Tobacco Harm Reduction in Afghanistan: A Recipe for Improving Smokers' Health

Abstract Almost three million Afghans smoke daily, the majority of whom are teenagers. Smoking is responsible for the deaths of thousands of Afghans every year. The previous Afghan government made significant efforts to control and reduce tobacco use through tobacco cessation policies and strategies. However, these policies were not effective in reducing the number of smokers and smoking-related deaths. Hence, there is a need to introduce and implement novel, realistic, and practical approaches that have been proven effective in smoking abstinence and minimizing tobacco harm. Community-based initiatives in Kabul and Herat have started advocacy campaigns since 2021 and tried to increase people's awareness of the tobacco harm reduction (THR) concept, paving the way for adopting new policies. Implementing these strategies in Afghanistan is likely to face many challenges. The current government’s low priority for tobacco harm reduction research and advocacy, funding issues, unfavorable market conditions for THR products and their high cost-effectiveness, THR product-related misconceptions, and the total prohibition of all tobacco products without any exception in Islam are the significant challenges. These obstacles can be overcome with effective THR policymaking that will promote THR products for smokers, market support and regulation, local and domestic manufacturing with healthcare professional oversight, conducting more engaging advocacy campaigns, and securing domestic sponsors.