Vaping debate clouds tobacco control progress

A woman smokes an e-cigarette. [iStockphoto]

As World Lung Cancer Day was commemorated on Friday, an emerging trend threatens to erode the gains made in reducing tobacco-related harm.

While approximately 25 per cent of lung cancer risk factors include exposure to second-hand smoke, environmental pollutants, radon gas and family history, smoking accounts for about 85 per cent of cases.

This concern arises amid an ongoing global debate on vaping as a strategy for harm reduction. In Kenya, psychiatrists and other medical professionals have traditionally used psychotherapy, nicotine gums and nicotine patches to support smoking cessation.

The country has maintained a robust national tobacco cessation programme aimed at reducing tobacco use and its associated health risks. This includes mass media campaigns, community outreach, and the provision of cessation services, with the overarching goal of protecting individuals from second-hand smoke and raising public awareness about the dangers of tobacco use.

The Kenya Tobacco Cessation Strategic Plan focuses on three key areas: demand reduction, supply reduction, and strengthening leadership and governance.

The current global discussion on harm reduction has, however, been complicated by the introduction of electronic cigarettes — commonly known as vaping. These devices produce an inhaled aerosol by heating a liquid that usually contains nicotine.

While harm reduction has been a successful public health approach in other areas — such as the use of methadone and needle-exchange programmes for managing intravenous drug use, condoms for HIV prevention, and helmets or seatbelts for road safety — some medical professionals remain unconvinced by its application to vaping.

They argue that this strategy may be driven more by the commercial interests of the tobacco and nicotine industry than by genuine concern for public health.

Moreover, historical examples — such as the introduction of filtered cigarettes in the 1950s and low-tar and low-nicotine variants in the 1960s and 70s — did not lead to reduced harm.

The fundamental science behind smoking-related harm reduction recognises that nicotine is the constituent of tobacco smoke responsible for reinforcing addiction and dependency. Nicotine withdrawal often triggers relapse among those attempting to quit.

Nicotine Replacement Therapies (NRTs), including patches and gums, were approved over three decades ago. Yet, they remain underutilised by some smokers and healthcare providers — partly due to concerns that they perpetuate nicotine addiction, and partly due to misconceptions about nicotine itself.

Most healthcare professionals, however, advocate for complete cessation of all tobacco and nicotine use. In contrast to NRTs, the long-term health effects of e-cigarettes remain uncertain.