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0:00 - Intro with Joanna Junak
0:32 - What's happening with THR in Africa? We talk to Sahan Lungu
1:29 - Demand for tobacco products in Africa is increasing with rapid population growth
3:52 - Access to safer nicotine products in Africa: what obstacles need to be overcome?
6:26 - Lack of specific safer nicotine product legislation in Malawi leads to confusion
9:39 - Safer nicotine product taxes and bans introduced in several African countries
11:10 - What next for THR in Africa?
14:51 - Closing remarks


Joanna: Hello and welcome. I'm Joanna Junak and this is GFN News on GFN TV. In today's program. Sahan Lungu, a THR practitioner from Malawi and recipient of the Kevin Molloy Fellowship with the Tobacco Harm Reduction Scholarship Program, will tell us more about the harm reduction situation in Africa. Thank you Sahan, for joining us today. First, can you tell us what do you do and what is your area of interest?

Sahan: All right, I am a tobacco harm reduction practitioner in Malawi. My work mainly involves educating or sensitizing people on the dangers of using combustible tobacco cigarettes and harmful forms of smokeless tobacco, such as chewable tobacco, while at the same time I raise awareness about tobacco habitat products and intervention. My current interest is in health behavior change. At the presentary I'm looking at how we can design programs or interventions that can effectively help people switch from harmful forms of tobacco consumption to the same forms of nicotine injection.

Joanna: What's happening now in Africa in terms of use of combustible cigarettes and the harm reduction situation?

Sahan: African countries at the moment are experiencing an increase in tobacco usage. There are factors such as rapid population growth and an increase in purchasing power among individuals. Here is making Africa, especially in the sub Saharan Africa, a viable market for tobacco products. And tobacco companies are intensifying marketing of tobacco and expanding tobacco manufacturing in Africa, especially in low and middle income countries like Malawi. For example, here in Malawi in 2010s, there has been an establishment of a cigarette manufacturing company which was not there before, because Malawi is mainly known for tobacco production, that is the growing and export of tobacco and not the manufacturing combustible tobacco cigarettes. So this company, for instance, is able to expand in the country, is able to market the products using intensive marketing promotion campaigns, and at presentry it sponsors the largest football club in the country. So right now in Africa, these factors are contributing to the increased combustible tobacco usage. So if we look at the figures, 80% of the countries, 80% of the 1 billion smokers in the world come from low and to middle income countries, and Africa is largely part of that low to middle income spectrum. And 1 million of the close to 1 million of the smokers are in Malawi at the moment, and at least 5700 people died from tobacco related infections each year.

Joanna: Do you think harm reduction is a good tool to reduce death and harm from disease?

Sahan: In terms of tobacco home reduction, the concept is new to most African or to most tobacco users in the African continent. On the African continent. This can be attributed in general to a lack of knowledge about what tobacco harm reduction is and what tobacco harm reduction products are. You find that a lot of tobacco users in Africa have expressed that to have never actually seen or ever used or to have ever accessed any kind of tobacco harm reduction product or intervention. At the same time, these tobacco harm reduction products are not easily accessible to most people in Africa. This is due to in general, because the high tech tobacco harm reduction dimensions such as e-cigarettes and heat, not burn devices are quite expensive for an average tobacco user in Africa to afford, where a lot of people in the population live below the poverty line. So it's very hard for them to access this intervention. At the same time, there are countries, such as Kenya or Uganda where you'll find that there are bans or taxes on tobacco harm reduction products such as e-cigarettes, which restricts a lot of people from access. So that is the main challenge with action in Africa. But on the bright side it has been an increase in awareness of tobacco harm reduction especially with people who are working in tobacco harm reduction such as myself and many other from across the continent who are doing a really good job at educating other masses and doing new context based research into tobacco harm reduction in Africa and generally spreading the message about tobacco harm reduction and helping tobacco users to access to tobacco harm reduction products.

Joanna: And what about easier access to safer nicotine products in Malawi? Where you live, are these products becoming more readily available?

