Across Africa, tobacco control policy remains largely frozen in time. While science and technology have evolved, many governments continue to regulate all nicotine products as if they carry the same level of risk as combustible cigarettes. The result is a growing gap between evidence and policy and real consequences for public health.

Smoking remains one of the leading causes of preventable death globally. The greatest harm comes not from nicotine itself, but from the toxic smoke produced by burning tobacco. Over the past decade, safer nicotine alternatives such as e-cigarettes, nicotine pouches, and heated tobacco products have emerged, offering adult smokers options that do not involve combustion.

Yet in much of Africa, these products are either banned, over-restricted, or left in regulatory limbo.

Many countries still rely on frameworks shaped primarily by the World Health Organization’s WHO Framework Convention on Tobacco Control, adopted more than 20 years ago. While the treaty has played an important role in reducing tobacco advertising and second-hand smoke exposure, its implementation across Africa has often failed to evolve in line with emerging harm reduction science.

The cost of this policy inertia is high. When safer alternatives are unavailable, unaffordable or poorly understood, smokers are more likely to continue using combustible cigarettes, the most dangerous form of nicotine consumption. In effect, outdated regulations can unintentionally protect cigarettes from competition.

There are, however, signs of progress.

Kenya has created a tax category for electronic cigarettes, recognizing them as distinct from traditional tobacco products. South Africa allows the sale of vaping and heated tobacco products, with a growing number of adult smokers switching. Morocco has also permitted regulated access to alternative nicotine products. These examples show that a more nuanced approach is possible.

The debate is often framed as a choice between protecting youth and allowing harm reduction. This is a false dichotomy. Effective policy can do both, enforce strict age restrictions, regulate marketing, ensure product standards, and still provide adult smokers with access to less harmful options.

Africa stands at a demographic and epidemiological crossroads. Smoking-related non-communicable diseases are rising, healthcare systems are strained, and a youthful population presents both risk and opportunity. By failing to modernize nicotine policy, countries risk perpetuating the high burden of smoking into future generations while missing out on public health tools that could ease that burden.

With rising rates of non-communicable diseases and overstretched health systems, the continent cannot afford regulatory stagnation. A risk-proportionate approach to nicotine, one that distinguishes between combustible and noncombustible products, would align policy with science and give millions of smokers a realistic pathway away from cigarettes.

Standing still is not neutral. In public health, failing to adapt can mean failing to save lives.