Showdown looms over SA’s new tobacco bill

SA is headed for a showdown with tobacco companies over  proposed legislation that introduces stringent new antismoking rules and regulates e-cigarettes for the first time.

The Control of Tobacco Products and Electronic Delivery Systems Bill was formally tabled in parliament by health minister Joe Phaahla last week. It proposes greater restrictions on smoking in public places, introduces plain packaging and picture warnings, bans vending machine sales, prohibits point of sale advertising, and for the first time regulates e-cigarettes and other new generation products in much the same way as tobacco.

While broadly in line with a draft version flighted for public comment in 2018, this bill contains the surprise addition of measures granting the Minister the power to compel tobacco companies to disclose research and information about their products. It also broadens the scope of the legislation to take account of new goods that arise from future industry innovation, and opens the way for the minister to pass regulations banning the addition of flavours.

Despite compelling evidence that tobacco kills, 29.4% of SA’s population over the age of 15 years either smoke or use smokeless tobacco products, according to the GATS SA survey, conducted by the SA Medical Research Council (MRC). Research on the use of e-cigarettes in SA is limited, but public health experts are worried about their use among teenagers and young adults, as a 2018 study published in the journal Home and Place found half of SA’s vape shops were located within 5km of a university or college campus and there was a positive association between the density and proximity of vape shops and study participants’ use of e-cigarettes. The GATS-SA study found e-cigarette use was highest among people aged between 15 years and 24 years, at 3.1%, compared to the overall prevalence of 2.2%

The fact that e-cigarette use is highest among the youth suggests they are not using vapes to quit smoking, and represent a new generation of nicotine addicts, said GATS-SA lead researcher Catherine Egbe, a senior scientist at the MRC. If vapes were an effective smoking cessation tool, one would expect its use to be highest among older people, who have higher smoking rates, she says.

When MPs begin processing the bill, they can expect to be lobbied hard by the tobacco industry and its allies, which campaigned intensely to water down the legislation when it was flighted for comment four years ago. In addition to seeking a lighter regulatory touch for non-traditional tobacco products, such as vapes and heat-not-burn devices, opponents to the bill argued that over-regulating the sector would lead to job losses and harm the economy. Now they are likely to push back on the new disclosure measures, and the scope provided by the bill to ban the addition of flavours, which are particularly appealing to young users.

The 2018 Global Tobacco Industry Interference Index ranked SA joint with the US out of 33 countries assessed for their capacity to resist industry influence. Its researchers said the tobacco industry was overly involved in policy development in SA, allegations the industry denied.

Another contentious issues likely to be aired during the bill’s passage through parliament is the safety of non-traditional tobacco products and nicotine delivery devices. These include heat-not-burn devices, which heat tobacco to a specific temperature to release a nicotine vapour instead of burning it, tea-bag like nicotine pouches, and e-cigarettes, which release a vapourised solution, usually containing nicotine.  

Proponents of these products argue they are less harmful than traditional tobacco products such as cigarettes and want differentiated rules that would allow them to advertise to consumers and pay lower excise taxes. Philip Morris International (PMI) SA consumer experience director David Kadalie recently told Business Day the company wants greater freedom to advertise its products so it can inform consumers of the health benefits of switching from smoking tobacco to its heated tobacco product iQos. “

At the recent 5th scientific summit on tobacco harm reduction in Athens, speakers lamented the fact that the World Health Organisation (WHO) and most governments opposed the tobacco industry’s efforts to position vapes and heated tobacco products as safer alternatives for smokers who were unwilling to quit. One notable exception is the UK, which promotes vaping as a safer alternative to smoking cigarettes, while cautioning that they are not completely risk-free.

PMI points to Japan as a case study illustrating the potential of non-traditional tobacco products. There an acceleration in the decline of cigarette sales coincided with the introduction and upswing of sales of heated tobacco products such as its iQos device.

“Virtually all heated tobacco product users (in Japan) had history of smoking, and after starting with HTP (heated tobacco products) virtually all of them stopped smoking,” says PMI director for external affairs Ondrej Koumai. About 70% of registered iQos users in SA quit smoking, according to Kadalie, conceding the company does not track how many of these people stop using its device and return to smoking.

Public health experts such as UCT pulmonologist Richard van Zyl-Smit remain unconvinced. Vaping may be safer than smoking, but it still carries health risks, and many people who switch from cigarettes to vaping, or other nicotine-containing products simply swap one habit for another.

“People switch, but they don’t get off. That’s not a good target,” he says.

Van Zyl-Smit is also worried about the long-term health consequences for children and teenagers who have never smoked yet get hooked on vaping. Addiction, even to a socially acceptable substance such as nicotine, can impede the development of vital coping skills and may have long-term psychological consequences, he says.

The bill is long overdue and brings SA back to the forefront of global tobacco control, says Lekan Ayo-Yusuf, director of the African Centre for Tobacco Industry Monitoring and Policy Research.

“SA had strong tobacco laws in 1995. But 20 years on SA is lagging behind and has the weakest regime in Africa,” he says.

Disclaimer: Kahn’s travel to the Athens summit was sponsored by PMI

kahnt@businesslive.co.za