The issue of tobacco and its impact on health is now a debate worldwide,” were the words from Supreme Court Justice Njoki Ndungu last week while delivering her ruling dismissing a petition by British American Tobacco challenging the 2014 Tobacco Control regulations which proposed to charge the tobacco industry a two percent fee to compensate people affected by smoking and also contribute to tobacco research.
Kenya’s tobacco manufacturing and distribution market is dominated by British American Tobacco (BAT) and Mastermind Tobacco Kenya controlling 78 percent and 20 percent respectively. About 31,000 tobacco farmers grow tobacco on an estimated area of 20,000 hectares under strict contractual agreement with the tobacco companies.
The public health concern is that more than 2.7 million Kenyan adults and 220,000 children use tobacco each day, and an estimated 6,000 people die of tobacco related diseases every year. Thirty-seven women die every week in Kenya due to tobacco-related complications. So, tobacco use is a public health problem in Kenya and around the globe so much so that WHO classifies it as the biggest public health threat the world has ever seen.
Currently, one of the biggest debates in the world the rise of e-cigarettes which use heat-rather-than-burn technologies and whether they are the panacea to tobacco’s killer ways.
They are considerably less harmful than tobacco cigarettes and estimated to carry approximately five per cent of the health risk associated with tobacco smoking, giving rise to its demand as a moderate risk where it is a safer alternative to conventional tobacco-based cigarettes.
The debate is urgent, according to a letter to the New York Times published last week, written by André Calantzopoulos, chief executive of the world’s largest tobacco company, Philip Morris International.
“Harnessing technologies, like e-cigarettes and heated tobacco products, to dramatically speed up the decline in cigarette smoking is the opportunity of this century,” argued Calantzopoulos. “But this opportunity cannot come at the expense of youth. We know from other countries that it is perfectly possible to rapidly shift adult smokers to better options while simultaneously preventing youth uptake.”
According to Centres for Disease Control and Prevention (CDC) e-cigarettes do have potential to help adult and non-pregnant women quit smoking but unsafe for youth, young adults, pregnant women or adults who do not use tobacco products.
That low-risk transition from tobacco-cigarette smoking to e-cigarettes - a safer alternative, has been the intentions of jurisdictions that have legalized e-cigarettes as one of tobacco-use public health management solution.
One of the unintended consequences of this policy has been the potential risk of creating a new generation of e-cigarette users therefore policymakers when adopting it are advised to restrict prioritization of e-cigarettes to only current smokers seeking to quit tobacco smoking and not a tobacco end-game strategy.
The other issue about e-cigarettes as a tobacco harm reduction policy seeking to quit as evidenced in jurisdictions who have licensed e-cigarettes is the regulatory dilemma they find themselves in; should e-cigarettes be marketed as drugs to help smokers quit combustible tobacco or as a less harmful tobacco product such as modified risk tobacco product for adults who still seek to use nicotine?
In the US where e-cigarettes have been legalised, marketing particularly online marketing, has contributed to the concerning rise of e-cigarette use among youth and teenagers.
It has been noted that tobacco is one of the fastest growing markets in Africa with consumption increasing by 52 percent in the last 30 years, whilst the developed economies are experiencing a decline in tobacco use due to increased regulation, monitoring and taxation.
Is this a public health policy Kenya can adopt? We need to hear more from Kenyan policymakers and policy specialists, public health practitioners and academics with interest in this field is deafening. Are e-cigarettes one of the options Africa should consider as a tobacco use reduction policy? Is Africa listening to the debate? Is Africa investing in research? These are some of the questions that remain unanswered.