers. They argue that delegates at COP11 will soon decide on policies that affect millions of smokers, yet those most affected remain excluded.
Dr. Mercy Korir, a medical journalist and Editor-in-Chief of Willow Health Media, said exclusion was the COP’s greatest undoing.
“Excluding independent scientists, advocates, and health experts silences evidence-based African perspectives, risks policy decisions detached from ground realities, and perpetuates inequitable, top-down global frameworks. Inclusive dialogue promotes transparency, accountability and practical solutions. It helps balance health protection with socio-economic realities, ensures public understanding through media, and builds shared ownership of tobacco control outcomes,” said Dr. Korir.
She added that African medical professionals should champion evidence-based dialogue by presenting locally grounded research on tobacco use, Harm Reduction, and public health impacts, ensuring that Africa’s realities, such as youth uptake, healthcare burden, and informal trade, inform global decisions.
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“They should be at the forefront of these discussions so that they give credibility and authenticity to public health discourse and policy decisions.”
Sahan Lungu, a Health and Behavior Change communication expert and academic from Malawi, said he expects COP11 to finally consider pro-THR evidence and adopt Harm Reduction as a legitimate public health strategy.
“Harm Reduction is being embraced in other public health spheres such as drug Harm Reduction and HIV/AIDS prevention, just to mention a few. Why not THR?” he said.
“Although we are hopeful, we are realists. We hear murmurs that proposals submitted by some parties to create a working group dedicated to THR, or to have a broader, evidence-based discussion, were reportedly excluded from the main agenda by the organisers, suggesting an active effort to limit the debate. With this, we expect nothing much from COP11 regarding THR, maybe just more creative ways of limiting it.”
He, however, believes a successful COP11 would be marked by inclusive, evidence-based policies that promote smoking cessation and strengthen local health systems while providing support for transitioning from tobacco farming to alternative livelihoods.
