Kenya Strikes Back: Graphic Warnings Replace Tobacco Logos to Save Lives

By Melisa Mong'ina - Kenya has taken a bold step to curb tobacco and nicotine use especially among the youth by rolling out Graphic Health Warnings (GHWs) that replace brand logos with stark images of disease and death.

Cigarette packs now graphically portray the devastating effects of smoking. Nearly 80% of the front is covered with hard-hitting images showing the toll tobacco use takes on human health.

The images include diseased lungs with tumors, rotting teeth, cancerous mouth lesions, amputated limbs, and infants struggling for life in incubators.

According to Thomas Lindi, CEO of the Kenya Tobacco Control and Health Promotion Alliance (KETCA), the organization spearheaded awareness campaigns and stakeholder engagement to push for the adoption of GHWs.

Thomas Lindi, Chief Executive Officer at Kenya Tobacco Control and Health Promotion Alliance

“As a leading civil society organization in Kenya, we organized a number of awareness forums and stakeholder meetings with the government.We also conducted social media advocacy to ease the process, which has taken quite a long time since it started in 2021,” says Thomas.

KETCA also played a hands-on role in the development of the warnings, assembling a team of graphic designers to work alongside the Ministry of Health.

Additionally, KETCA conducted pre-testing to assess public understanding of the images and messages.

“KETCA forwarded a team of graphic designers who worked with the Ministry of Health on these new graphic health warnings. We were also involved in pre-testing to understand how people interpret these warnings,” he adds.

He explains that the tobacco industry mounted significant opposition to the new warnings especially because they targeted emerging products like nicotine pouches. They used legal loopholes, lobbied politicians, and manipulated media narratives to block or delay implementation.

“We encountered significant interference from the tobacco industry because these warnings targeted emerging tobacco products like nicotine pouches. They employed various tactics, including exploiting legal loopholes, lobbying politicians, and influencing media narratives,” says Thomas.

The tobacco industry didn’t take the changes lightly. It reportedly influenced media coverage, imposed economic threats, and lobbied for weaker warning labels particularly on products like nicotine pouches.

“During the process, we received a total media blackout. I think they had been influenced by the tobacco industry to only share the industry's narrative and delay the process. They also lobbied the government to weaken the health warnings and threatened to pull out investment in a proposed new factory in Kenya,” Thomas explains.

While public awareness has grown, Lindi points out that many young people still don't understand the risks, especially with flavored or disguised nicotine products marketed to look harmless.

“Despite growing awareness, significant knowledge gaps remain among the youth. Emerging tobacco products are flavored and designed to deceive, so many people don’t know they are consuming tobacco,” he added.

Thomas stresses the need for targeted education to explain the contents and health impacts of these products, which are often misunderstood by young consumers.

“There’s still a need to engage people, especially university students, so they understand the contents and health effects of these products and how they harm the body,” Thomas emphasizes.

Graphic health warnings are seen as crucial in both deterring current users and informing potential new users. They offer constant, visible reminders about the severe health risks.

“Graphic health warnings are vital tools in reducing tobacco consumption. They deter current users and inform non-users about the dangers they expose themselves to,” says Thomas. He also advocates for banning flavored tobacco products that attract youth.

To effectively educate youth, Thomas proposes a multi-pronged strategy involving school-based programs, social media campaigns, peer education, and community engagement.

“There’s a need for social media campaigns since many youths are online. Peer education and involving community leaders in churches and mosques can also help tailor messages for the youth,” stresses Thomas.

He further calls on the Kenyan government to end its interactions with the tobacco industry, citing legal frameworks such as the Framework Convention on Tobacco Control and the Tobacco Control Act, which prohibit such engagements.

“We are asking the government to stop their interaction with the tobacco industry. These relationships are prohibited by both international and national laws. The industry uses bribes and intimidation to protect their profits. The government must stop such interactions especially during World No Tobacco Month,” he urges. 

He encourages civil society organizations to remain bold and continue advocating for strong tobacco control policies and effective public education.

“We wish to encourage civil society organizations to continue being bold, to advocate for stronger tobacco control policies, and support public education initiatives. These efforts are vital in protecting the health of Kenyans,” Thomas notes.

Dr. Catherine Karekezi, the Executive Director of the Non-Communicable Diseases (NCD) Alliance Kenya, emphasizes that the dangers extend beyond smoking cigarettes; they include the cultivation and handling of the tobacco plant itself.

Dr. Catherine Karekezi, the Executive Director of the Non-Communicable Diseases (NCD) Alliance Kenya

The farming process exposes communities especially women and children to harmful chemicals and health risks. Beyond health, tobacco cultivation depletes soil nutrients and accelerates environmental degradation.

“It's not just the cigarettes, but the tobacco plant itself. Tobacco leaves contain over 250 harmful substances more than 60 of which are known to cause cancer. Cultivating tobacco exposes farmers and their families to hazardous chemicals either from those used in farming or just from handling the plant. Tobacco also poisons the soil, leading to environmental degradation,” says Dr. Karekezi.

She explains the physiological impact of nicotine, the addictive component in tobacco. Nicotine stimulates the nervous system, increasing heart rate and narrowing blood vessels leading to serious cardiovascular problems.

Long-term nicotine exposure is also associated with the development of Type 2 diabetes, various forms of cancer, and other non-communicable diseases (NCDs).

