Consequences of prohibition on public health can be significant and far-reaching

Some of the potential consequences due to prohibitions, as anti-smoking and drug abuse campaigns, can be significant and far-reaching on public health, which include increased illicit use, high risks of overdose and death, mental health impacts, spread of infectious diseases, reduced access to treatment and increased violence and crime.

According to research that has been shared in various international Harm Reduction summits, such prohibitions can lead to the proliferation of illicit substances, which may be more potent and unpredictable than regulated substances.

Drug-use injections may also increase due to prohibition, which can contribute to the spread of diseases like HIV/Aids and hepatitis, and exacerbate mental health issues such as anxiety and depression, particularly among individuals struggling with addiction.

Prohibition can also limit access to evidence-based treatment and Harm Reduction services, making it harder for individuals to seek help as well as fueling organised crime and violence, as illicit markets thrive in the absence of regulation.

According to health reports in Malawi, prohibition policies may have unintended consequences, such as increased risk of cholera and other waterborne diseases — since inadequate sanitation and hygiene infrastructure can contribute to outbreaks.

Prohibition also limits access to healthcare since it can lead to diversion of resources away from essential healthcare services, thus exacerbating existing health disparities.

Malawi health system calls for effective public health strategies prioritising evidence-based approaches, which include providing access to e-cigarettes products, sterile needles, naloxone, and other Harm Reduction services as part of Harm Reduction.

It also has access to evidence-based treatment and support services — while implementing regulated markets to reduce illicit trade and generate revenue for public health initiatives.

Further regulations as part of supporting health systems include global anti-smoking campaigns, which provide alternatives such as e-cigarettes, heated tobacco, and oral nicotine products as representing a pragmatic, safer and science-based option.

At the 8th Summit on Tobacco Harm Reduction organised in Athens, Greece, last week hosted by Strengthening Capacity for One Robust Evaluation (SCOHRE), it was observed that quitting smoking benefits not only physical but also mental health — reducing anxiety and depression while improving concentration and quality of life.

In a panel discussion at the Summit, Karl Fagerström presented that Sweden has reduced smoking prevalence to just 5%, the lowest in the European Union — a success largely attributed to the widespread use of snus, traditionally common among Swedish workers. 

He indicated that this achievement “is clear proof that Tobacco Harm Reduction works, supported by robust real-world data and yet, despite this undeniable evidence, snus remains banned across the rest of Europe”. 

“It is time to revisit this policy and ensure that science — not ideology — guides public health decisions,” maintained Fagerström while Dr. Stelios Kympouropoulos, psychiatrist and former member of the European Parliament, indicated that Harm Reduction is a duty when safer, regulated alternatives exist.

This can serve as a complementary strategy, as non-combustible alternative products, if strictly regulated, since they are less harmful than conventional cigarettes — at the same time, strong measures are needed to protect young people. 

Dr Kympouropoulos suggested five key policy pillars for the EU reiterating that “Europe must invest in smart and practical regulation, grounded in science aimed at reducing smoking and protecting youth, while also preventing the growth of illegal markets.”

SCOHRE is present in Malawi as a project that aims to strengthen the capacity of government officials and other stakeholders to design, implement, and use evaluations to inform policy decisions. Tobacco Harm Reduction in Malawi is gaining momentum, with the Tobacco Harm Reduction Scholarship Programme (THRSP) playing a significant role — an initiative that has invested in local scholars, promoting awareness about safer nicotine products and their potential to reduce smoking-related harms.

THR Malawi is a consumer group established by Chimwemwe Ngoma, focusing on breaking misconceptions about safer nicotine products and promoting tobacco Harm Reduction and research initiatives including scholars exploring topics like the feasibility of local snus production and the toxicity of traditional oral tobacco products. The Ministry of Health expressed commitment to incorporating Tobacco Harm Reduction elements into national policy with challenges being that Malawi’s economy is heavily reliant on tobacco, making it a complex issue to address.

Limited access to regulated nicotine products and lack of comprehensive tobacco control policies is also a challenge while progress is Malawi ratifying the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) in 2023 — demonstrating its commitment to reducing tobacco consumption.

Efforts to diversify crops and promote alternative livelihoods for tobacco farmers are underway through mega irrigation farm initiatives that include the Shire Valley Transformation Programme, through the construction of the largest irrigation canal in the sub-Saharan African Region.

With the historic decision made in 2023 when Malawi’s approved the WHO’s FCTC, the country joined a community of 182 other Parties to the Convention, affirming it’s high-level political commitment to combatting the global tobacco epidemic and prioritising public health and well-being. 

The Convention, which Malawi ratified in August 2023, is a crucial international treaty designed to address the severe public health risks associated with tobacco consumption and exposure to tobacco smoke. Its ratification by Malawi demonstrates the country’s determination to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke.

At the SCOHRE Summit in Athens, a lively panel discussion around ‘Consumer and Healthcare Professionals’ Misconceptions on the Harms of Nicotine’, noted that many healthcare professionals mistakenly consider nicotine itself as highly harmful — a misconception reinforced by contradictory scientific literature. 

The panel concluded that the scientific community must consistently communicate evidence-based findings across all audiences and channels, while media outlets carry the responsibility to correct misinformation quickly and provide balanced coverage of Harm Reduction, avoiding sensationalism.

It was observed that FCTC was created to address the global smoking crisis by reducing its health, social, economic, and environmental impacts, providing countries with a framework that included advertising bans, higher taxes, sales restrictions, and cessation support. Five major diversions from the FCTC’s original goal were highlighted that included misplaced risk comparisons between cigarettes and novel products; excessive focus on nicotine and addiction; exclusive attention on youth; preoccupation with the tobacco industry; and prohibition of lower-risk alternatives. 

“We have to go back to the objective. There is one and only one big idea — to transform nicotine use from high-risk to low-risk behaviour,” emphasised panelist Clive Bates, a leading policy expert in tobacco control.

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