By Dr Tendai Mhizha
Across the world, countries are racing to become “smoke-free”, and some have already made remarkable progress. Sweden, for example, recently announced that only around 4.5% of its population still smoke cigarettes — the lowest reported rate in Europe.
Their success has been celebrated as a model for others to follow. However, beneath the applause lies a crucial question that we all need to think about: can African nations truly copy Sweden’s playbook and expect the same results?
Lessons from Sweden — and their Limitations
Sweden’s triumph came largely through innovation. The Swedes developed commercial snus — a moist or dry, smokeless tobacco ball or pouch placed under the lip and absorbed through the gums. It was inspired by an age-old tradition that was modernized and elevated for broad consumer use. It doesn’t involve smoke, ash, or spitting, and for many Swedes, it has become a socially acceptable alternative to cigarettes. As a result, rates of lung cancer and other smoking-related diseases have dropped dramatically.
This story is inspiring, yes — but it is also deeply Swedish. Snus fits naturally into the Swedish lifestyle and culture. It’s regulated, trusted, and accessible within a strong public health system. The problem arises when this model is exported, packaged as a ready-made solution for other nations, including those in Africa. What works in Stockholm may not work in Nairobi, Dakar, or Harare.
Imported Solutions, Local Realities
In recent years, some African countries have tried to replicate elements of Western harm reduction strategies. Kenya, for instance, has made great progress through strong tobacco laws, public education, and taxes that make cigarettes much less accessible. Smoking has fallen to under eight percent of adults — a major achievement for a country that once had nearly double that rate.
But newer nicotine products, like imported pouches and vapes, have entered the market without proper regulation. They’re being sold as ‘safer alternatives,’ echoing Sweden’s success with snus, yet their safety, quality, and long-term impact in African contexts remain uncertain. Moreover, many people simply don’t trust them. They feel foreign and out of place in cultures where smoking is already viewed with suspicion or stigma.
Africa’s challenge isn’t only about what to use, but how and why. A solution that fits one culture cannot simply be copied into another. Tobacco harm reduction is not a one-size-fits-all issue; it is deeply rooted in identity, economy, and tradition.
The Danger of the “One Africa” Mindset
Too often, the African continent is treated as a single, homogenous entity — as if one approach could solve the problem for over 50 diverse nations. But Africa does not have one story. From the bustling streets of Cape Town to the rural communities of Malawi, tobacco use carries different traditions, meaning and challenges.
In some areas, smokeless products might be acceptable but unaffordable due to taxes being as high as cigarettes. In others, they may clash with cultural or religious norms. In communities where misinformation about harm reduction is widespread, the first step might not be introducing products at all. It might be education, delivered in languages and ways that resonate with local people.
If we fail to recognise these differences, we risk replacing one imported idea with another — a ‘continental’ strategy that looks good on paper but fails in practice.
Health Sovereignty: Building from Within
Finding Africa’s own path in Tobacco Control and tobacco harm reduction is not about rejecting Western models. It’s about reclaiming our sovereignty and the right to design solutions rooted in our national realities. Africans are more than capable of creating innovative, science-based approaches to public health. However, the space, trust, and support to do so are required.
Imagine if African scientists, entrepreneurs, and communities were afforded an enabling regulatory environment to collaborate in designing tobacco harm reduction products that reflect local culture, taste, and economics. Products that are safer, regulated, and made for African lifestyles that are able to replace combustible cigarettes over time. Imagine if policies were crafted region by region, not copied from abroad but grown from within through research, consultation, and community participation. Tobacco harm reduction in Africa could be tackled more holistically by working from the roots of dependency and not just the symptoms couched in global practices.
Africa must not be left behind
Africa can and should learn from the world — from Sweden’s pragmatism, the UK’s harm reduction model, or even New Zealand’s smoke-free policies — but learning is not the same as imitating. We must adapt global lessons into local wisdom.
That means investing in local research, training policymakers who understand both science and culture, and ensuring that local media tells African stories about tobacco, not just recycled headlines from elsewhere. It also means protecting public health policy from the influence of the many key players in the global tobacco industry, who continue to see Africa as their next big market for perpetuating combustible cigarettes.
If African nations do not move to differentiate combustible cigarettes from risk reduced products they will surely be left behind with an ever-growing burden of non-communicable diseases, wasting critical resources that should be directed towards the ongoing battle with deadly communicable diseases.
A Call to Courage and Creativity
Africa’s future in Tobacco Control will not be built in European laboratories or American boardrooms. It will be built in African universities, health ministries, and community halls — by people who understand that health sovereignty is part of political sovereignty.
Africans have the creativity, knowledge, and lived experience to design what the next phase of tobacco harm reduction looks like — not just for Africans but for the world. The question is no longer whether African nations can follow in others’ footsteps, but whether Africa is ready to lead with homegrown policies and solutions.
References
Global State of Tobacco Harm Reduction (GSTHR), Kenya Country Profile (2024).
The Star Kenya, “Kenya gains in war on tobacco but losing to nicotine pouches – WHO” (2024).
World Health Organization (AFRO), Kenya leads global World No Tobacco event (2023).
Harm Reduction Journal, Snus: a compelling harm reduction alternative to cigarettes (2019).
Swedish Public Health Agency, Use of tobacco and nicotine products (2024).