Sahan: No, the problem is in Malawi, because in Malawi, when it comes to tobacco control, we only regulate the export of raw tobacco and not the import of the export of raw tobacco. That is where much of tobacco control is focused on, not on tobacco products they see. So you find that yes, the sale of tobacco products is legal in a sense, but also legal tobacco harm reduction products such as e-cigarettes. They are not part of the legal framework in terms of like taxation, on how people can import them. So you find that leaders would like to stop these tobacco products, but they don't know how they can go about stotting them, how they can go about importing them and what classification can they put an e-cigarette, an electronic device or is it a tobacco product? So this makes it very hard for leaders. So for the few that do manage to bring them in, they have to really come through the gray area of the taxation law and find out how they can bring them in and how they can sell them and promote them to the customers. Especially most of the times it is on need basis. If I go to a retailer who I know that has supplied in the past, I just ask that could you please help me find an e-cig? And then they can just supply to me on need basis. I know that I can just go to a store and just find them. So it is quite difficult. In terms of other harm reduction products such as Snus for example, it's just that it is not widely available. I know I have done a study on how Snus can be accepted by women in new areas. I had put your thoughts on that, but the challenge is still remaining that there is no company here in Malawi with the time to just tobacco from the field and manufacturers rotate as tobacco reduction interventions such as Snus. There is one, but then they're still working on getting the approvals right. So that takes a lot of time. Maybe in the long run the country will see an improvement in how people can access tobacco harm reduction products.

Joanna: Do you think policymakers and some activists are against the use of alternative tobacco products?

Sahan: Some are. That is why in Africa at least six or seven countries have completely banned the sale of e-cigarettes and other tobacco related products. And there's huge taxation on combustible cigarettes and tobacco products in general. And they are caused by some activists in Tobago control calling for African countries to heavily regulate e-cigarettes. So that there is a belief that maybe the evidence is not sufficient enough for African countries to just accept the use of e-cigarettes or other tobacco harm reduction products. So yeah, there are, I believe that, but at the same time there are some of us who are proud of harm reduction because we need evidence from countless independent research that carried out out there, really shows that tobacco reduction works and it can help reduce harms and incidents of death to tobacco among tobacco use from tobacco, among others.

Joanna: Last question Sahan. What need to change in order to help Africa decrease its smoking rate?

Sahan: For Africa to change smoking rates. I believe what needs to be done is I don't want to say the word change, but I just want to say what needs to be done for tobacco harm reduction to be widely known and for most tobacco, for most countries, to accept that these interventions in tobacco can really help reduce harms and protect people from tobacco related harms. So I'd say that there needs to be awareness. So people have to know about this project, people have to be aware of the science found in this project. So the question needs to be more context based research into the feasibility and acceptability and accessibility of these products, make them more research into how casually acceptable they are within a certain context in Africa, a certain population, a certain aspect of a particular demographic. How they are able to access to access products at the same time also needs to be homogenization of tobacco harm reduction products. In Africa and countries such as Malawi, Kenya and Zimbabwe, we find that there is huge amounts of raw tobacco that is. So what if we had our own tools to manufacture tobacco harm reduction products? If we can make, for instance, the raw take of tobacco reduction products such as Snus, it is possible for African countries to venture into studies and after a radical motive to their masses and safer than the combustible cigarettes, the evidence shows that these products are safer at the same time. There also need to be deliberate efforts, either policy wise or economic wise, to make tobacco harm reduction interventions available, the current ones that are there, because at the end of the day, sometimes it's just a matter of policy, there are nothing happening in policies that allow for maybe good practitioners, that allow for retail shops, that allow for retail pharmacies to stock tobacco harm reduction products and then offer them as alternatives to tobacco users whenever they visit these key areas that I've mentioned. So that would also help change the landscape of tobacco harm reduction and help a lot of tobacco users switch from unsafe forms of tobacco consumption to safe forms of tobacco consumption.

Joanna: Thank you, Sahan. And starting from next Monday, we will be uploading daily Christmas episodes where experts around the world will share their New Year's wishes, join us to hear their hopes and expectations for tobacco harm reduction in 2020. Free. And we hope you will join us in the New Year for brand new GFN TV videos every Tuesday and Friday. Thanks for watching or listening. See you next time.