Nicotine activates reward pathways in the brain that influence motivation, pleasure, concentration and mood. Repeated exposure leads to dependence, cravings, withdrawal.
Kenya is rethinking how it regulates tobacco. A proposed law has put a long-running question back on the table: should cigarettes and newer nicotine products like vapes and pouches be treated the same way, or does the difference in how they work mean they should be regulated differently?
The Tobacco Control (Amendment) Bill, Senate Bill No. 35 of 2024, seeks to update Kenya’s existing law to cover electronic cigarettes, nicotine pouches, synthetic nicotine products, and online and digital advertising, products largely absent when the original legislation was enacted. At the heart of the debate is the concept of tobacco harm reduction: the idea that adult smokers who cannot quit may benefit from switching to products that carry lower health risks than combustible cigarettes.
Experts gathered at the National Medico-Legal Roundtable on Tobacco Control Policy, organised by Willow Health Media, broadly agreed on three things: smoking remains a major public health threat; nicotine products require regulation; and young people must be protected from nicotine addiction. Beyond those points, views diverged sharply on how the new law should be structured.
Tobacco harm reduction rests on a straightforward public health principle: if people who smoke cannot or will not quit nicotine entirely, reducing their exposure to the most harmful products may lower their health risks. The approach does not replace smoking cessation. It seeks, instead, to reduce the damage caused by combustible tobacco, which remains responsible for the overwhelming majority of smoking-related illnesses. For decades, tobacco control efforts have focused on encouraging smokers to quit completely through counselling, nicotine replacement therapies and public awareness campaigns. Yet many smokers struggle to stop despite understanding the risks.
Cancer, cardiovascular disease and chronic lung disease don’t appear overnight, but over decades of exposure
One view at the roundtable framed the challenge in terms of chronic disease development. Clinicians typically encounter patients only once disease has become detectable, by which point cancer, cardiovascular disease and chronic lung disease have already developed over decades of exposure.
Healthcare systems too often focus resources on diagnosing and treating disease after it has already taken hold. Prevention requires intervening earlier to change the trajectory of disease rather than simply responding to it.
Burning tobacco creates toxic smoke, carbon monoxide, ash and thousands of harmful compounds
A central claim made by harm reduction advocates is that much of the danger associated with smoking comes not from nicotine itself but from the burning of tobacco. Evidence presented at the roundtable showed that combustion fundamentally alters tobacco’s chemical composition, producing toxic smoke, carbon monoxide, ash and thousands of harmful compounds that damage the lungs, blood vessels and other organs.
Tar accumulates in the respiratory system and damages the cilia, tiny hair-like structures that help clear harmful particles from the airways. Carbon monoxide interferes with oxygen transport in the bloodstream, increasing the risk of heart attacks and strokes. Combustion generates between 6,000 and 7,000 chemicals, including hundreds classified as harmful or potentially harmful. The concern, participants noted, is not simply tobacco itself but what happens when tobacco is burned.
Unlike conventional cigarettes, products such as nicotine pouches, heated tobacco devices and electronic cigarettes do not rely on combustion and generally produce fewer toxic chemicals. Those who submitted recommendations on the Bill to Parliament argued that scientific evidence supports treating combustible and non-combustible products differently. The toxicological, efficacy, safety and relative-risk evidence, they said, all support differentiation.
Cigarettes, vapes, e-liquids and nicotine pouches are all treated in the same basket
Attention was drawn to regulatory decisions by the U.S. Food and Drug Administration, which has authorised certain heated tobacco products as reduced-exposure products and approved several nicotine pouch products after determining they may benefit adult smokers who switch completely from cigarettes. When combustion does not occur, there is a significant reduction in harmful and potentially harmful chemicals.
Concern was also raised about the Bill’s current design, with critics arguing that it groups everything together, cigarettes, vapes, e-liquids and nicotine pouches, under the same regulatory basket. A differentiated framework could help smokers trying to quit while maintaining strict safeguards against misuse. The intended users, it was argued, should be smokers who are trying to quit, not teenagers experimenting with nicotine.
A more medically oriented approach was proposed, in which certain nicotine alternatives could be accessed through pharmacies rather than kiosks and informal retail outlets, a model that would anchor these products more firmly within smoking cessation rather than recreational use.
Not everyone at the roundtable was persuaded. Some argued that discussions about smoking often underplay the effects of nicotine itself, noting that people smoke primarily because of nicotine.
Strong arguments exist that adolescents must be shielded from nicotine addiction
Nicotine activates reward pathways in the brain that influence motivation, pleasure, concentration and mood. Repeated exposure leads to dependence, cravings and withdrawal, effects observed daily in clinical practice. Nicotine use disorder is a recognised medical condition characterised by increasing use, cravings, tolerance and withdrawal symptoms.
While eliminating smoke exposure may reduce certain physical health risks, caution was urged against presenting nicotine products as harmless. Both combustible and non-combustible products are harmful, it was argued; the difference lies only in how the nicotine is delivered. The ultimate objective, some maintained, must remain complete cessation. Harm reduction may have a role, but cessation remains the goal.
Strong agreement existed across the roundtable that adolescents must be shielded from nicotine addiction. Teenagers are especially vulnerable to nicotine exposure and to the marketing tactics used to promote these products. Adolescents process risk differently from adults and are less responsive to conventional warning messages. Particular concern was raised about the growth of online sales and weak age-verification systems.
Many online vendors require users only to confirm they are over 18, which participants argued is not sufficient. Unlike cigarette packs, which carry large graphic health warnings, nicotine pouches and vaping products often carry minimal health messaging. Cases of nicotine toxicity among adolescents were also flagged, where excessive exposure has resulted in nausea, vomiting and other acute symptoms.
Every reduction in exposure is a reduction in future disease
Harm reduction advocates frequently cite Sweden, where widespread use of oral nicotine products has coincided with some of the lowest smoking rates in Europe, as the strongest available evidence that alternative nicotine products can contribute to reductions in cigarette use.
The stakes are particularly high for Kenya, where a young and growing population is increasingly bearing the burden of non-communicable diseases. Decisions made today will shape disease patterns decades from now. Allowing a young population to drift in the direction seen elsewhere would have predictable and serious consequences. Every reduction in exposure is a reduction in future disease.
As lawmakers deliberate on the proposed amendments, Kenya must weigh two competing public health priorities: preventing young people from becoming addicted to nicotine, and ensuring adult smokers have access to lower-risk alternatives that may help them move away from combustible tobacco.
Whether Kenya adopts a risk-proportionate regulatory framework or opts for uniform treatment of all nicotine products, the outcome will have lasting implications for smokers, for healthcare systems, and for generations yet to be affected by the choices made now.
