Can alternatives stub out smoking?

(Special to the Reporter)

Cape Town, South Africa—In the outer neighborhoods of Addis Ababa, the Summit area has emerged as a vibrant enclave of bars, lounges, and restaurants—favored by a new wave of urban dwellers priced out of the capital’s core. But as the city’s social life expands outward, so does a problem that many establishments are struggling to contain: smoking.

“There are so many customers who want to drink, eat—and smoke—all in one place,” said a bartender at one of the popular venues in Summit. “When we ask them to step outside, some get angry. Others sneak into the restrooms to smoke in secret.”

It’s not just a nuisance; it’s illegal. In Ethiopia, as in much of Africa, public smoking is banned under government regulations aimed at reducing the health burden of tobacco use. Businesses caught flouting the law risk stiff penalties. Yet for many restaurateurs, the demand for designated smoking areas remains persistent—and complicated.

While local venues grapple with enforcement on the ground, a broader conversation about tobacco control is gaining momentum across the continent.

Earlier this month, South Africa’s Western Cape hosted a high-level summit bringing together health experts, policymakers, and industry players determined to shift the trajectory of smoking in Africa—the world’s fastest-growing tobacco market.

The summit spotlighted new strategies aimed at creating smoke-free societies, including the use of alternative nicotine products. Experts shared evidence from countries that have adopted harm-reduction approaches, touting innovations like e-cigarettes, heated tobacco, and oral nicotine pouches as tools to curb combustible cigarette use.

Executives from Philip Morris International (PMI), one of the world’s largest tobacco companies, were also in attendance. The company says it has invested more than USD 14 billion in research and development to move smokers towards reduced-risk products. These include e-vapor devices and heat-not-burn tobacco technologies.

“Innovation can address some of the world’s most pressing health challenges—and Africa must not be left behind,” said Tommaso Di Giovanni, a PMI executive, during the discussion. He pointed to South Africa as a case study where such products are widely available and regulated.

In South Africa, heated tobacco devices and oral nicotine products can be purchased legally and are increasingly visible. PMI and its partners hope this model can be replicated elsewhere on the continent.

In Ethiopia—as in many parts of Africa—acceptance of smoke-free alternatives has been slow, stifled by a market flooded with substandard, contraband tobacco products. These cheaper, often unregulated cigarettes have become deeply entrenched, making public health efforts all the more difficult.

Back in 2014, inspired in part by Canada’s aggressive anti-smoking stance and alarmed by the rising healthcare costs linked to tobacco use, the government introduced sweeping tobacco control legislation. Among its many restrictions was a ban on electronic cigarettes.

PMI, which had already begun investing in non-combustible alternatives, publicly criticized the move. In an open letter, the company wrote: “The directive’s ban on electronic cigarettes will be a missed opportunity for Ethiopia to improve public health. It’s equivalent to banning electric cars to maintain gasoline engines.”

Since then, PMI has continued to lobby Ethiopian authorities to reconsider.

The stakes are significant: Ethiopia’s population is nearing 130 million, and the World Health Organization estimates that nearly 9 percent of adults are regular smokers—a number that could grow without meaningful intervention.

For some smokers, the appeal of alternatives is beginning to take hold.

Tedwodros “Teddy” Gebremeskel, a longtime smoker in Addis Ababa, was skeptical when he first encountered e-cigarettes during a visit to Johannesburg. But over time, his skepticism gave way to cautious acceptance.

“These products are still new in Ethiopia,” he said. “But more people are importing them, selling them on social media. It’s not perfect—but it’s a better alternative than what we have.”

As e-cigarette use gains traction, particularly among younger Ethiopians, the government faces growing pressure to reconsider its restrictive policy.

Advocates point to countries like Japan, the United States, and Sweden, where the introduction of next-generation nicotine products has coincided with a sharp drop in cigarette use. Japan, for instance, reported a fivefold decline in smoking after alternative tobacco products became widely available.

A Generation Shift and a Growing E-Cigarette Subculture

Henok Tadesse, a 21-year-old university student at Unity College in Addis Ababa, has witnessed a quiet revolution on campus: the rapid rise of e-cigarette use among his peers. Sensing a market opportunity, he began importing vaping devices from Dubai and selling them online—a side hustle that has quickly grown into a lucrative business.

“Young people are usually the first to embrace new things. They see vaping as healthier and less intrusive—it doesn’t bother others like cigarette smoke does,” he said.

His friend, a 20-year-old student who asked to remain anonymous because he hasn’t told his family about his smoking habit, agreed. He uses both nicotine patches and e-cigarettes, preferring the discretion they offer.

“With the patch, I don’t even need to step outside to smoke,” he said. “It’s private—and more affordable now that people are bringing them in from abroad.”

The evolving preference for contemporary, less conspicuous options is music to the ears of PMI executives, who anticipate a national shift away from conventional cigarettes.

“Innovation needs to be accessible and impactful,” said Jacek Olczak, CEO of PMI, speaking at the recent health summit in Cape Town. “It is imperative that countries worldwide adopt a policy framework that keeps pace with these innovations to deliver on the promise of progress.”

But not everyone is convinced.



While PMI champions its heated tobacco devices and e-vapor products as tools to transition away from cigarettes, many African public health experts remain skeptical. They argue that the evidence behind these alternatives remains insufficient and that it is not backed by science.

Across Africa, few governments have embraced alternative nicotine products in their public health frameworks. Most continue to lag behind, wary of shifting regulation too quickly in the absence of conclusive data.

Still, on the ground in Ethiopia, some are already noticing the practical benefits.

Thomas Asseged, a middle-aged taxi driver who frequently picks up international arrivals at Bole International Airport, remembers a time when passengers would ask to smoke cigarettes in his cab.

“I let them smoke back then because I needed the income,” he said. “But I would cough all the time.”

Today, he says most of his customers use nicotine pouches instead of demanding to smoke freely in his taxi. For Thomas, it’s a welcome change.

And for Ethiopia, the question now is whether public health policy can evolve fast enough to respond to both market demand and mounting evidence that not all nicotine delivery systems are created equal.