A smoke-free future for Cameroon: Lessons from Sweden's harm reduction strategy.

Despite various anti-smoking efforts, many smokers continue to struggle with quitting, leading to a persistent burden on the healthcare system.
Sweden, however, offers a hopeful example of tobacco harm reduction. It is on the verge of becoming Europe’s first smoke-free country, with smoking prevalence as low as 5.6%. The Swedish success story is attributed to a balanced approach that includes the widespread use of snus, a moist smokeless tobacco product that is far less harmful than cigarettes. The Swedish model demonstrates that by providing safer nicotine alternatives, alongside comprehensive public health campaigns, countries can significantly reduce smoking rates and smoking-related diseases.
In light of the growing public health concerns surrounding tobacco use, the Institute for Liberty and Policy Innovation (ILAPI) recently organized a roundtable on tobacco harm reduction (THR) in Ghana. This critical forum brought together experts to discuss the future of tobacco regulation in Africa. As a public health expert, I had the privilege of participating in this event, where discussions highlighted the importance of adopting innovative strategies to reduce the harm caused by smoking. Central to the conversation was the Swedish model of harm reduction, a proven approach that has significantly lowered smoking rates and tobacco-related diseases. This model offers promising potential for Cameroon and other African nations as a practical pathway toward achieving a smoke-free society.
This model has the potential to be adapted in Cameroon, where the high smoking rates are accompanied by a growing burden of smoking-related illnesses. By adopting harm reduction strategies similar to those in Sweden, Cameroon could achieve significant public health gains while mitigating the risks associated with smoking.
Sweden’s remarkable achievement is not the result of draconian smoking bans or punitive regulations. Instead, it comes from a balanced strategy of encouraging the use of safer nicotine alternatives, alongside comprehensive public health campaigns and collaborative regulatory reforms. Central to Sweden’s success is the widespread use of snus, a smokeless tobacco product that has been shown to be far less harmful than combustible cigarettes*. By offering smokers  safer alternatives, Sweden has been able to significantly reduce the harm caused by tobacco use without forcing smokers into a binary choice between quitting or continuing with combustible products and the associated health risk.
The key to Sweden’s approach is the accessibility, acceptability and affordability of safer nicotine alternatives. These pillars ensure that such alternatives are available to smokers, culturally accepted and within financial reach. Cameroon could adopt these principles by promoting similar smokeless products or less harmful nicotine delivery systems*, ensuring they are widely available and affordable.
Harm reduction acknowledges that while quitting smoking is the ideal outcome, providing safer alternatives can significantly reduce the harm caused by continued tobacco use*. In the case of Sweden, adopting safer nicotine alternatives like snus, oral nicotine pouches and vaping devices has been a game-changer, contributing to substantial declines in smoking-related illnesses such as lung cancer and cardiovascular disease. The impact of such strategies on public health is undeniable, and it is time for other nations to consider adopting this pragmatic approach.
Rather than focusing solely on smoking cessation campaigns, Cameroon could incorporate harm reduction into its tobacco control efforts. The Swedish model provides a viable roadmap for reducing the harm caused by tobacco without stigmatizing smokers or resorting to heavy-handed regulation. Cameroon can benefit by making safer nicotine products accessible and offering smokers practical alternatives.
As public health strategies in Cameroon evolve, it is essential to recognize that quitting smoking is not always possible for everyone. Harm reduction provides a pathway to minimize the damage caused by tobacco use, and Sweden’s experience offers valuable lessons that Cameroon can adapt to its unique socio-economic realities.
By embracing harm reduction, Cameroon could save lives, reduce healthcare costs and create a healthier future. Now is the time to act and implement a tobacco control strategy that addresses the complexities of addiction and the real-life challenges faced by smokers.

References:
1. [Smoke-Free Sweden] (https://smokefreesweden.org/)
2. [Sweden’s Journey to Becoming Europe’s First Smoke-Free Country] (https://learningenglish.voanews.com/a/sweden-close-to-becoming-smoke-free-country/7117051.html)  
3. https://worldvapersalliance.com/swedens-success-a-blueprint-for-tobacco-harm-reduction/
4. https://ahra.info/swedens-smoke-free-policies/
5. https://pubmed.ncbi.nlm.nih.gov/17498798/

* Based on the weight of evidence and assuming a complete switch from cigarette smoking. These products are not risk free and are addictive.

By Prof. Dickson Nsagha, Professor of Public Health.