Tobacco harm reduction: A pragmatic pathway to better health outcomes in Nigeria

Globally, Tobacco Harm Reduction (THR) is increasingly recognised as a science-based and pragmatic approach to improving public health outcomes. It acknowledges a simple reality that decades of tobacco control have made clear: while complete cessation remains the best option for health, a significant number of adult smokers will continue to seek nicotine. The goal, therefore, is to provide less harmful, scientifically substantiated alternatives that reduce exposure to toxic substances, complementing, not replacing, existing tobacco control measures.

For Nigeria, where smoking prevalence stands at about 3.7 percent of adults (World Health Organization, Global Adult Tobacco Survey Nigeria 2023), adopting a risk-proportionate THR framework presents a strategic opportunity. By integrating science, regulation, and responsible communication, Nigeria can meaningfully reduce smoking-related risks while supporting informed consumer choices.

A 2022 review by Public Health England concluded that vaping is at least 95 percent less harmful than smoking, largely because of the absence of smoke and tar. Similarly, the U.S. The Food and Drug Administration (FDA) has authorised certain heated tobacco and oral nicotine products for marketing as Modified Risk Tobacco Products, acknowledging evidence that they expose users to lower levels of toxicants.

For Nigeria to capture the potential of THR, a clear and risk-proportionate regulatory framework is essential. This should include robust product testing and certification standards, transparent labelling, and responsible marketing practices. Equally important is the alignment of fiscal policy with harm reduction principles. Excise structures should reflect relative risk, ensuring that non-combustible products are not taxed more heavily than cigarettes. Such alignment will encourage adult smokers who would otherwise continue smoking to switch to lower-risk options.

Read also: How science is shaping tobacco harm reduction

This approach is consistent with guidance from the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), which recognises harm reduction as a legitimate component of comprehensive tobacco control under Article 1(d). It also reflects regulatory best practices from countries such as the United Kingdom, Sweden, and Japan, where harm reduction has contributed to measurable declines in smoking prevalence without undermining tobacco control goals.

Implementation must be accompanied by transparency and public trust. Policymakers, health experts, and manufacturers should collaborate to ensure product safety, responsible communication, and evidence-driven policymaking. Civil society and the medical community are equally critical to success. A 2024 study published in the International Journal of Medical Students found that while Nigerian medical doctors-in-training were aware of THR concepts, many expressed uncertainty about their application, underscoring the need for balanced, factual education within the healthcare community.

Finally, establishing independent advisory mechanisms and post-market surveillance systems will enhance oversight, track consumer use patterns, and measure public health outcomes. Such infrastructure will not only strengthen confidence in Nigeria’s THR strategy but also help build a transparent, evidence-based approach that integrates harm reduction within broader tobacco control efforts.

In summary, tobacco harm reduction represents a reasonable, science-led, and complementary strategy for improving public health. With the right balance of science, regulation, and public education, Nigeria can meaningfully reduce the health impacts associated with smoking while empowering adults with safer choices. The opportunity for progress is clear, and the time for a balanced, evidence-based approach is now.

Dr Adebayo is a health professional, pharmacist, epidemiologist, and health systems researcher.

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