“Nicotine, the primary addictive component, stimulates the nervous system, raises blood pressure and heart rate, and affects blood clotting. These clots can block blood flow, causing heart attacks, strokes, and in some cases, amputations. Long-term, it contributes to cardiovascular issues, Type 2 diabetes, and certain cancers,” Dr. Karekezi highlights.

Dr. Karekezi also points to the link between tobacco use and infectious diseases such as pneumonia and tuberculosis (TB), particularly in vulnerable populations.

“Tobacco is a risk factor for infectious diseases like tuberculosis and pneumonia. Smokers are more likely to contract TB and experience worse symptoms. It also increases vulnerability to pneumonia, especially when someone already has respiratory infections,” she states.

To counter these risks, graphic health warnings (GHWs) on tobacco packaging are seen as a critical public health tool. These warnings are designed to show the real consequences of tobacco use.

“These graphic warnings illustrate the conditions tobacco causes. They provide a visual picture of how it affects body organs, which helps people better understand the risks than just reading about them,” adds Dr. Karekezi.

The implementation of such warnings is a key step in Kenya’s broader strategy to fight NCDs, including heart disease, stroke, cancer, and diabetes.

Dr. Karekezi further says the NCD Alliance Kenya plays a key role in raising awareness to ensure the effectiveness of these warnings, particularly among youth who are increasingly targeted by the tobacco industry through flavored products, colorful packaging, and misleading claims.

“NCDAK supports the Ministry of Health by raising awareness about the dangers of these products, especially among young people. These warnings will appear on nicotine products that are currently marketed as less harmful and made appealing through flavors and colorful packaging to lure youth,” says Dr. Karekezi.

Dr. Karekezi also emphasizes the connection between tobacco use and mental health conditions such as depression and anxiety. She warns that tobacco exacerbates complications from NCDs like hypertension and sickle cell disease.

“Tobacco use can lead to depression, anxiety, and other mental health conditions. It also worsens complications of NCDs like hypertension and sickle cell disease,” explains Dr. Karekezi.

Kenya’s adoption of Graphic Health Warnings aligns with its national NCD reduction strategy, aiming to deter tobacco use, prevent related illnesses, and ease the economic burden on individuals and the health system.

“These warnings support Kenya’s plan to reduce NCDs. Tobacco, as a major risk factor for NCDs, burdens both individuals and the economy, affecting productivity and development,” she says.

However, for this initiative to succeed, Dr. Karekezi calls for resilience among policymakers in the face of strong opposition from the tobacco industry, which prioritizes profits over health.

“Policymakers must stand firm against industry interference. The tobacco industry is focused on profits, these vivid, graphic warnings are meant to discourage use. Naturally, the industry will push back,” urges Dr. Karekezi.

The implementation of the newly gazetted Graphic Health Warnings will prevent young people from using tobacco and nicotine products. These warnings aim to scare them away as they show the harms tobacco causes in the body.

Ken Marau, Programs Manager at the International Institute for Legislative Affairs (IILA), describes the new graphic health warnings as a major public health victory for Kenya. He commends the Ministry of Health for prioritizing health over the commercial interests of the tobacco industry.

Ken Marau, Programs Manager at the International Institute for Legislative Affairs (IILA)

“This is a big win for public health in Kenya, and I applaud the Ministry of Health for putting health above the tobacco industry’s interests,” says Marau.

The new warnings are expected to significantly raise public awareness through vivid and relatable imagery. By clearly highlighting the dangers of tobacco and nicotine products, the warnings aim to decrease their use across the population.

“These new warnings will greatly help in the fight against tobacco and nicotine use by increasing awareness and making the dangers more visible to the public,” he explains.

Marau notes that the updated warnings mark a significant improvement. A 2018 IILA study found that older warnings lacked impact and clarity. The new images are vivid, high-resolution, and emotionally powerful.

“In 2018, IILA conducted a study that showed the older warnings lacked impact. The new ones use vivid and striking imagery designed to be more visible and memorable,” Marau states.

The revised warnings now include new and emerging products, such as Velo and vapes, which were previously unregulated. This closes loopholes that the industry had used to target the youth.

“These updated warnings now cover products like Velo and vapes, which were previously excluded. This is a big step forward, especially in protecting the youth,” he underscores.

Marau emphasizes the improved design and messaging of the warnings. He advocates for larger warning coverage up to 80% of packaging to reduce the space for branding. He envisions Kenya moving toward plain packaging in the future.

“We are pushing for 80% of the packaging to be covered with warnings. My hope is that Kenya will eventually adopt plain packaging, showing our progressiveness in tobacco control,” Marau stresses.

To ensure effectiveness, he calls for a detailed implementation plan and strict adherence to WHO guidelines. He warns against industry tactics like altering resolution and placement to weaken the impact. He also stresses the importance of training enforcement officers.

“There must be a clear implementation roadmap. The Ministry should follow WHO recommendations and guard against industry manipulation. Enforcement officers, especially at ports, need training to recognize the new warnings,” he urges. 

Marau calls on policymakers to consistently prioritize public health over profits and ensure full enforcement of tobacco laws both nationally and at the county level. He ties this moment to World No Tobacco Day to boost public visibility and engagement.

“Policymakers must put public health first and ensure full enforcement of the Tobacco Control Act and these new warnings across all levels of government,” he says.

Marau urges all sectors government, civil society, and the public to unite in exposing the deceptive allure of tobacco products and resisting the industry's tactics.

“We must unmask the appeal of these products and expose the industry’s tactics. Too many young lives have already been lost. It’s time for everyone government and civil society alike to unite and confront this common enemy,” Marau emphasizes.