The Tobacco Harm Reduction (THR) discourse in Africa has suffered major setbacks over the years due to persistent misinformation about nicotine, which continues to cloud public understanding. At the click of a button or tap of a smartphone screen, unverified health rumours can spread within seconds. Amid polarised policy debates and the absence of scientific voices, particularly from independent researchers and responsible industry scientists, the information gap continues to widen.
With the 11th Meeting of the Conference of the Parties (COP) to the Framework Convention on Tobacco Control (FCTC) set to take place in Geneva, Switzerland, from November 17 to 22, 2025, world leaders are preparing for another round of global talks where tobacco and nicotine policies will take centre stage. Yet scientists warn that exclusionary decision-making risks leaving African consumers behind.
The COP, held under the World Health Organisation’s (WHO) FCTC, serves as the main platform for shaping global tobacco control policy. However, it has long been criticised for excluding industry voices and independent scientists from its discussions, largely over perceived conflicts of interest. The process limits the participation of the tobacco industry and its advocates, including proponents of Tobacco Harm Reduction and nicotine innovation, in official deliberations. This stance is rooted in Article 5.3 of the FCTC, which instructs Parties to protect tobacco control policies from commercial and vested interests.
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Although the intention is to safeguard public health from corporate interference, this rigid exclusion also eliminates valuable scientific input that could enrich evidence-based policymaking. The absence of diverse perspectives has created a vacuum that fuels misinformation and one-sided narratives, particularly around Harm Reduction, nicotine science, innovation, and the future of tobacco control.
Despite nearly two decades of coordination under the FCTC, tobacco use remains high, especially in low- and middle-income countries. The treaty’s goal, as stated in Article 3, is to protect current and future generations from the health, social, environmental, and economic consequences of tobacco use. In 2014, COP6 adopted a voluntary target to reduce global tobacco use by 30 percent by 2025, a goal that is now far from being met. WHO data shows the number of tobacco users has barely declined, from 1.3 billion in 2005 to 1.25 billion in 2022, with only modest reductions among men. Experts note that while the FCTC has been effective in high-income countries, most low- and middle-income nations, including those in Africa, continue to see slow or stagnant declines in smoking rates.
Access to safer nicotine products such as e-cigarettes, snus, nicotine pouches, and heated tobacco remains uneven across countries. Evidence shows these products are significantly safer than combustible cigarettes and have helped millions quit smoking. Yet WHO guidance has generally discouraged Harm Reduction approaches, leaving many regions with regulatory gaps and limited public awareness of safer alternatives. Countries that have embraced pragmatic Harm Reduction strategies, like New Zealand and the United Kingdom, have recorded dramatic reductions in smoking—demonstrating what evidence-based policies can achieve.
Professor David Khayat, a leading French oncologist, recently challenged one of the most persistent misconceptions in tobacco science: that nicotine causes cancer.
“Nicotine is not the enemy. It is addictive, yes, but it is not carcinogenic. What causes cancer are the thousands of toxic substances released when tobacco is burned,” he said.
He warned that Africa, where smoking rates are projected to rise and access to cancer care is limited, could face a future cancer epidemic if Harm Reduction continues to be ignored.
Despite the exclusion of the tobacco industry from COP processes, smoking persists globally, showing that prohibitionist and traditional tobacco control measures alone cannot end the epidemic. According to WHO data released in June 2025, tobacco kills more than 7 million people each year, including about 1.6 million non-smokers exposed to second-hand smoke. The report also noted that roughly 80 percent of the world’s 1.3 billion tobacco users live in low- and middle-income countries. In Africa, where the youth population is rapidly expanding and digital media dominates information flow, the absence of balanced, science-driven dialogue leaves the region vulnerable to misinformation and to increased uptake of combustible tobacco.
Why Inclusion Matters
Inclusion of industry experts and independent scientists in Tobacco Harm Reduction discussions is not about giving the tobacco industry free rein, it is about ensuring that global decisions are informed by a full spectrum of scientific evidence and perspectives. The exclusion of credible researchers and advocates has left a vacuum often filled by ideology rather than empirical science.
As Clive Bates, a global THR advocate, told a Tobacco Reporter, “The WHO has become unethical, unaccountable, and ineffective. If they truly care about saving lives, they must stop ignoring the science. Harm Reduction has to be part of the solution.”
Engaging industry researchers and independent experts under transparent, regulated conditions allows policymakers to distinguish between predatory commercial interests and legitimate scientific inquiry. It can enhance accountability, promote evidence-based debate, and ensure that Harm Reduction policies are shaped by verifiable data rather than moral judgment. In Africa, where cessation services are scarce and smoking-related diseases are on the rise, such inclusion could determine whether the region moves forward or remains stuck in outdated approaches.
Exclusion, on the other hand, perpetuates misinformation and alienates the very experts capable of clarifying how innovation in nicotine science supports public health goals. If COP decisions continue to be made within closed circles that exclude scientific diversity, Africa risks adopting obsolete tobacco control strategies and widening the global health gap even further.
Nicotine Misconceptions in Africa
Nicotine misinformation remains widespread across the continent, driving harsh taxation and restrictive policies on safer nicotine products. Some of the most persistent myths include:
1. “Nicotine causes cancer.”
As Professor Khayat highlighted, even health professionals often believe nicotine is the main cause of cancer and heart disease. In truth, the danger comes from the combustion of tobacco, not the nicotine itself . Decades of successful use of nicotine replacement therapy (NRT) for smoking cessation further disprove this misconception.
2. “Nicotine is as harmful as smoking.”
Many people still conflate nicotine with the thousands of carcinogens found in tobacco smoke. While nicotine is addictive, it is not responsible for the diseases caused by smoking. Delivered through non-combustible means, such as vaping or nicotine pouches, it presents a fraction of the risk.
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3. “Nicotine causes behavioural problems among youth.”
A South African study suggests there is an association between nicotine dependence and risky behaviours among adolescents, but this relationship is complex and influenced by multiple social factors. Stigmatising nicotine without context only complicates prevention and treatment efforts.
4. “Nicotine replacement therapies are unsafe.”
A lack of understanding about the safety and efficacy of NRT, coupled with distrust of pharmaceutical oversight, has led to underuse. In reality, NRTs remain among the most effective and widely recommended cessation tools worldwide.
5. “Nicotine equals tobacco.”
Many Africans still struggle to distinguish between nicotine and tobacco smoke, leading to confusion about Harm Reduction options like vaping and heated tobacco . This misunderstanding undermines public confidence in safer alternatives and slows progress toward smoke-free goals.
Misconceptions like these hinder effective harm reduction and smoking cessation across Africa. Addressing them requires a multi-pronged, inclusive approach that embraces constructive dialogue, respects scientific inquiry, and encourages innovation. Achieving a smoke-free world demands cooperation, not exclusion, between policymakers, independent scientists, consumer advocates, and responsible industry actors.
The COP should not be a closed forum where only a few voices are heard. It must evolve into an open, transparent platform where evidence, innovation, and accountability drive decision-making for the health and future of all people, especially those in regions most burdened by smoking-related diseases.
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