By Providence Ayanfeoluwa

Across the world, conversations about tobacco control often revolve around data, regulations, and health outcomes. Yet, one critical group remains consistently missing from these discussions – the people most affected: smokers themselves.

For decades, public health policies have been designed for smokers, but rarely with them. Decisions are made in conference rooms, research institutions, and policy forums without the input of those living the daily struggle of nicotine dependence. As a result, many well-intentioned interventions fail to resonate with real people or achieve the intended results.

In Nigeria, where tobacco use remains a contentious public health issue, this disconnect is particularly glaring. The national conversation on smoking often carries moral undertones, painting smokers as offenders rather than individuals in need of help and understanding.

Understanding Harm Reduction Beyond the Moral Lens

Harm reduction is a pragmatic and compassionate public health philosophy. It acknowledges a simple truth: while quitting smoking entirely is the best possible outcome, some people will continue to smoke – and they deserve safer options that can minimize health risks.

In tobacco control, harm reduction refers to the promotion of smoke-free alternatives that reduce exposure to harmful chemicals found in combustible cigarettes. Products like e-cigarettes, heated tobacco, and nicotine pouches have been scientifically evaluated and are increasingly being used in countries such as the United Kingdom, Sweden, and New Zealand to support smokers who are unable or unwilling to quit entirely.

These nations have demonstrated that supporting harm reduction does not mean encouraging smoking; it means confronting reality with empathy and science. For example, the UK’s National Health Service (NHS) recognizes vaping as a less harmful alternative to smoking and provides smokers with credible information to help them transition safely. Similarly, Sweden’s use of nicotine pouches has brought its smoking rate to below 6%, earning it the reputation of being on the verge of becoming the first “smoke-free” country in the world.

These approaches underscore an important lesson for Nigeria: public health policies work best when they prioritize evidence and inclusion over ideology.

Reassessing the Role of the WHO FCTC in Harm Reduction

As the world marks the 20th anniversary of the WHO Framework Convention on Tobacco Control (FCTC), it is crucial to reflect on its impact and limitations in addressing the evolving landscape of tobacco use. The FCTC, adopted in 2005, was the first global public health treaty aimed at reducing tobacco-related harm through comprehensive regulation of advertising, packaging, and public smoking. Nigeria ratified the treaty in 2005 and enacted the National Tobacco Control Act in 2015 to align with its provisions. However, critics argue that the FCTC has not sufficiently embraced harm reduction strategies, often equating smoke-free alternatives with traditional tobacco products or advocating for their prohibition. This stance is under renewed scrutiny as global health leaders prepare for the Eleventh Conference of the Parties (COP11) to the FCTC, scheduled for November 17–22, 2025, in Geneva. COP11 is expected to be a pivotal moment, with calls for greater transparency, inclusiveness, and scientific integrity domi

Stigma and Silence: The Invisible Burden

One of the greatest obstacles to meaningful harm reduction in Nigeria is the pervasive stigma associated with smoking. Society often views smokers through a moral or judgmental lens, rather than a compassionate one. This stigma isolates them from public health conversations and makes it difficult for them to seek help or speak openly about their challenges.

In a country where cultural and religious values strongly influence behavior, smokers are often reluctant to identify themselves publicly for fear of being shamed or misunderstood. Consequently, their absence from harm reduction dialogues becomes self-perpetuating – policymakers do not hear their perspectives, and the public continues to perceive them as voiceless or unwilling participants in their own health outcomes.

Addressing this requires a deliberate effort to humanize the issue. Smokers should not be treated as a problem to be solved but as individuals whose health and dignity matter. Civil society organizations and the media have a crucial role to play in shifting this narrative by creating safe spaces where smokers can share their experiences without fear of judgment.

Putting People at the Center

Ultimately, the heart of harm reduction lies not in products or policies, but in people. When smokers are excluded from the conversation, harm reduction loses its human focus and becomes a theoretical exercise.

In Nigeria’s tobacco control space, many civil society groups, health advocates, and regulatory agencies are actively working to reduce tobacco use- an admirable goal by every measure. However, these conversations are often dominated by experts and institutions that speak about smokers rather than with them.

This exclusion raises a fundamental question: Who represents smokers in Nigeria’s harm reduction dialogue?

Smokers are often portrayed as a homogeneous group, yet their motivations, challenges, and circumstances vary widely. Some smoke to manage stress, others as a social habit, and many because nicotine addiction is not easy to overcome. For those who genuinely want to quit, the barriers can be overwhelming – from the lack of access to cessation aids and misinformation about alternatives to the social stigma that labels them as irresponsible.

Without including smokers in policy formulation, these nuanced realities remain invisible. As a result, interventions risk being detached from the lived experiences of the people they are meant to help.

If the goal of public health is to save lives, then empathy and inclusion must be the foundation of every tobacco control initiative. Listening to smokers does not mean endorsing tobacco use; it means acknowledging their humanity and giving them the respect of being part of the solution.

Nigeria’s policymakers, civil society, and the media must take deliberate steps to bring smokers to the table. The path to a healthier nation cannot be charted without including those who are most affected.

Because at its core, harm reduction is – and must always remain – about people. Until their voices are included, the conversation will remain incomplete.