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Smoking kills thousands of Malawians every year. We need to act.

By Chimwemwe Ngoma

There is a deadly public health crisis in Malawi which kills over 5,700 people every year. It is smoking. There are over one million adult daily smokers in Malawi (source: 2018 GSTHR report). We know that tobacco is extremely harmful: there are more than 4,000 chemical compounds in tobacco smoke; 250 of these are known to be harmful and more than 50 are known to cause various cancers.

Why do people smoke? Usually, they have become addicted to nicotine. But smoking tobacco is the most dangerous way to consume nicotine. People smoke for the nicotine, but they die from the tar and gases they ingest from tobacco smoke. Smoking is a major contributor to deaths from non-infectious diseases, both in Malawi and across the globe.

What can we do about this crisis? People must be prevented from starting to smoke and those who smoke but can manage to quit must be helped to stop. Many do manage to quit. But many smokers try and fail, time and again. We must help those people find another way.

The principle of harm reduction undoubtedly has the potential to help deal with this epidemic. Harm reduction refers to policies, regulations and activities that reduce health risks or encourage less risky behaviours, by providing safer forms of hazardous products rather than concentrating on banning hazardous products or risky behaviours only.

The concept of harm reduction is not new; it is employed in HIV/ AIDS prevention, where it promotes the use of condoms to reduce the risk of HIV. Harm reduction is also employed in road safety; a number of measures including seatbelts, airbags and road signs help reduce the risk of road accidents.

What does harm reduction look like when it comes to tobacco? New products have come onto the market in recent years which offer smokers a way to ingest nicotine in much less hazardous forms. E-cigarettes and heat-not-burn devices are giving smokers something which replicates many of the pleasurable aspects of smoking, but with drastically reduced health costs.

The World Health Organization’s Framework Convention of Tobacco Control (FCTC) of 2002 supports harm reduction as one of its main tactics, describing tobacco control as “a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke”.

Tobacco Harm Reduction Malawi, an information dissemination project, is now seeking to reach Malawi’s smokers with scientifically-proven information both on quitting and safer means of nicotine consumption. To further advance the cause, THR Malawi will later this month on 13 March, 2019 host the Malawian launch of No Fire No Smoke: The Global State of Tobacco Harm Reduction, published by Knowledge·Action·Change, a UK-based public health agency. At the launch, the report and other harm reduction information will be discussed and shared by public health professionals and advocates.

Just like the World Health Organization, Tobacco Harm Reduction Malawi believes that all citizens of Malawi should be informed of the health consequences, addictive nature and mortal threat posed by tobacco consumption and exposure to tobacco smoke, in order for them to be able to make more informed public and personal choices, and live longer and healthier lives.

The Global State of Tobacco Harm Reduction can be found at

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